Hip Trochanteric Bursitis – A Runner’s Approach to Diagnosing, Treating & Preventing the Injury

0

The hip is not only one of the largest joints in the body, but it is also one of the most mobile. Like other large, mobile joints, the hip is more prone to overuse, injury, and other ailments, like bursitis. This is especially common in runners because of an overuse injury, and runners use their hips not only during their workouts, but also during every other movement-based moment of their day. Additionally, the impact of running can contribute to the development of hip bursitis. If left untreated, this condition that will not only affect your performance as a runner, but also your ability to carry out simple, everyday activities like walking, climbing stairs, and getting up from a chair.

Hip-Bursitis-Hip-Pain-Main

Suffering from this condition can be painful. Luckily, the pain can be treated and additional bouts of inflammationcan be prevented with stretching and strength exercises. Although part of your treatment plan may include taking a break from running or decreasing the amount you run for a period of time, you don’t have to stop working out altogether, which means you will be able to maintain your fitness level while you wait for  your hip to heal. Read this article to get a complete overview of what hip bursitis is, its symptoms, risk factors, treatment options, and how to prevent suffering from this condition in the future so you can keep on your path to meeting (and exceeding) all of your running goals.

 

What is Bursitis?

Bursae are small sacs of fluid that resemble tiny water balloons filled with jelly. They rest between bones and soft tissues, with the primary job of reducing friction throughout the body.

Even though these tiny sacs play a big part in helping us move comfortably, bursae can become irritated and inflamed, and ironically, can then cause us even more pain. The most common areas of the body that develop bursitis are the shoulder, elbow, and hip. There are three types of conditions, and they can occur simultaneously, so that means that you can feel the pain in your hip from your gluteus muscles all the way down to your knee. Keep reading to learn more about each type, the symptoms you can experience if you have this condition, and ways to treat and prevent this condition that so often affects runners.

Hip-Bursitis-Bursae-Inflamed

Types of Hip Bursitis

Presentation of the Three Types:

  • Trochanteric Bursitis: The trochanter of the femur connects several gluteal muscles to the pelvis. The trochanter feels like a bump or knob sticking out from the side of your hip, and is lubricated by the trochanteric bursa. Trochanteric bursitis is when the trochanteric bursa becomes inflamed.
  • Ischial/ischio-gluteal Bursitis: The ischial bursa is located between the bottom of the pelvic bone and the muscles of the gluteus maximus and gluteus medius. Also known as “weaver’s bottom,” ischial/ischio-gluteal bursitis is when the ischial bursa becomes aggravated.
  • Iliopsoas/iliopectinial Bursitis: Almost directly below the trochanteric bursa, the iliopsoas bursa is tucked away deep in your groin, and is the largest bursa in your body. Its main function is to reduce friction between the thigh bone and the iliopsoas tendon. When this bursa becomes irritated, the result is iliopsoas bursitis.

 

The most commonly occurring type of is trochanteric bursitis because it is a point of attachment for several gluteus muscles as well as a large tendon that passes over the trochanter of the femur.  Unfortunately, the three types do not always occur independently. Depending on your specific symptoms and the cause, you may experience more than one of the types at the same time.

 

Symptoms

Runners experiencing pain usually experience the following symptoms:

 

How and where these symptoms occur on each individual depends on which type or types is affecting the athlete.

  • Trochanteric Bursitis: Pain related is usually located on the outside of the hip or the buttocks. The pain is usually felt when lying on the affected hip, applying pressure to the outside of the affected hip, when standing from a deep seated position, and/or walking up stairs.
  • Ischial/ischio-gluteal Bursitis: is most often causes pain in the gluteus and hamstring. The pain is most often felt when sitting or lying down, rather than standing, during sprints and incline runs, and/or while bending forward. Those affected also commonly experience pain when sitting along the SITS bone, or the bone that contacts a chair directly when seated.
  • Iliopsoas/iliopectinial Bursitis: The pain can extend from the thigh all the way down to the knee. The pain of iliopsoas bursitis has been known to radiate to the lower back. “Snapping” of the hip is also associated with iliopsoas bursitis. Athletes affected experience painful symptoms when walking or crossing their legs, internal rotation of the hip or hyperextension of the hip, and/or after resting for an extended period of time.

