Greater Trochanteric Bursitis
The topic of this week’s blog is a particular type of hip pain known as Greater Trochanteric Bursitis (GTB). GTB is an inflammatory condition that affects the bursa overlying the bony prominence on the side of your hip, known as the greater trochanter (GT).
The reason we want to discuss GTB is that, because of its location, it is prone to becoming inflamed due to the number of tendons that insert around the area and when it does it can create an acute pain on the outside of the hip that may radiate along the outside of the thigh.
A bursa is a small, fluid filled sack located near joints and muscles that decrease friction and allow for smooth, painless movement of muscles and tendons over bone. There are over 150 bursa located in many different places throughout the body such as the knee, hip, elbow and shoulder.
There are two main bursa that sit around the greater trochanter:
1. The gluteus medius bursa which lies beneath the glutes medius tendon and medial to the GT
2. The trochanteric bursa which lies lateral to the GT.
Because of the relationship between the bursa and the gluteus medius tendon, quite often gluteus medius tendinopathy and bursitis co-exist.
The inflammation apparent in gluteus medius and trochanteric bursitis are usually caused by the group of overlying muscles including the gluteus medius and minimus and the Tensor fascia latae (TFL). When these muscles get tight they have a rubbing effect on the bursa as it is squeezed between the tendon and the thigh bone. This causes irritation and inflammation in the area which results in pain. Other causes can include direct trauma to the area, scoliosis of the spine which results in an altered posture and gait, as well as arthritis in the lower back or hips.
The main cause we see clinically, is poor lateral pelvic stability.This is an inability of the gluteal muscle group to hold our hips stable when we stand on one leg (i.e. every time we take a step). As a result, our hips shift in a sideways movement during single leg stance and the hip on the opposite side will drop down. This causes a pull on the TFL and glute muscles and causes them to compress the bursa whilst activating resulting in the friction and inflammation mentioned above. Constant exposure to this stress causes repetitive irritation and the ensuing bursitis. This sideways movement of the hip also creates an over stretching to gluteus medius tendon which can lead to the co-existing tendinopathy.
Bursitic pain can come on acutely, such as after a long run or direct contact during a fall. More commonly it will arise slowly, over a period of repetitive exposure to overstretching. It normally presents as a dull ache around the outside of the hip (due to muscle tightness) with periods of intermittent sharp pain when the bursa is compressed. Pain is experienced in activities that create a stretch to the gluteus medius or require its activation. These activities include, walking, running, climbing stairs, getting in and out of cars, cycling or when you have direct contact over the outside of the hip, such as when sleeping on the affected side.
Trochanteric bursitis is a common inflammatory condition, that is easily diagnosed in the clinic and with the use of ultrasonic imaging. It is always important to engage in a though physical examination to identify secondary issues such as co-existing tendinopathies and contributing biomechanical factors such as poor pelvic stability, lumbopelvic dysfunctions or foot posture issues.
As GTB is an inflammatory condition, initial treatment involves reducing the swelling and pain using ultrasound, ice application and anti-inflammatory medication. As pain subsides we aim to unload the soft tissue in the area by using deep tissue massage, dry needling, mobilisations to stiff joints and taping to unload the hip and further reduce the pain around the area. Once you are pain free, the goal is to restore correct function to the surrounding muscles using strengthening and stabilising exercises. In addition to this your therapist will address any underlying causes such as scoliosis or leg length inequalities which may be a factor for reoccurrence of the condition.
3 tips to help minimise the risk of trochanteric bursa injuries arising in the first place are:
1. Make sure you engage in a good warm-up and cool down process before and after all exercise, especially if that exercise involves running.
2. Regularly stretch through the gluteal muscles to maintain good length in these muscles – hold each stretch for 15 seconds and repeat x 2 on each side.
3. Maintain good strength in your gluteus medius muscle by engaging in regular strengthening exercises such as bridging and side leg raises. Perform 3 sets of 10 repetitions daily.
So that’s a brief overview of how greater trochanteric bursitis occur and what can be done to prevent. If you do experience any of the symptoms mentioned above or suffer from recurrent pain on the outside of the hip, then consult your healthcare practitioner sooner rather than later. If you have questions or comments feel free to e-mail us at firstname.lastname@example.org and we will happily answer them you.
If you think you may already be suffering from trochanteric bursitis and want relief now, then call us on (08) 9486 8653 and we will arrange an appointment for you.