Hip bursitis

What is Hip bursitis?

Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful.

Hip Bursitis refers to a situation where the Trochanteric Bursa has become irritated and inflamed. This can be caused either by a direct blow to the area or by repetitive friction of the Ilio Tibial Band on the bursa, as occurs during long-distance running.

What causes hip bursitis?

Hip bursitis can be associated with different types of patients:

• Athletes
  Hip bursitis is commonly seen in runners or athletes who participate in running-oriented sports (e.g. soccer, football, etc.).
  
  
• Injuries
  Hip bursitis is sometimes associated with patients who fall onto their upper thigh, causing a so-called traumatic bursitis. The symptoms are similar to a hip pointer.
  
  
• Post-surgical
  Patients who have had surgery, such as hip fracture surgery, or total hip replacement, may complain of pain over the outside of the hip. These symptoms are often due to irritation to the bursa causing hip bursitis.

Hip Bursitis Signs & Symptoms

A person suffering from Hip Bursitis will have pain over the area of the bursa, but in severe cases it may radiate down the leg. The pain will usually be brought on by hip movements such as walking, running, and climbing stairs. The physiotherapist should be able to diagnose the condition through manual tests, but it can be confirmed by an ultrasound scan.

Hip Bursitis Treatment

Rest is very important in the treatment of Hip Bursitis in order to allow the condition to settle down. Physiotherapy treatment typically includes ice therapy, electrotherapy and stretching of the Ilio Tibial Band, and may be successful in curing the condition. Ice Packs can be applied for twenty minutes every couple of hours to help relieve pain (never apply ice directly to the skin as there is the danger of an ice burn). Anti inflammatory medication from the pharmacist can also be very effective at relieving hip pain and inflammation.

However, in a number of cases, particularly chronic (long-term) cases of Hip Bursitis, a Corticosteroid injection may be necessary (a corticosteroid is a naturally occurring substance which can settle down inflammation). Following a Corticosteroid injection into the Hip Bursa it is necessary to rest from sports for around one week to allow the problem to settle down.

Once the condition has settled down, core strengthening and stabilising exercises can begin. Core Strength and Core Stability exercises can improve muscle function across the trunk and pelvis and this can reduce the risk of overuse injuries. Core strength exercises on a mat using a Swiss Ball and Resistance Bands are ideal. Once Core Strength and Hamstring strength are improved, then a return to functional activity is possible.

Is surgery ever necessary for hip bursitis?

In those few cases where surgery is needed, this can be done through a small incision, or sometimes it can be performed arthroscopically. Either way, the bursa is simply removed (called a bursectomy), and the patient can resume their activities. The surgery is done as an outpatient, and most often crutches are only used for a few days. Patient's do not need a bursa, and therefore there are few complications from this type of surgery. The most common complications are anesthetic-related complications, and infection.

Hip Bursitis Prevention

As with all overuse injuries, doing too much, too soon can be a major contributing factor in developing Hip Bursitis. When beginning or stepping up a running program, gradual progress must be made. For example, it is impossible to increase from running 2 miles per day one week to running 10 miles per day the next week, because the tissues of the body are not prepared for the increased stress and they may fail under the increased load. By gradually increasing the training intensity, frequency and duration the tissues can adapt without a problem.

Core Strength and Core Stability exercises can improve muscle function across the trunk and pelvis and this can reduce the risk of overuse injuries. Core strength exercises on a mat using a Swiss Ball and Resistance Bands are ideal. Once Core Strength and Hamstring strength are improved, then a return to functional activity is possible.