 

When afflicted with this condition, the pain is usually worse at nighttime, especially when lying on the affected hip, and sleeping can be difficult. Symptoms can be provoked by activity, pressure, stretching, and/or any movement that causes flexing of the hip. Pain can be aggravated or increased when changing from a seated to standing position, such as getting out of a car or chair. It is not unusual to experience numbness around the affected hip joint, as the swelling of the bursa compresses nearby nerves. Stiffness may increase, and as a result you may hear snapping or feel popping when attempting to move after feeling stiffness.

Hip-Bursitis-Bursae-Inflamed-symptoms

 

Causes

Inflammation is the most common cause of hip pain, and is very common in athletes, like runners, that subject their hips to frequent, repetitive movements.

This section elaborates on the most common causes which are:

  • Overuse
  • Pressure
  • Direct injury
  • Previous surgery

One major cause is overuse. By repeating the same movements over and over again, the hip bursae experience constant stress, causing inflammation and irritation. This is often the cause of bursitis in runners, cyclers, walkers, dancers, soccer players, and people that perform a lot of squatting or lunging movements on a regular basis. Women are also more likely to experience this pain than men because they tend to rotate their hips more when walking.

A second major cause  is pressure. Any pressure applied to your hips in a constant, unforgiving manner can irritate the bursae, cause inflammation, and therefore, bursitis. Some ways that constant pressure is applied to the hips include excessive periods of sitting, standing, or lying on a hard surface without changing positions.

Direct injury to the hip can result in inflammation of the hip bursae. When an injury to the hip causes bursitis, it is known as traumatic hip bursitis because it is caused by a trauma, or impact to the hip area. Events that can cause trauma to the hip and result in bursitis include a fall on a hard surface or a car accident. Traumatic hip bursitis also has the potential to tear the bursa sac, which can result in bleeding. The bleeding is not a serious issue, but the bursa can have an inflammatory response to the blood in the sac, which is the actual cause of the inflammation.

A previous hip surgery or hip area can also be a cause. Some examples of hip surgeries are hip replacement or arthroplasty. If the bursa becomes irritated by the surgery, the patient may experience the pain symptoms of inflammation. Additionally, if a patient receives inadequate rehabilitation after hip or gluteal surgery, the bursa can become inflamed.

Hip-Bursitis-Bursae-Inflamed-causes

 

Risk Factors

Any athlete that performs intense physical activity or exercise on a regular basis has the potential to develop hip bursitis. However, there are some factors that increase one’s likelihood and they include:

  • Age – the elderly are more prone to developing the condition
  • Gender- is more common in women
  • Weight- People that are overweight, even those that are not runners or other types of athletes, are more apt to develop this condition. This is because the extra body weight causes more stress and pressure to be placed on the hips, which eventually leads to the irritation and inflammation that are the hallmarks.
  • Spine disease- including scoliosis or arthritis of the spine
  • Leg-length inequality- Your stride and gait are affected when you have legs of two different lengths. This can irritate the hip bursa.
  • Rheumatoid Arthitis- This condition makes is more likely for bursa to become inflamed.
  • Infection: Especially with a bacteria, such as staphylococcus aureus (i.e. Staph infection)
  • Bone spurs or calcium deposits- When bone spurs and calcium deposits develop within the tendons that are associated with your hips, the bursa can become inflamed.
  • Previous injuries or surgeries: Any prior damage to the hip area, or a lack of rehabilitation thereafter, can cause irritation and inflammation of the bursa.

Hip-Bursitis-Bursae-Inflamed-risk-factors

 

Diagnosis

In order to be properly diagnosed, you will need a comprehensive physical examination from a doctor. They will closely examine the areas of tenderness and pain in your hip, gluteal muscles, and leg, and will also perform additional tests to rule out other causes of your hip pain, such as an injury or an illness. Tests that may be performed as part of the comprehensive physical examination include x-rays, bone scans, and/or an MRI.

There are some conditions that can be misdiagnosed as hip bursitis. These include a tear in the bursa sac, femoral acetabular impingement, a groin pull, arthritis, dysplasia, tendinitis, and pinched nerves, among others. For more information about these potential misdiagnoses, read the section in this article called “False Positives.”

