What is Trochanteric Bursitis?
Trochanteric bursitis is the most common hip bursitis. Bursae (plural for bursa) are small, jelly-like (fluid-filled) cushioning sacs located throughout the body, where tendons pass over areas of bone around the joints. There are more than 150 bursae in the body and they are found around the shoulder, elbow, hip, knee, and heel joints. They are designed to decreased friction between bones and soft tissue, making movement smooth and effortless.
Bursitis is inflammation of the bursa. Trochanteric bursitis is the inflammation of the superficial bursa located between the greater trochanter of the hip (bony prominence in the lateral part of the femur) and the muscles and tendons of the thighs and buttock. This is the most commonly affected bursa and occurs more often in middle age or elderly women than younger people or men. A deep trochanteric bursa lies deeper and can become inflamed in more severe cases.
The hip joint is a ball-and-socket type joint and is formed where the femur (thigh bone) meets the pelvic bone. The hip joint consists of two main parts: the femoral head a ball-shaped piece of bone located at the top of your femur (thigh bone) and the acetabulum, a socket in your pelvis into which the femoral head fits.
The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. The femur has a bony process just outward from the top of the bone known as the greater trochanter. Large ligaments, tendons, and muscles around the hip joint hold the bones in place and keep it from dislocating. The greater trochanter is a point of attachment of several gluteal muscles. The gluteal muscles originate from the pelvis and insert into the top of the femur (thigh bone) overlying the greater trochanter. The gluteal muscles are primarily responsible for moving the hip and stabilizing the pelvis during activity and are particularly active during walking, running, jumping, climbing stairs, lunging and squatting.
Cause of Trochanteric Bursitis
Trochanteric bursitis most commonly occurs due to repetitive or prolonged activities increasing friction over the trochanteric bursa or activities that required repeated twisting or rapid movements. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. The following risk factors have been associated with the development of trochanteric bursitis:
- Repetitive stress/overuse injury such as walking (especially up hill), running, bicycling, jumping, lunging or squatting.
- Prolonged or sustained activities causing pressure over the bursa such as prolonged standing or side lying position.
- Direct trauma to the hip, including falls or sport related impact.
- Weakness of the hip and pelvic muscles, which leads to poor muscle control and biomechanics.
- Joint and muscle stiffness
- Secondary injury associated with other conditions such as spine disease, rheumatoid arthritis, hip osteoarthritis or spine, leg length discrepancy, previous surgery, iliotibial band syndrome, etc.
Signs and Symptoms of Trochanteric Bursitis
- Pain in the outer aspect of the hip, which sometimes radiates to the buttock and down the outside of the thigh
- Pain may worsen at night, especially if lying on the affected hip
- Increased pain during activities such as walking, running, stair climbing, prolonged sitting, getting in and out of the car and cross-legged position
- Tenderness to touch over greater trochanter area
- Swelling around greater trochanter (outer aspect of hip)
- In severe cases, decreased lower extremity strength
Our Physiotherapy Approach for Trochanteric Bursitis
Step 1 – Thorough History & Assessment
The key to an effective treatment plan is to have the correct diagnosis. We start every management plan with a thorough history of your condition followed by a physical exam to ensure the correct diagnosis is made. We also rule out any medical condition for which further evaluation may be required. Then we determine if a referral to your doctor, orthopedic specialist or the need to get further testing is needed, such as an x-ray prior to treatment. Next, we discuss our findings and treatment options and together decide on a treatment plan. Once this is agreed upon, treatment typically starts on the first visit.
Step 2 – Pain Management and Decrease Swelling
Managing pain and swelling is usually the primary goal for patients with trochanteric bursitis. To help with this, we will choose the most appropriate from a variety of modalities. These modalities may include electrotherapy (interferential current, TENS), cold therapy, anatomical acupuncture and manual techniques to help improve your pain.
Step 3 – Restoring Range of Motion and Strength
Increasing range of motion and strength is an important part of the rehabilitation process and crucial in reducing the risk of future injuries. Manual therapy techniques (passive range of motion, joint mobilization, muscle energy technique, and facilitation techniques) in addition to an exercise routine (including stretching and range of motion exercises) will help you to restore hip flexibility and range of motion. Also, an individualized strengthening exercise program, targeting specific muscles will help to increase your strength, balance and overall function.
Step 4 – Restoring Function And Providing Walking Aids
Some patients with trochanteric bursitis will experience difficulty with certain activities, such as walking, sitting-to-standing, climbing stairs and running. Restoring function is the ultimate goal of the physiotherapy treatment. As part of your rehabilitation process, a functional exercise program is designed to help you improve your function and facilitate your daily activities.
When rest, medications, and physiotherapy do not relieve your pain, your physiotherapist may recommend to follow-up with your doctor to discuss other treatment options. An injection of a local anesthetic and/or a cortisone preparation may be helpful. Therapeutic injections (lidocaine plus a corticosteroid) are useful both because they are therapeutic and also because they can help the physician differentiate trochanteric bursitis from other problems.
Step 5 – Education and Self-Management
We believe that good communication and education is crucial in achieving positive outcomes. We educate our patients on their conditions, what to expect, and give you the proper tools to help with your recovery from home.
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“My first meeting with Dr. Nick helped to put the pain in context. Finally, an explanation and some real answers.”
– Jeff Smith, Sackville, NS