Imagine if your body was made up of thin, slippery sacs filled with a small amount of fluid. And the purpose of these sacs was to reduce friction between bone and surrounding soft tissue, such as skin, muscles, ligaments, and tendons. And what would you think would happen if one of these sacs became inflamed, no longer being able to provide proper cushioning?
Well, your body IS made up of roughly 160 of these sacs. Known medically as bursae, they are located around many of the body’s major joints, like the elbow, shoulder, and knee. And when the one around the outside of your hip becomes inflamed, that’s when greater trochanteric bursitis rears its ugly head.
Unfortunately, trochanteric bursitis is a common problem causing pain on the outside of the hip and along the outer upper thigh. While I’ve seen it mostly in clients who are runners, the condition can affect cyclists, soccer players, football players and even in the general population as well. So how do you know if you have trochanteric bursitis? And what can be done to handle it? Well, that’s what good ol’ Dr. Rob is here for. So, let’s delve in and learn about this aggravating condition, and how some simple PT exercises can help, shall we?
What Symptoms of Trochanteric Bursitis Should I Be on the Lookout For?
So what are the telltale signs that you are suffering from trochanteric bursitis? Well, the first clue to look out for is limited range of motion in the legs and throughout the hips. The inflammation that is caused by bursitis can make it difficult to move the hips and legs in any direction. It may be especially difficult even walking for short distances if severely irritated. Any foot contact with the ground while standing or walking will cause the muscles over this bursa to compress it against the bone underneath resulting in pain.
Another warning to look out for is how the hip pain actually progresses. Most often, a person who is suffering from bursitis will first notice a small amount of pain, discomfort, or tightness in the hips. This pain could come and go. The pain can become quite intense at times but ease with movement. However, over time, you may notice it gradually worsen. The pain may last for a few days at a time, weeks, or may even persist for months. When bursitis starts to get worse, the pain becomes more persistent. If proper care is not taken, it can lead to the bursa rupturing, which can cause even more pain and further issues with daily function.
Does your hip have increased warmth to the touch? That’s actually another common symptom of people who are suffering from trochanteric bursitis. Sure, there will be pain around the area (and remember, it does not necessarily need to be JUST the hip - it can be anywhere near the pelvis, inner thigh or lower back), but if you feel a heat emanating from the area, chances are the bursae are inflamed and you are suffering from trochanteric bursitis.
I also find that clients who are suffering from bursitis may have difficulty sleeping. The reason for this is because the pressure from either lying directly on the bursa or the bursa being compressed while lying on the unaffected side as your top affected leg crosses the midline of your body. This may also be caused by different movements during sleep causing you to wake up in the middle of the night. People who tend to sleep on their sides may find that they can no longer sleep on any particular side. They may find that sleeping with their legs in certain positions will either worsen the pain or alleviate the pain.
Why Do Certain People Develop Trochanteric Bursitis?
As a Doctor of Physical Therapy, I’ve had many patients come through my door suffering from trochanteric bursitis. But why do some people develop it while others never have to deal with the pain and discomfort? Well, there are a host of reasons some people are more prone to the condition. In no particular order, some common culprits include:
Previous Injury/surgery
A history of falls or bumping the hip hard against something can cause trochanteric bursitis. In addition, a person is more likely to get trochanteric bursitis if they have had surgery on their hip in the past, including a hip replacement.
Overuse
As mentioned above, people who perform repetitive physical activities can cause inflammation of the bursa sacs in the hip, especially if their musculature and body are not used to tolerating the stresses imparted on it. This is especially true for the endurance athletes out there who are not regularly performing strength training or ramping up their training schedule too significantly or before they are ready.
Poor Posture
Sitting in a curved posture or another poor-posture position (i.e., sitting on one foot crossed under you) can place extra strain on the hips. Posture-related conditions, such as scoliosis, can also cause trochanteric bursiti because of the stress it places on one side versus another.
History of certain chronic diseases
People who have chronic diseases, such as gout, thyroid disease, psoriasis, and rheumatoid arthritis, might be at higher risk of developing trochanteric bursitis.
Weight
Excess weight or obesity can also contribute to trochanteric bursitis if your musculature is not strong enough to support your body size. This is because the excess weight places greater strain on the hip and area around it.
Even (believe it or not!) gender
Women have wider pelvises which place higher levels of stresses on the muscles that stabilize the hip compared to men, creating a greater risk for developing hip conditions. Yup, you guessed it, trochanteric bursitis, but others as well, including IT band syndrome and patellofemoral pain syndrome.