Hip-Bursitis-Bursae-Inflamed-diagnosing

 

Treatment

Even though the hips are a very important component of almost every physical movement we make, it is possible to experience relief from the pain of hip bursitis. The first options are always non-surgical. The non-surgical treatment options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDS): Your doctor may recommend that you take an over-the-counter NSAID, such as ibuprofen or naproxen, to help lessen the pain. Taking an NSAID may also help reduce swelling, especially if used in conjunction with an ice pack.

 

  • Activity modification: Your doctor may recommend that you avoid or lessen participation in the activities that aggravate the symptoms. This will definitely be a recommended course of action if your condition is caused by overuse. For example, if overuse by running is the underlying cause, your doctor may ask you to run less frequently or take a break from running for a period of time. He or she may also suggest engaging in an alternative physical activity, such as swimming or boxing, until your symptoms subside. Your doctor may also suggest that you continue the modified activity schedule to prevent instances of bursitis in the future.

 

  • Assistive devices: If you have especially severe symptom and are not able to cease activity or movement that is aggravating your doctor may recommend that you utilize an assistive device, like crutches, as part of your treatment. Crutches are utilized as a treatment option for at least one week and sometimes longer. The use of crutches relieves pressure from your leg and eliminates use because the leg is elevated during walking.

Hip-Bursitis-Bursae-Inflamed-crutches-treatment

  • Physical Therapy: You doctor may recommend hip stretching and strengthening exercises as part of your treatment plan for hip bursitis. You may have to attend physical therapy sessions at a prescribed location, or your doctor may show you how to do the exercises independently at home. Other treatments that are often prescribed along with physical therapy include massage, heat therapy, ice therapy, and/or ultrasound therapy.

 

  • Steroid Injections: The injection of a corticosteroid directly into the bursa sac (after numbing the area using a local anesthetic) has been shown to help relieve the symptoms. Steroid injections can provide temporary (months) of relief, or can even provide permanent relief in some patients. A series of injections may be scheduled if the symptoms persist after the initial injection. The additional steroid injections will be spaced months apart. Although steroid injections provide relief of symptoms, it is important to limit the number of injections, as they can damage the tissue surrounding the bursa or the bursa itself.

On very rare occasion is surgical treatment required. Surgery may be recommended if, after trying all non-surgical options, the inflammation and pain remain a problem. However, this is a recommendation that is made very rarely.

The surgery to relieve a patient issues involves removing the affected bursa sac. The hip can function normally without the bursa. Traditional, invasive surgery can be used to remove the bursa, but a newer option is arthroscopic removal of the bursa. In this procedures, a ¼ inch incision is made over the hip, and the surgeon uses an arthroscopic camera to guide the removal of the bursa using microscopic tools. With the arthroscopic bursa sac removal, the incision is smaller, less pain is experienced afterward, and recovery time is faster.

Both the traditional and arthroscopic methods of removing the bursa sac are performed as out-patient procedures. This means that no overnight hospital stay is required.

Hip-Bursitis-Bursae-Inflamed-surgery-last-resort
Invasive Surgery should always be last resort

 

Prevention

There are a few steps you can take to help prevention, they include:

  • Avoiding repetitive activties
  • Losing weight
  • Shoe inserts
  • Eating anti inflammatory foods
  • Building hip strength and flexibility

Avoid repetitive activities that put stress on the hips: Avoiding repetitive motions that affect the hips will greatly decrease the amount of irritation that is causing the bursa to become inflamed. This is because the friction causing the irritation and inflammation are being eliminated. Once your doctor says it is safe for you to begin physical activity again, be sure to get back into your routine slowly and gradually build up the amount of activity you perform and the intensity of that activity. Otherwise, you risk experiencing the symptoms once again.

Lose weight: A reduction in body weight helps to reduce stress on your joints, including your hips. Less joint stress means less friction, which will help prevent the irritation and inflammation that are the underlying causes.

Get a shoe insert to compensate for differences in leg length: Many people have a discrepancy in leg length and can go about their daily activities without any pain or discomfort. However, people with a noticeable difference in leg length may experience pain in a variety of areas in their body, including the hips. The pain is a result of the body’s natural adaptations in movement to compensate for the leg length discrepancy. Although it enables the person to function, it causes a whole body imbalance, which results in pain and discomfort. This imbalance can be made worse by performing high-intensity athletic activities, such as running. Inserting a heel lift into the shoe of the shorter leg will make your legs the same length, allowing your body to keep its natural balance, stride and gait. Now that it is in balance, your body will not have to adjust its movements as a means of compensating for the shorter leg, and the pain and discomfort is eliminated.

