Is the pain in your hip more than bursitis?

That nagging ache on the side of your hip – often quickly labeled "bursitis" – might be telling a more complex story than you think. While inflammation can certainly play a role, understanding the intricate anatomy of the hip joint; from the prominent greater trochanter and the gluteal muscles holding all the pelvic and hip structures in place, to the often-implicated bursa; is the first step in truly addressing this discomfort. This blog will delve into the common misconceptions surrounding lateral hip pain, shedding light on the emerging research that points towards gluteal tendinopathy as a more frequent culprit, and empower you with practical strategies to modify your daily activities and take a more active approach towards lasting relief. So let’s dive in!

Anatomy of the Hip

Let’s break this down by starting with the anatomy of the hip joint. The outside portion of your hip, which has a bony prominence, is known as the greater trochanter. This is actually part of the femur (thigh bone) and serves as an attachment site for multiple muscles, including the gluteus medius and minimus. The action of these two muscles are primarily for moving the leg away from midline (hip abduction) while not standing on the leg. These muscles also help to stabilize the pelvis while in a standing position. More superficially, or closer to the skin, lies the tensor fascia latae and gluteus maximus muscles, which both attach into the Iliotibial band (IT band). This IT band runs from the pelvis all the way down to the outside of the knee and is a very thick band of tissue. Lastly, let’s talk about the bursa, which is a fluid filled sac that provides padding for these muscles over the bone, to cushion the tissues and decrease friction. There are several bursa located throughout the body, all with the intent to provide protection over boney points, all through the body that stick out.

Trochanteric Bursitis Diagnosis

Understanding the anatomy in this area can help in defining trochanteric bursitis as well as helping patients in their comprehension of an appropriate rehabilitation program. However, many individuals associate their symptoms of “lateral hip pain” directly to the word “bursitis” based on what they’ve heard, been told, or read. Sometimes when hearing the suffix –itis, we tend to think the best course of treatment would be ice, rest and possibly anti-inflammatories due to the inflammation and irritation in the area. While trochanteric bursitis very well could be the case, research has shown that the majority of lateral hip pain is actually associated with gluteus medius pathology.  More specifically, gluteus medius tendinopathy (i.e tendon  injury) was found to be more common in patients with symptomatic lateral hip pain rather than bursitis. 

What does all this mean?

While inflammation to this area could still be present or even a contributing factor to lateral hip pain, this is not typically the primary driver of symptoms. Therefore, using the term hip bursitis shouldn’t be something we should just throw out there when our patients have lateral hip pain. The reason for this is to help shift our mindset and guide a treatment in which we take more of an active approach. For example, just as I spoke about earlier, if we assume that our symptoms are strictly due to inflammation, we tend to take a passive approach. However, if we treat these symptoms like a tendinopathy, meaning we manage the load to the area as needed, then we place ourselves back in control of our treatment.  Although an injury can be due to inflammation, what is the root cause of that inflammation? That is the key to understanding and providing a proper treatment approach.

Now, let’s talk about what this looks like.

How can I modify my activity to decrease this pain?

Consider the following to potentially help reduce the amount of hip pain caused by the load that the gluteal tendons place on the hip and build up their capacity so that these muscles can handle higher loads over time:

• Sleeping: If you are a side sleeper, make sure to lay on your unaffected side. You could also try and place a pillow or two between your legs to help even up your legs so that they are more in line with your hips.

• Sitting: Keep yourself from sitting cross legged or in a deeply flexed position for extended periods of times. If you are driving think about your leg positions. Are your knees above your hips? This places you in a flexed position for an extended period and the best way to fix this is to sit on a pillow, or if your vehicle is able, adjust your seat accordingly.

• Stretching: Temporarily avoid stretching the muscles that are known to place friction on the hip such as the piriformis and ITB stretches. It’s possible that these stretches may contribute to pain symptoms, and stretching may just intensify that pressure and pain.

• Standing: Be mindful of your standing posture and try to reduce the time you spend “standing” on one leg (i.e. leaning to one side with the hip out as if you are holding a baby on the hip). As in, no more passively resting on just one side for extended periods.

• Walking: If you are someone that tracks your steps, take note of your tolerable baseline of steps before symptoms arise then build up your steps over time. Walking is good exercise, but walking to the point of pain is not helpful and will only irritate the symptoms.

• Stairs: The tendons around the hip need to be offloaded to help heal the tendinopathy. If you use the handrail on the opposite side of your affected hip when going up or down stairs, this will help to reduce that load.

  
  

  

What does the physical therapy treatment approach look like?

When a patient comes in for treatment of lateral hip pain, they will typically have bilateral (both sides) weakness through their hip abductors, as well as compensations overtime causing an altered walking patter. Physical therapy can help build an exercise program to help strengthen these muscles and normalize the gait pattern to where the patient can progress to single leg and weight bearing exercises, and help restore their function. If a patient continues with their home exercise program as prescribed and continue to consistently make progress week by week, their symptoms can resolve as soon as 2-3 months after PT has begun. The main goal of physical therapy is to stabilize the hip and pelvic joints and restore patient’s function to allow them to return to their normal life. This can vary from patient to patient and the treatment plan will adjust to these variances in order to meet each individual’s goals.

Give the Physical Therapy Specialty Center a call if you are experiencing any of these symptoms or have been diagnosed with hip bursitis and would like to take an active role in getting back to the things you love without hip pain.