Trochanteric bursitis is the most common bursitis of the hip. 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 is located over the greater trochanter. This is the most commonly inflamed bursa. A deep trochanteric bursa lies deeper and can become inflamed in more severe cases.
What are Trochanteric Bursitis Symptoms?
One or more of the following symptoms may be experienced:
Pain and swelling occurring over the side of the hip
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 (eg. in a car)
Pain when climbing stairs
Pain in sitting with the legs crossed
Increased pain when walking, cycling or standing for long periods of time
What Causes Trochanteric Bursitis?
The trochanteric bursa may be inflamed by a group of muscles or tendons rubbing over the bursa and causing friction against the thigh bone. This injury can occur traumatically from a fall or a sport-related impact contusion. It can also be a case of gradual onset via a repetitive trauma to the bursa from such activities as running (with poor muscles control or technique), walking into fatigue, or cycling, especially when the bicycle seat is too high. It is also a secondary injury associated with chronic conditions such as:
Scoliosis - curvature of the spine
Unequal leg length
Weak hip muscles
Osteoarthritis (degenerative joint disease) of the hips or lower back
Calcium deposition in the gluteal tendons that run over the bursa
How is Trochanteric Bursitis Diagnosed?
Dr. Mullen will provide you with an assessment of your medical 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. Diagnosis can also sometimes be confirmed by medical imaging techniques that include ultrasound scan and MRI, but milder cases may not be readily apparent on imaging.
What is Trochanteric Bursitis Treatment?
Ice. Bursitis is an inflamed bursa. Daily application of ice packs is highly recommended to reduce your pain and swelling.
Medications. NSAIDs or anti-inflammatory drugs (i.e. ibuprofen). Use of these medications should be discussed with your doctor.
Corticosteroid Injections. Single injection of a corticosteroid with a local anesthetic into the bursa may be required to stimulate your healing response. It is preferable to have this injection using ultrasound guidance.
Approach to Trochanteric Bursitis Treatment
PHASE I - Pain Relief & Protection
Managing your pain and inflammation. Pain is the main reason that you seek treatment for trochanteric bursitis. In truth, it was actually the final symptom that you developed and should be the first symptom to improve. Bursa inflammation it best eased via ice therapy and techniques or exercises that deload the inflamed structures. Your physical therapist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.
PHASE II ‑ Restoring Normal ROM, Strength
As your pain and inflammation settles, your physical therapist will turn their attention to restoring your normal hip joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern). Hip researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of: deep, then intermediate and finally superficial muscle firing patterns in normal pain‑free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs. A "Hip Core Stabilization Program" to assist patients to regain normal hip muscle control is employed here.
PHASE III ‑ Restoring Full Function
The final stage of your rehabilitation is aimed 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 it is simply to walk around the block. Others may wish to run a marathon. Your physical therapist will tailor your hip rehabilitation to help you achieve your own functional goals.
PHASE IV ‑ Preventing a Recurrence
Trochanteric bursitis does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In addition to your muscle control, your physical therapist will assess your hip biomechanics and start correcting any defects. It may be as simple as providing you with core abdominal exercises or some foot orthotics to address any biomechanical faults in the legs or feet. Fine tuning your hip stability and function is done by addressing any deficits in core strength and balance, as well as learning self‑management techniques. Safely returning to your previous sporting or leisure activities is always the goal.
Trochanteric Bursitis Surgery
Surgery is not a common path.
How Can You Prevent Trochanteric Bursitis?
Muscle weakness or fatigue is a major cause of trochanteric bursitis. So addressing your strength and endurance is necessary to avoid a recurrence. Wearing adequate footwear which supports any biomechanical imbalances in your feet is a key preventative measure. Successful weight management minimizes excess stress on the hip joints which can alleviate pressure on the bursa. If you need advice regarding your weight‑loss please discuss with your doctor or dietitian.
What Results Can You Expect for Trochanteric Bursitis?
While some people can respond quickly to cortisone injection and/or physical therapy treatment within a few weeks, more chronic cases where a tendinopathy exists in the gluteal muscle group under the bursa can require a few months to achieve recovery. Trochanteric bursitis is successfully managed in the vast majority over a period of approximately six week. It is important to not stop your rehabilitation exercises as soon as your pain abates. Excellent hip muscle control is your best rehabilitation and prevention strategy. Please follow the advice of your physiotherapist or doctor.