Hip Bursitis is inflammation of a fluid filled or gel like cushion on the head of the femur, on the outside of the hip, mainly causing pain when lying on your side. A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. “Bursae” is the plural form of “bursa.” When a bursa becomes inflamed, the condition is known as “bursitis.”
Hip bursitis is inflammation that affects this a fluid filled sac or cushion (bursa) over the a bony point at the side of your hip. This condition occurs when the bursa becomes irritated, compressed or infected.
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How does this Bursitis happen?
A Bursa is a gel-like, fluid filled sack that normally prevents muscles or tendons that slide over a bony part to allow smooth movement over the bone, so basically they prevent friction between a muscle or tendon and that must slide over a piece of bone.
When the bursa becomes swollen, the muscle’s normal movement gets limited and painful when you contract them. Repetitive scraping of the muscle or tendon onto the bursa causes the bursa to stay swollen and has a very definite pain when pressed on, like lying on your side.
2 Bursae in your hip
There are two major bursae of the hip, the trochanteric bursa and the ischial bursa. These are cover the bone on either side of the femur (thighbone) and pelvic bone. The bursa deep to the Gluteus maximus muscle is called the Trachanteric Bursa, the main culprit that becomes inflamed causing a bursitis in the hip.
Sports that involve a lot of running, twisting, changes of direction when your full weight is on the leg such as hockey, cycling, running and athletics. These sports will cause repetitive friction between the bony edge of the femur called the greater trochanter and the gluteus maximus muscle.
Stiffness around the hip is a big contributor to develop a bursitis due to already tight and limited movement of the muscle or tendons to slid over the femur. Risk factors for hip bursitis include activities that could strain the hip area, including going up and down stairs, repetitive activities such as stair-climber exercising, etc.
With repetitive movements at maximum contraction this fluid filled sack become inflamed and swollen. Other bio-mechanical abnormalities such as unequal leg length may also increase the likelihood of developing a hip bursitis.
Symptoms of a Bursitis in your Hip
You may feel some tenderness over the bony point at the upper part of your hip and pain running across the outside of your hip or down the outer part of your thigh. You may also feel some swelling in the area around the bursa.
Pain on the outer part of your hip and thigh, making it difficult to lie on your side, this frequently causes it to be difficult to sleep. Trochanteric bursitis also causes a dull, burning pain on the outer hip and thigh that is made worse with excessive walking, exercise, or stair climbing. Iliotibial band syndrome is ussually associated with trochanteric bursitis. Lying directly on the painful side will make the pain worse. Bending or extending your hips during walking may cause a burning ache, and pains at the top and side of your hip.
The ischial bursa is located in the upper buttock area. Ischial bursitis cause dull pain just under the fold of your butt, that is most noticeable when climbing up stairs. The pain sometimes occurs after sitting on hard surfaces for a long time.
Hip Bursitis: Diagnosis
Physiotherapists will be able to diagnose your condition through physical examination and recommend an ultrasound (diagnostic sonar) to confirm the diagnosis, but in most cases a bursitis improves quickly with treatment, without any expensive tests.
In all but the extreme cases of Trochanteric bursitis, you should recover quickly and be able to return to sport 2 weeks after you have followed the prescribed treatment protocol from the physio. In some cases, patients opt for surgery to remove the bursa (This we would never recommend). If you had surgery you should be fully fit within 6 – 8 weeks.
If you think you may have a Hip bursitis you should:
- Stop any activity that causes pain
- Apply ice
- Call us to set up an appointment
If you are diagnosed with a trochanteric bursitis your physio will recommend to continue to rest and avoid any activities that may inflame your bursa. In severe cases we will recommend that you consult with your GP to prescribe pain relief medications.
The physiotherapist treatment plays a vital role to relieve your pain, restore the normal slide of the tendon and muscle over the bursa and strengthen the surrounding hip muscles.
There are various other causes of your hip pain that we need to test and exclude to confirm your diagnosis:
- The movements from your ankle, knee and hip (how they interact with each other)
- Lumbar and Sacral vertebrae
- Pelvis (forwards and backwards tilt)
- Muscles surrounding the hip joint
- Core muscle control and pelvic floor muscles
- All the thigh muscles that attach onto the Femur (Quadriceps, Hamstrings, Adductors)
- The Sciatic and Femoral nerves
- The articular surface of the Ball and socket joint of your hips
Physiotherapist will use various treatments such as electrotherapy to do to reduce local inflammation.
Research has proven good results using extracorporeal shockwave treatment (ETS) in which sound waves are directed at the bursa, to speed up the healing process and we assess the intensity & duration of your training and modify these accordingly.
We analyse your biomechanical movement of your foot, ankle, knee and hip in order to pick up on any asymmetry or imbalances. A full biomechanical assessment of your foot and ankle will show if you need insoles or orthotics to support the medial arch. (Correct footwear prescription)
You may begin:
- Self massage of your hip with a hard Foam Roller.
- Exercises to activate and strengthen your gluteal muscles, as your pain allows.
You should be able to:
- Walk without pain.
- We will assess your single vertical and horizontal hops and adopted crossover hopes to establish a Baseline score.
- Transfer of forces to the surrounding muscles in your hip to prevent it from coming back.
If your hip bursitis fails to respond to rest and physiotherapy treatment
You may be referred to your GP for local injections anesthetics or corticosteroids into the bursa.
If all other treatments have failed as a last resort your therapist may recommend surgery to remove the bursa. The orthopaedic surgeon will advise you to use crutches for up to 2 weeks after the surgery and refer you for a physiotherapy rehabilitation program.
Other Causes of Hip pain
- Joint – Hip joint pain, Labrum tear, Osteoarthritis of the Hip joint
- Muscles – Gluteus muscle strain, Quadriceps muscle tear, Groin muscle tear, Hamstring muscle tear
- Tendons – Quadriceps tendinitis, Gluteal tendinitis, Hamstring tendinitis
- Bursa – Hip Bursitis
- Ligaments – Inguinal ligament sprain
- Nerve- Pinched Sciatic nerve over the hip
- Bone – Femur Fractures, Avultion fractures or Stress fracture of Femur Head
- Iliotibial band