The hip bursa, also known medically as trochanteric bursa, is a fluid-filled sac located on the outer side of the hip. This bursa provides cushioning between the bony prominence of the femur (thigh bone) known as the greater trochanter, and the muscles and tendons running over it. It assists in reducing friction between these structures.
During contraction of the gluteals and muscles overlying the hip, friction is placed on the trochanteric bursa. When these forces are excessive due to repetitive activities or high force, irritation and inflammation of the bursa may occur. This condition is known as trochanteric bursitis.
Trochanteric bursitis presents as pain and tenderness along the outer aspect of the hip and possibly radiating down the outer aspect of the thigh as far as the knee.
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Trochanteric bursitis is generally an overuse injury, caused by repetitive or prolonged activities that place excessive strain on the trochanteric bursa. This particularly occurs due to repetitive running, jumping and walking activities or due to prolonged pressure on the bursa (such as excessive side-lying particularly on hard surfaces). Occasionally the condition may occur suddenly after a direct blow to the hip. Several factors can increase a person’s risk of developing trochanteric bursitis. These include:
- Participation in sports such as running, hiking or those with contact such as rugby and football.
- Abnormal biomechanics of the knee, feet or hips
- Lower limb muscle imbalance, particularly weakness of the gluteals or hamstrings
- Tight muscles around the hip joint, particularly the gluteals or muscle along the outside of the leg (ITB)
- Stiffness of the hip joint
- Poor training techniques such as lack of warm-up and cool down or excessive training
As with many conditions that we see, the cause of trochanteric bursitis is many. As such, seeing a Physiotherapist who will take the time to listen to your history and perform a thorough orthopaedic assessment is essential.
Biomechanical assessment and special orthopaedic tests are used to identify the painful bursa and what structures are causing the increased friction and inflammation. These assessments will allow your Physiotherapist to develop an individual treatment plan for your condition.
The primary aim of initial treatment is to reduce associated pain and inflammation. Once your condition has settled, it is crucial to address the underlying cause to avoid symptoms recurring. This may be through a program of stretching and strengthening, the use of biomechanical aids such as orthotics, massage, joint mobilisation, core strengthening, sports specific training and Clinical Pilates.
Education and advice regarding appropriate warm up and cool down, regular stretches and technique corrections are also important.
Most individuals recover well with a physiotherapy guided program and a gradual return to activity is achieved once pain-free. This could take a few weeks to several months in the worst-case scenario.