Trochanteric Bursitis

Trochanteric Bursitis

Article by John Miller

Hip Bursitis

What is Trochanteric Bursitis?

The Most Common Hip Bursitis

Trochanteric bursitis is the most common bursitis of the hip. It is also a common cause of Greater Trochanteric Pain Syndrome.

Trochanteric bursitis is inflammation of the bursa (a small, cushioning sac located where tendons pass over areas of bone around the joints), which lies over the prominent bone on the side of your hip (femur).

The superficial trochanteric bursa lies over the greater trochanter. This bursa is the most commonly inflamed hip bursa. A deep trochanteric bursa lies deeper again and can become inflamed in more severe cases.

What is Bursitis?

What Causes Trochanteric Bursitis?

Typically, repeated compression of the bursa results in inflammation and bursa pain. It is usually associated with weakness of the gluteal muscles, particularly gluteus medius, that results in a Trendelenburg gait pattern that is a sign of hip muscle weakness. It can be related to a previous back or hip injury. Researchers have found that gluteal weakness is a side effect of poorly rehabilitated low back pain or hip pathologies.

The good news is that muscle weakness and an appropriately progressed exercise protocol can reverse Trendelenburg gait. The exercises prescribed should be focused on retraining your individually weak muscles. This specifically targeted exercise is vital since various activities strengthen different gluteal and hip rotator muscles.  For more specific advice regarding your hip muscle weakness, please seek the advice of your physiotherapist, who has a particular interest in gluteal and hip pathologies.

While gluteal muscle weakness does become more prevalent as we age, we certainly also see occasional deficits in the younger active population. Muscle fatiguing activities can induce trochanteric bursitis or be related to gluteal tendinopathy. High load activities include running (with inferior muscles control or technique), bushwalking into fatigue, or cycling, especially when the bicycle seat is too high.

Occasionally, acute onset trochanteric bursitis can occur following a fall or a sport-related impact to the hip.

How is Trochanteric Bursitis Diagnosed?

Your physiotherapist or doctor can typically diagnose trochanteric bursitis in the clinic. Your diagnosis will arise following an assessment of your history and a physical examination of your hip, pelvis and back. A hallmark sign is if you feel tenderness over the bursa or greater trochanter (hip bone) when pressure is applied.

An ultrasound scan or MRI may conform to the diagnosis.

What is Trochanteric Bursitis Symptoms?

You may experience one or more of the following symptoms:

  • Pain and swelling occurring over the side of the hip bone (greater trochanter)
  • Referred pain that travels down the outside thigh and may continue down to the knee
  • Pain when sleeping on your side; especially the affected hip
  • Pain upon getting up from a deep chair or after prolonged sitting (e.g. in a car)
  • Pain when climbing stairs
  • Discomfort in sitting with the legs crossed
  • Increased pain when running, walking, cycling or standing for long periods

Please seek the advice of your trusted hip physiotherapist or doctor.

What is the Best Treatment for Trochanteric Bursitis?

The best treatment for trochanteric bursitis involves:

  1. Early Pain Relief & Anti-inflammatory Treatment
  2. Corrective Exercises to address specific muscle weakness
  3. Preventative Exercises to reduce the risk of future bursa irritation

Ice

Bursitis is an inflamed bursa. We recommend the application of ice packs a few times per day to reduce your pain and swelling. Ice is a natural anti-inflammatory that is more likely to assist bursitis than heat packs.

Anti-inflammatory Medications

NSAIDs or anti-inflammatory drugs (i.e. ibuprofen) may assist but appear less successful for trochanteric bursitis. Many patients also trial natural anti-inflammatories such as arnica. You should discuss the use of these medications with your doctor to avoid any side effects.

Corticosteroid Injections

Combined injection of a corticosteroid plus a local anaesthetic into the bursa may reduce your bursa inflammation. It is preferable to have this injection using ultrasound guidance.  The local anaesthetic will provide immediate short-term relief (a day or two). The cortisone is slower acting and will take a few days up to a week to work on inflammation reduction.

How Can You Prevent Trochanteric Bursitis?

Reversing the typical causes of trochanteric bursitis is the key. It would help if you addressed any muscle weakness, muscle fatigue or gluteal tendinopathy signs.

Addressing your muscle strength and endurance is recommended to avoid a recurrence. Wearing adequate footwear which supports any biomechanical imbalances in your feet is also a critical preventative measure.

Successful weight management minimises excess stress on the hip joints, which can alleviate pressure on the bursa. If you need advice regarding your weight loss, please discuss it with your doctor or dietitian.

Trochanteric Bursitis Treatment

PHASE I – Pain Relief & Protection

You are managing your pain. Pain is the main reason that you seek treatment for trochanteric bursitis. In truth, it was the final symptom that you developed and should be the first symptom to improve.

You are managing your inflammation. Your bursa’s inflammation treatment options include active rest, ice therapy, cortisone injections, supportive taping techniques or exercises that encourage your muscles to decompress the bursa.

Your physiotherapist may use an array of treatment tools to reduce your pain and inflammation. These can include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage and temporary use of a mobility aid (e.g. cane or crutch) to off-load the affected side.

PHASE II – Restoring Normal ROM, Strength

As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal hip function. This treatment may include your joint range of motion, muscle length and resting tension, strength and endurance, proprioception, balance and gait (walking pattern).

Hip researchers have discovered the importance of your hip muscle recruitment patterns with a standard order of deep, intermediate, and finally, superficial muscle firing patterns in healthy, pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you, specific to your needs.

PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients in regaining standard hip muscle control. Please ask your physio for their advice.

PHASE III – Restoring Full Function

The final stage of your rehabilitation aims at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some people, it only is to walk around the block. Others may wish to run a marathon.

Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.

PHASE IV – Preventing a Recurrence

Trochanteric bursitis does tend to return. The main reason is due to insufficient rehabilitation.

In addition to your muscle control, your physiotherapist will assess your hip biomechanics and start correcting any defects. It may be as simple as providing you with gluteal or deep hip rotator exercises to address any biomechanical faults in your leg. Your physiotherapist will guide you based on your assessment.

You are fine-tuning your hip stability and function by addressing any deficits in core strength and balance, learning self-management techniques and achieving the ultimate goal of safely returning to your previous sporting or leisure activities.

Trochanteric Bursitis Surgery

Surgery is not a familiar path. However, in persistent cases, you can perform removal of the bursa (bursectomy).

What Results Can You Expect for Trochanteric Bursitis?

While some people can respond quickly to physiotherapy treatment within a few weeks, more chronic cases may not. Stubborn examples include gluteal tendinopathy in the gluteal muscle group under the bursa can require a few weeks and sometimes months to recover.

Trochanteric bursitis treatment is successful in the vast majority over approximately six weeks. It is essential not to stop your rehabilitation exercises as soon as your pain diminishes. You may continue some prevention exercises to perform as a part of your weekly health and wellbeing program.

Excellent hip muscle control is your best rehabilitation and prevention strategy. Please follow the advice of your hip physiotherapist or doctor.

Hip Pain Treatment

A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.

Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence,  or improve your athletic performance.

The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.

However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.

You should consult a healthcare practitioner who has a particular interest in hip pain and injury management to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all impact, especially at the high athletic performance end. A quality practitioner will educate you on your condition and combine it with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.

Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.

For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapists experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.

Hip Pain Treatment Options

Your hip physiotherapist may consider an extensive range of treatment options, including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and hip joint control exercises as they deem appropriate for your specific functional and sporting needs. Please consult with them for advice.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.