So How Will Physical Therapy Help?
Time and time again, it has been proven that physical therapy is a very effective treatment. One of the best options for overcoming trochanteric bursitis pain is to go through exercises that help to stretch and strengthen the hip. As a trained doctor of physical therapy, I will be able to help teach you proper exercises to do in order to help heal bursitis in the hip. By using hands-on treatment and targeted stretching, you can overcome the pain and regain range of motion in the hips.
I also believe it’s important to improve strength and coordination in the buttock and hip muscles, as this will enable the femur (thigh bone) to move in the socket smoothly and help reduce friction on the bursa. The severity of your pain will determine how many sessions you need but I’ve had patients return to full motion and function in as little as a couple of sessions.
A trained physical therapist will also be able to provide you with education about preventing future episodes of hip pain. There are several strategies to prevent hip bursitis, such as performing daily hip stretches and maintaining lower back and spinal mobility and strength.
If you start to feel your hip pain creeping back in, your physical therapist may have you modify some of your activities. A little bit of relative rest, combined with the right stretches and strengthening exercises, may be the recipe to prevent a full-blown attack of trochanteric bursitis. But the only way to get you on the right path is to begin working with a physical therapist. So if you have pain, what are you waiting for?
Exercises for Trochanteric Bursitis
So what exercises can you do right now to get some relief from the pain? I highly recommend doing some exercises to strengthen your thighs and hips (specifically your glutes) which will help stabilize your hip joint and protect it from injury. The four exercises demonstrated below (by none other by yours truly) are great ways to alleviate pain caused by trochanteric bursitis.
Standing Hip Abduction (can be done with a resistance band or an ankle weight)
Stand with your back straight and your feet facing forward.
Maintain good posture.
Move one leg out to the side until you feel a contraction or strain along the outer side of your hip and leg (should not be painful).
Bring your leg back down to a standing position.
One set of 12 to 15 repetitions is enough for most people.
Complete the exercise with your other leg afterward.
Dr. Rob’s Quick Tip: While doing standing hip abductions, you need to make sure that you’re not leaning too far forward, backward, or to either side. Keep your abdominal muscles tight throughout the exercise.
Lateral Walks with Resistances
Place a loop band around your ankles and stand with your back straight.
Begin exercise by stepping in one direction while facing forward for about 20 feet (or as much room as you have).
Legs should be relatively straight with a slight knee bend and slight forward lean of the torso with your abdominals tight. Simply pick one foot up off the ground and step to the side and then follow with the other foot.
Reverse movement and step in the other direction for 20 feet.
Dr. Rob’s Quick Tip: Don't drag your feet on the ground and don’t sway from side to side. Keep your torso as steady as possible.
Step Ups
Stand tall with or without holding a pair of dumbbells at arm’s length by your sides, and place your left foot on a bench so that your hip, knee, and ankle are all bent 90 degrees or on a step that has more convenient access for you to perform this activity.
Keeping your chest up and shoulders back, push your body up with your leg on the step or bench until it’s straight (keep your right foot elevated).
Pause, and then lower your body back to the starting position under control. Perform equal reps on both legs.
Dr. Rob’s Quick Tip: You might be tempted to only focus on the stepping up part of the move, but you want to also be mindful of how you step down. Make sure to avoid your knee caving inward and dropping onto your non-working leg by lowering your body in a slow and controlled motion.
Goblet Squats
Hold a weight at your chest using both hands and stand with your feet about hip-width apart.
When you're ready to begin, brace your core, then drop your butt back and down to lower into a squat while keeping your chest up.
As you squat, sit back into your heels without shifting your weight forward onto the balls of your feet. Try to get as deep into the squat as possible to maximize glute activation.
Then, driving through your heels, come back up to standing and squeeze your glutes at the top. That's one rep.
Dr. Rob’s Quick Tip: If you have limitations in your ankle mobility, consider raising your heels up one-half to two inches with weight plates or a similar object so that you can squat [more] comfortably, Then, over time, reduce the height of the weight plates until you can do them on the flat ground.
So there you have it folks. If you have questions about any hip pain you are dealing with, please let us know! We would love to assist in any way to make sure you stay active and healthy, and our new North Massapequa clinic will make you feel right at home. To learn more or speak with a Doctor of Physical Therapy, please give us a call at 516-387-0053. You can always email me as well at rberghorn@ascentphysicaltherapyny.com. And if you would like to follow us along as we present more information about different topics related to endurance athletics, please give us a follow on Instagram.