Hip-Bursitis-Bursae-Inflamed-prevention-heel-lift-insert

 

Eat foods that have anti-inflammatory properties: Small dietary changes can help prevent the inflammation and the resulting pain. Eating a diet that is high in omega-3 and omega-6 fatty acids, anthocyanins, phytonutrients, and polyphenols helps your body fight inflammation naturally. Some foods that are rich in anti inflammatory properties include fatty fish, berries, kale, sweet potatoes, and avocados.

Build and maintain the strength and flexibility of the hip muscles: Strengthening your hip abductors, adductors, and gluteus muscles can help prevent hip bursitis. The hips are an incredibly important in producing the power and force that our lower body needs to not only perform athletic activities, but also everyday movements.

Stretches for Hips: Step by Step

Kneeling Hip Flexor Stretch
  1. Kneel down on your right leg, keeping your left leg bend at a 90 degree angle with your foot flat on the floor.
  2. Raise your hands above your head.
  3. Push your hips forward while leaning your arms and upper body backward. Go only as far as is comfortable and so you feel the stretch.
  4. Hold for 10-15 seconds. Switch stance and repeat on other side.

 

Pigeon Pose
  1. Rest the outside of your right shin on the floor while your left leg extends straight behind you.
  2. Press your right glute toward the floor.
  3. With your hands pressing into the ground for support, hold the stretch for 10-15 seconds.
  4. Extend your arms in front of you and bring your torso down toward your leg as far as possible.
  5. Hold for 10-15 seconds, then repeat on other side.

 

Twisting Hip Stretch
  1. Kneel down on your right leg, keeping your left leg bend at a 90 degree angle with your foot flat on the floor.
  2. Place your right hand on the floor, directly next to the inside of your left foot.
  3. Twist toward your left, raising your left hand straight into the air.
  4. Hold pose for 10-15 seconds, then switch your stance and repeat on other side.

 

Strength Exercises for Hips: Step by Step

Single Leg Hip Lift
  1. Lay down on your back.
  2. Bend your knees so your feet are flat on the floor.
  3. Lift your left leg off of the ground. It can be bent or straight.
  4. Press your hips off the ground using only your right leg.
  5. Complete 8-12 reps, then switch sides.

 

Split Squat
  1. Stand with your hands on your hips.
  2. Position one foot a stride’s length in front of the other.
  3. Squat down while until your back knee almost touches the floor.
  4. Press up to return to starting position.
  5. Complete 8-12 reps on this side, then switch sides.

 

Lateral Squat
  1. Stand with your feet apart, approximately twice as wide as your shoulders are.
  2. With your arms out straight in front of you, squat down to the right, dropping your hips down and back.
  3. Pause for two counts, then return to the starting position.
  4. Repeat on other side. Complete 8—12 repetitions per side.

 

X-Band Walk
  1. Step both feet into a large exercise band or tube (be sure it is whole/circular).
  2. Move your feet shoulder width-apart.
  3. Twist the top of the band to form an X.
  4. Take 10 steps to the right.
  5. Take 10 steps to the left to return to your starting position.

 

False Positives

The hips are one of the largest joints in the body, with the largest bursa in the body. Hip pain is a common ailment, especially among runners. Although bursitis may be the cause of your hip pain, there are some other ailments that you can rule out by having a comprehensive examination completed by your physician, including:

  • Joint diseases
  • Snapping hip
  • Stress fractures
  • Femoroacetabular impingement
  • Myoxoid tumors

Joint diseases: There are many joint diseases that can cause inflammation, pain, and discomfort in the hips. These include osteoarthritis, rheumatoid arthritis, avascular necrosis, pigmente vollonodular synovitis, synovial chrondromatosis, gout, chrondrocalcinosis, trauma, lupus, and pyogenic infection. During a comprehensive exam, your doctor will be able to run tests and scans that will help him or her better determine the specific cause of your hip pain and inflammation.

Hip-Bursitis-Bursae-false-positive

Snapping hip: Snapping hip is a condition in which activities like walking, running, or getting up from a seated position cause a snapping or popping sensation in your hip. The snapping or popping is caused by a muscle or tendon moving over a bony protrusion in your hip.  Snapping hip is usually only associated with the sound of the snapping, and is a painless condition. However, it can be a precursor, as the snapping of the muscle or tendon over the bone can cause irritation and inflammation.

