Hip Bursitis or Trochanteric Bursitis: Causes, Symptoms, Treatment, Exercises

A bursa is a sac that is filled with lubricating fluid situated between tissues like muscles, tendons, skin and bone. Bursa helps to lessens irritation and friction between the tissues and bone. The bursa are sacs filled with gelatinous substance and works as shock absorber during movements and activities.^[1] The inflammation of bursa is called bursitis. The direct impact or repeated rubbing of sac of bursa initiates inflammatory reaction of sac. Hip bursitis is also called as trochanteric bursitis.^[2] Hip Bursitis could be explained as an inflammation of the bursa that is a sac filled with fluid adjacent to the joints that acts like a cushion for the joint. The bursa causes pain in the hip when subjected to continual trauma resulting in swelling and inflammation. Hip Bursitis or Trochanteric Bursitis could strongly affect athletes such as runners, footballers and soccer players who frequently put the entire weight of their body on their hips.^[3]

• Trochanteric Bursa: Trochanteric bursa is located on the outer side of the hip between the greater trochanter and tendon of gluteal muscles that is attached to bone.^[4]
• Gluteus Medius Bursa: Gluteus medius bursa is a small bursa, which is located between the greater trochanter and gluteus medius muscle.
• Iliopsoas Bursa: Iliopsoas bursa is located between the iliopsoas muscle which is present at the front side of the joint of the hip and the underlying bone. Bursitis in this region is also called as iliopectineal bursitis.
• Ischial Bursa: Ischial bursa is located between the base of the pelvis and the hamstring tendons.^[5]

However, among all of the bursae, the most commonly affected hip bursa is the trochanteric bursa. The inflammation of bursa is known as a bursitis. Trochanteric bursa gets inflamed following trauma cause by fall or direct impact resulting in repeated rubbing of bursa between tendon, muscle and bone. The repetitive friction is observed in athletes involved in running, cycling and participating in contact sports. This repeated friction causes inflammation of wall of bursa. Sac of bursa become swollen and inflamed as the tendons keep on rubbing the bursa resulting in pain. Hip bursitis or trochanteric bursitis is very frequent among runners or athletes, who participate in running-oriented sports.

Direct impact- Fall directly over the muscle and joint causes direct trauma of bursa or microscopic rupture. The trauma and minor leak initiates inflammation of sac known as bursitis. Bursitis is very painful condition. Pain becomes severe with any movement causing rubbing action of bursa.^[6]

Repeated movements- Repeated use of gluteal muscles causes repeated friction of bursa which sitting between muscle, tendon and greater trochanter. Thus majority of cases of bursitis of the hips are caused as a result of overuse injuries resulting from biomechanical abnormalities.

Twist of bursa- Over pronation causes twist of hip or trochanteric bursa. Repeated pronation causes repeated turn and twist of bursa that eventually ends in inflammation of the sac followed by bursitis.

Bone spur-Most gelatinous sacs (bursa) are positioned between bone and tendon or bone and muscles. Bone spur are sharp protrusion of surface of bone. If bursa is lying close to the bone spur, then every movement involving muscle next to bursa causes direct friction with bone spur. Repeated rubbing against bone spur will initiate inflammation of bursa.

Squeeze of bursa- Small or large bursa occasionally get squeeze between tendon and muscle or against the bone. Such squeeze may involve adjacent bursa and hip flexors, hamstrings or iliotibial band that may results in bursitis.

Pain- One of the common symptoms of hip bursitis or trochanteric bursitis is severe pain at rest and during activities. Pain intensity increases with activities. Individual is unable to sleep on the side of bursa.

Restricted Activities-Exacerbation of pain while performing activities like climbing stairs, getting out of a car and running can also be a symptom of hip or trochanteric bursitis. Eventually all activities become restricted as pain intensity increases with any and all movement.

Tender spot- Pain is experienced while pressing on the outer side of the hip. Any pressure or touch over the bursa results in severe pain. The severe pain after examination stays for several hours and may subside to lower intensity of pain after few hours.

Pain at rest- If bursitis is ignored then gelatinous substance of the sac may get infected and pain spread around the bone, tendon and muscles. such pain is continuous and become severe even at rest.

Referred Pain- The pain caused by inflamed bursa associated with hip bursitis may also spread down the outer thigh.^[7]

Rest- One of the best ways to treat hip bursitis or trochanteric bursitis is to provide enough rest.

Cold Therapy- Acute pain during initial stages responds to cold therapy. Cold therapy involves pressing ice, ice pack or ice containing bag placed over the skin of pain area. Cold therapy is useful treatment to ease the pain associated with bursitis of the hip.

Restricted activities- Avoiding activities that aggravate the symptoms can help to ease the symptoms of hip bursitis.

Anti-inflammatory medications- Most non-steroidal anti-inflammatory medications such as ibuprofen, aspirin, celebrex and naproxen may help in reducing inflammation and swelling of the inflamed bursa. The treatment lasting 7 to 10 days helps to relieve pain associated with hip or trochanteric bursitis.

Needle aspiration- The procedure is performed in surgical center. Needle placement within bursa involves use of ultrasound or X-ray. Once the fine needle is placed within burse the gelatinous fluid is removed to remove the tension over the wall of the bursa. The fluid then sent to lab to check for infection. If bursal sac is infected, then patient is given antibiotics.

Corticosteroid injections- The inflammation causing bursitis is treated with corticosteroid injection. The aspiration of fluid is performed following needle placement within bursa. Immediately after removal of fluid from bursa cortisone is injected in sac. Corticosteroid is the best anti=inflammatory medications.

Physical Therapy- Physical therapy is advised with NSAIDs treatment. The combination of physical therapy and anti-inflammatory medication relieves the pain and inflammation.

