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What's causing my hip pain?

If you are experiencing pain around the outside of your hip or thigh, there is a good chance that you have what is commonly known as hip bursitis, or medically termed trochanteric bursitis. While it is more common in women and the elderly, it could affect anyone throughout their lifetime, even if you do not fit within these classifications.

Inflammation of trochanteric bursa causes hip pain
Left trochanteric bursa (highlighted blue)

What is it?

Bursitis refers to the irritation or inflammation of the bursa – a fluid-filled sac that sits between tendons and bones and is designed to prevent friction between the two structures as they slide over each other during movement. There are multiple bursae in the human body, most of which lie over major joints in the body like the shoulder and the hip. Trochanteric bursitis is inflammation of the trochanteric bursa. The trochanteric bursa is located on the outside upper region of your thigh over a bony prominence you can feel around the height of your hip. This bony prominence is known as the greater trochanter of the femur, hence the medical terminology trochanteric bursitis.

Tight ITB causes trochanteric bursitis
ITB overlying the trochanteric bursa

What could cause it?

The most common irritation to the trochanteric bursa comes from an increased friction by the ITB (iliotibial band). The ITB runs along the side of the thigh, extending from the hip to the knee. Repetitive activity, such as cycling or running, causes the ITB to become tight, this in turn compresses and irritates the trochanteric bursa located beneath it. Weakness of the gluteal muscles and consequently the lack of hip stability during activity aggravates the problem by increasing load through the ITB. This irritation causes the body to produce inflammation in the region in response to the perceived injury. Other causes that may result in irritation of the trochanteric bursa include a direct trauma to the side of the hip, prolonged periods of lying on one side of your hip, and postural discrepancies such as a short leg which causes the body to load the hip inefficiently when walking and running.

How would it affect me?

The main symptom of hip bursitis is pain. This pain may initially be sharp and localised to the point of the hip, but later progresses into a dull ache over a larger area, with referral into the outside thigh or buttocks. You will most likely experience pain at night while lying on the side that is affected. You will also notice it more when attempting to get out of a deep chair or a car and walking up stairs. The pain may also stop you from walking, running, cycling, and standing for long periods of time.

How is it treated?

An ultrasound or an MRI may be used to confirm inflammation of the trochanteric bursa. The initial goal of treatment is to reduce pain and inflammation so that we can restore your movement. This is achieved through a variety of manual therapy modalities including soft tissue massage and joint mobilisation. Once you have normal mobility, it is then important to re-educate the body in how to move so as to prevent recurrence. This is achieved through re-learning movement patterns and building strength. Additionally, activity modification may be necessary to prevent further irritation of the bursa. For instance, you may need to sleep on a different side at night, or temporarily switch over from jogging and cycling to swimming for exercise, as these changes will help reduce continual irritation, whilst you are learning new movement patterns.

What could be done to prevent it?

The most important factor for prevention is to maintain flexibility and strength in your muscle and tendons to decrease the risk of irritation. Maintaining correct posture and movement patterns during activity is equally important so as not to create extra stress on your muscles, tendons, and joints. Losing weight could potentially be beneficial as it means reduced loading on the muscles and joints.

If you are looking for more information or treatment because you may be suffering from trochanteric bursitis, please get in touch with us so we may assist you further.

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