Stress fracture: A stress fracture, is an overuse injury. A stress fracture occurs when muscles become tired and cannot absorb impact from activity. Eventually, the tired muscle transfers the shock absorption to the bone, which causes a small fracture. Stress fractures are often caused by increasing the amount and/or intensity of physical activity too quickly. More than half of all stress fractures occur in the lower half of the body, as the legs are responsible for bearing the load of our body weight. A doctor can determine if you have a stress fracture by running tests and scans, like an MRI.

Hip-Bursitis-Bursae-false-positive-stress-fracture

Femoroacetabular impingement: Femoroacetabular impingement, also known as FAI, is a condition in which an extra bone grows along one or both of the bones that form the hip joint. This gives the bones an irregular shape and does not allow them to fit together properly. As a result, the bones rub against each other during movement, and this friction can eventually damage the joint, resulting in pain and lessened mobility or ability to complete physical activities. There are three types of FAI, based on where the extra bone forms. They are pincer, cam, and combined. To determine if you suffer from FAI, a doctor will perform an impingement test and a combination of imaging tests, which could possibly include x-rays, MRIs, and CT scans.

Myoxoid tumors: Myoxoid sarcoma is a very rare type of cancer that develops deep in the soft tissue. This type of fatty tumor usually presents itself as a painless lump.  A myoxoid tumor is usually not noticed by the patient until it is has grown large enough to put pressure on the tissues that surround it, and by this point the cancer usually has reached a more advanced stage.  If your doctor suspects, after a thorough examination and appropriate testing, that a myoxoid tumor is the cause of your hip pain, he or she will refer you to the appropriate specialists to treat this disease.

To Sum It Up

Reading this article should have adequately informed on the symptoms of, causes of, and treatment. Refer back to this article in the future if you need a refresher on this condition. The comprehensive information provided in this article may be helpful if you believe that you are suffering from hip bursitis. If you have worries about developing the condition or are already suffering from this condition, this article can provide you with some knowledge about how to prevent and treat this condition.

With an appropriate training regime that includes hip strengthening and stretching exercises, most cases of hip bursitis can be managed or prevented. Consulting a medical professional is also a helpful step in the treatment process.  Paying attention to the messages your body sends you, and responding to those messages with some TLC, is an important step in being the best runner you can be.

Sources used while conducting our search

The sources listed below back up several health claims made in this article. They are pulled from scientific studies and online posts written by medical professionals. Regardless of the amount and quality of the research put in, this article is only meant to inform. Do not treat the contents of this article as professional medical advice. You should always talk to a doctor if you are experiencing unfamiliar pain in order to get an accurate diagnosis.

Sources

  1. Ortho Info, Hip Bursitis,
  2. Cleveland Clinic, Trochanteric Bursitis,
  3. MyBursitis, Hip bursitis debunked,
  4. Running Institute SD, Ischial Bursitis,
  5. Audrey De Bry | Andrea Nees | Laura Danhieux, Iliopsoas Bursitis,
  6. Michiel Cassiman, Ischial Bursitis,
  7. William C. Shiel Jr., MD, FACP, FACR, Hip Bursitis Facts,
  8. Marco Funiciello, DO, Hip Bursitis Causes,
  9. Dr. Thomas Ellis, Why is a Common Hip Problem So Frequently Misdiagnosed? (Op-Ed),
  10. LComstock, Hip Bursitis: How to prevent it,
  11. FamilyDoctor, Bursitis of the Hip,
  12. Richard W. Zehr, Leg Length Discrepancy, aka Short Leg Syndrome, and Heel Lifts,
  13. Jarlo, Hips Don’t Lie: Exercises for Power and Hip Mobility,
  14. Dan Kehlenbach, Dan Kehlenbach,
  15. ExRx, Split Squat,
  16. Ryan Obernesser, 4 Hip Flexor Stretches to Relieve Tight Hips,
  17. Ortho Info, Snapping Hip,
  18. HoustonMethodist, Stress Fracture of the Hip,
  19. Ortho Info, Stress Fractures,
  20. Ortho Info, Femoroacetabular Impingement,
  21. Sarcoma Oncology Center, Myxoid sarcoma cancer,