Surgery- Surgery is recommended if all other treatment fails. Surgery is usually performed to remove the inflamed bursa.^[7]

Physical therapy for hip or trochanteric bursitis is important in speeding up the healing process. Physical therapy also decreases the likelihood of recurrences of conditions like bursitis of the hip in the future.

Physical therapy may include following choices:

Local therapy- Application of local heat and ice is the most effective physical therapy for hip bursitis.

Ultrasound- Ultrasound therapy is non-invasive treatment. The most painful and tender area is evaluated by examination. The ultrasound probe is placed over the skin surface of the painful area. Once the probe is connected to power supply the ultrasound waves are generated piezoelectric effects. The ultrasound waves then targeted to the inflamed bursa. Ultrasound waves are passed as pulsed (intermittent) or continuous depending on response during treatment. If pain increases during continuous ultrasound therapy, then pulse therapy is preferred. Ultrasound therapy is beneficial in increasing blood flow and relaxes the soft tissues.

Electrotherapy- There are several options of electrotherapy available. The main principle of electrotherapy is to pass low energy electric current through the overlying skin to the inflamed tissue. There are two option that could be beneficial to treat bursitis. The choices are use of TENS unit or interferral therapy. The treatment helps to relieve the pain. Treatment often combined with NSAIDs to treat pain and inflammation.

TENS unit- The low energy electric current is passed through sticky pad attached to skin. Two or three pads are used for positive and negative current. The vibration sensation is felt during the treatment. The treatment can be continued for 2 to 3 hours and repeated several times a day. The treatment simulates production of endorphin by underlying tissue. Endorphin acts like an analgesics resulting in adequate pain relief.

Interferential therapy- The treatment involves passage of two high frequency currents through the skin overlying the most painful area. The current from both source passes through the skin and interfere with each other at deeper level creating heat and endorphin secretion. The treatment is beneficial to treat bursa that is placed in deeper tissue.

Soft tissue massage- This is a useful treatment to speed up the healing time for hip bursitis or trochanteric bursitis as massage helps improve circulation, it stimulates the release of endorphins within subcutaneous tissue and around the inflamed bursa. Endorphin helps to control the pain.

Stretches- Performing stretches helps in decreasing muscle tightness, which could be a contributing factor for trochanteric bursitis. Stretching of leg at hip joint stretches the leg muscles around the inflamed bursa. The stretching releases the pressure on bursa and also improves the blood circulation. The stretching involves hyper flexion, hyper extension, hyper abduction and hyper abduction of painful lower leg for as long as a person can hold. The stretching movement repeated several times per day. More about exercises and stretches are explained below.

Dry needling- This is an effective treatment for people with hip pain in which one can avoid the potential harmful effects of steroids. Dry needling is as effective as cortisone injection in reducing pain associated with this condition.

Joint mobilization- Joint mobilization is an active exercised performed without stretching the joint. The repeated mobilization helps to increase blood flow to the leg and joint. The increase blood flow helps to relieve the tissue edema and releases pressure over the bursa.

Joint immobilize- During NSAIDs therapy it is beneficial to immobilize the painful area for few days. Rest and use of crutches for movement helps to give complete rest to the area where bursitis is located.

Exercises- The severe pain lasting for several weeks often causes muscle weakness and beginning of mild muscle atrophy. The muscle tone in other muscles is important to maintain near normal activities. Physical therapist will choose the various exercises to keep power and tone near normal of muscle around the bursa as well as well as other part of the body. Muscle exercises improves the strength and flexibility muscles suffering with iliotibial band.

Education- Physical therapist will explained and discussed the cause and treatment plan with patient. Prevention of recurrence of inflammation of bursa depends on education to know how to avoid the various action that may has cause the inflammation of bursa.

This exercise for hip bursitis or trochanteric bursitis is performed by lying down on the back. With the help of hands, bring the knee towards the opposite shoulder. The hip joint is stretched to maximum or until a mild to moderate pain-free stretch is felt along the buttocks or at the front side of the hip. Hold the position for about 15 seconds and release. Repeat four times ensuring there is no exacerbation of pain. The exercise repeated 3 to 4 times a day.

This exercise for hip bursitis or trochanteric bursitis is performed by lying down on the back. Now gradually pull the belly button inwards away from the belt line and breathe normally. Make sure that the rib cage remains relaxed and does not elevate while performing this exercise. Muscle contraction should be felt if pressed deeply 2 cm from the bony prominence at the front of the pelvis. Practice holding this muscle at one third of a maximal contraction during everyday activities provided it is pain free.^[8]

The hip joint bursitis is diagnosed by clinical examination and ultrasound study. Bursa is not observed under X-Ray or CT scan. Targeted MRI over the inflamed bursa may show soft tissue swelling and hypertrophy. The finding is compared with opposite side. The diagnosis is confirmed following clinical examination when ultrasound or MRI finding suggests presence of hypertrophy and inflamed sac of bursa.

References:

Also Read:

1. Hip Dislocation: Types, Causes, Signs, Symptoms, Treatment, Exercises, Tests
2. Hip Flexor Strain: Types, Causes, Symptoms, Treatment. Exercise, Recovery
3. Hip Pointer: Causes, Symptoms, Treatment, Exercises, Recovery
4. Hip Sprain: Causes, Symptoms, Treatment, Exercises
5. Hip Tendonitis: Causes, Symptoms, Treatment, Exercise, Prevention
6. Labral Tear of the Hip Joint
7. Snapping Hip or Dancers Hip: Treatment, Exercise, What Can Cause Your Hips to Snap?
8. Hip-Opening Yoga Poses & Its Benefits, Precautions