What is Trochanteric Bursitis?
The most common form of hip bursitis is trochanteric bursitis.
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.
Trochanteric Bursitis Symptoms?
Bursitis may develop gradually or traumatically.
- Pain 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
- 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 with running, walking, or cycling, especially when the bicycle seat is too high. It may also occur in some people who have:
- scoliosis
- an unequal leg length
- weak hip muscles
- osteoarthritis (degenerative joint disease) of the hips or lower back
- rheumatoid arthritis
In many cases, the cause may be unknown by the sufferer due to subtle biomechanical faults. The repeated trauma to the bursa as you walk or exercise irritates the bursa and results in pain.
Trochanteric bursitis may also occur as a result of direct trauma to the side of the hip.
How is Trochanteric Bursitis Diagnosed?
Your physiotherapist will provide you with a thorough quiz of your medical history and a physical examination of your hip and back to determine if you have trochanteric bursitis. While you are lying on your unaffected side, your physiotherapist will carefully examine the greater trochanteric bursa area. If you feel tenderness over the bursa when pressure is applied, a diagnosis is confirmed.
The diagnosis is the easy part. Your physiotherapist will also undertake a biomechanical analysis to determine what the cause of your bursitis actually is. Factors may include muscle weakness, tightness, pain inhibition, leg length discrepancy, training techniques and more.
How is Trochanteric Bursitis Treated?
Ice
Apply ice to the area to decrease inflammation. We generally recommend that you apply a large ice pack on the affected area for 20 to 30 minutes. You should repeat the ice application 2 to 3 times a day.
Weight Loss
Weight loss may be recommended if you are overweight to reduce the stress placed through your hip joint and bursa.
Shoe Lifts
Shoe lifts may be ordered for individuals with an unequal leg length.
Physiotherapy
Your physiotherapist will use electrotherapy modalities to hasten your healing rate. After assessing your biomechanics and training regime they will also recommend specific exercises to prevent a recurrence.
Bursitis is commonly a secondary condition. Usually we find that hip muscle weakness does not support the hip correctly when walking resulting in a dropping hip that presses the large trochanter bone against the bursa. The resulting irritation from repetitious tasks, such as walking, causes the bursa to swell and become very painful. The solution in this instance is to treat both the acute bursitis and the hip muscle weakness that originally caused the problem as well. If you don't, the hip bursitis will become chronic and cause calcification within the bursa and even nastier pain and disability.
Bursitis symptoms can have other causes as well. If you are experiencing this type of pain, be sure to consult your physio. It is not uncommon that many people with trochanteric bursitis also have other conditions, such as osteoarthritis or rheumatoid arthritis, which can make it hard to diagnose this type of bursitis of the hip.
While you are recovering from your injury you will need to change your sport or activity to one that does not make your condition worse. For example, you may need to swim instead of running or bicycling. If you are bicycling, you may need to lower your bicycle seat.
Common Trochanteric Bursitis Treatments
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Medications
Sometimes non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are prescribed. They are usually ineffective since the bursa is isolated from your blood stream. NSAID gels appear to be more effective.
Injection
A corticosteroid injection into the bursa may help reduce the pain and swelling in stubborn cases.
What is Your Prognosis for Trochanteric Bursitis?
The prognosis for recovery is very good. Most people with trochanteric bursitis respond very quickly to physiotherapy treatment.
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your leg recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
- You have full range of hip movement in the injured leg compared to the uninjured leg.
- You have full strength of the injured leg compared to the uninjured leg.
- You can jog straight ahead without pain or limping.
- You can sprint straight ahead without pain or limping.
- You can do 45-degree cuts, first at half-speed, then at full-speed.
- You can do 20-metre figures-of-eight, first at half-speed, then at full-speed.
- You can do 90-degree cuts, first at half-speed, then at full-speed.
- You can do 10-metre figures-of-eight, first at half-speed, then at full-speed.
- You can jump on both legs without pain
- You can hop on the injured leg without pain.
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How Can You Prevent Trochanteric Bursitis?
Trochanteric bursitis is best prevented by warming up properly and stretching the muscles on the outer side of your upper thigh. Muscle weakness or fatigue is a major cause of trochanteric bursitis. Addressing your strength and endurance is necessary to avoid a recurrence.
FAQs about Trochanteric Bursitis
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