Hip Pain Bursitis
What is Trochanteric bursitis?
Trochanteric Bursitis is just one common type of Bursitis and one possible reason for hip pain. However, there are many other reasons that one might experience hip pain. Hip joints are relatively solid and simple ball and socket joints in many respects, though they are weight-bearing joints. Hips mobility is required for most activities and in many types of sport. Sports injuries affecting the hip can easily lead to symptoms of hip bursitis and other conditions. As with most things, the more complicated something is, the more there is to go wrong. For example, the shoulders joint complex consists of many joints and a wide variety of muscles and other structures, meaning there is a lot that can go wrong. The complicated nature of the shoulder probably explains why there are so many types of shoulder injuries, including subacromial bursitis.
Image of Left Hip and Trochanteric Bursa (highlighted)
Images produced with kind permission of 3d4medical.com from Essential Anatomy 5
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Bursitis involves inflammation of bursae, which are small fluid-filled sacs and individually named. Trochanteric bursitis is simply an inflammation of the trochanteric hip bursa. Bursae exist between bone and soft tissue structures in areas of high friction. The presents of bursae reduce frictional forces during movement. When a bursa becomes inflamed, it presses on the surrounding tissues, often restricting mobility and creating myofascial pain. As bursae exist in high friction force areas, inflammation will compound such forces. Equally, most types of activity involve the hip joints, and it is relatively easy to irritate tissues, increasing the levels of inflammation within and around the affected bursa.
Possible Hip Bursitis causes
There are generally three reasons for experiencing hip bursitis pain:-
- Trauma - Typically treatable with MSK Therapy techniques once out of acute phase.
- Gradual onset - Typically treatable with MSK Therapy techniques.
- Infection - Requires Medical assistance and prescribed medication.
Falls are a prevalent type of trauma involving the hip and often lead to the trochanteric head of the femur taking the brunt of the falling force. Such a fall will likely squash the soft tissues and trochanteric bursa between the trochanteric head and the ground. As with most traumas, one is likely to notice a lot of swelling, bruising and pain at the time of the injury. Research has also shown associations between trauma, myofascial trigger point formation and associated pain. Injury severity often dictates how long swelling and bruising remain, usually a few weeks and sometimes longer. Issues such as Trochanteric bursitis may not be noticeable at the time of injury due to the other associated pain and trauma. However, as time progresses and healing takes place, hip mobility and pain may persist. The initial injury and subsequent soft tissue repair can alter biomechanics (see related articles section). Bodily movement adaptations can aid soft tissue repair caused by trauma, though they can often irritate other tissues and structures. Hence, all the bruising may heal without problems, yet the changes in applied forces prevent the bursa from healing correctly.
Gradual onset hip pain
Changes in Biomechanics can occur for many reasons, including previous and unresolved injuries or alterations due to habitual behaviours (habits). Such factors relate to the kinetic chain and the forces applied to various tissues and joint structures within the body. Most activities involve hip joint motion, even going from sitting to standing. Loads are typically distributed evenly through the relevant structural components if the hip joint moves correctly. Forces through the hip joint can differ due to small changes affecting the hip joint ball and socket position. Such changes may directly or indirectly impact hip mechanics, mobility and the kinetic chain. For example, structural issues involving the hip joint itself would affect mobility. Equally, soft tissues and fascia could have a functional impact on hip mobility. Bursa can become inflamed due to increased loads (friction), which tend to become more noticeable with repetitive motions and time.
Infection of bursa
Bursa can become infected for a variety of reasons. Such infections require professional medical attention due to the possible viral or bacterial infection. No amount of MSK therapy or other manual therapy will resolve such cases, as they will likely require prescribed medication. MSK therapy can help reduce mechanical loading to the inflamed bursa, soft tissue adaptions and resulting changes in movement patterns. However, MSK therapy will only be successful if a medical doctor treats the underlying infection. Hence, the best results often require a multidisciplinary approach.
Typical Hip Pain Bursitis Symptoms
Trochanteric bursitis usually involves pain and tenderness around the lateral and posterior aspects of the greater trochanter (commonly viewed as the hip by the general public). Symptoms are often worse first thing in the morning and then appear to improve a bit with movement, only to get worse again later. Also, it tends to be uncomfortable to side-sleep on the affected hip. Distance runners often present with Hip Bursitis symptoms, though other conditions may have similar symptoms. Sometimes, hip-related conditions may produce back pain or even upper leg and knee pain [link]. Another condition that may feel similar to hip bursitis or contribute to it is Iliotibial Band Syndrome (ITBS). Many runners will have undoubtedly experienced Iliotibial Band issues or "snapping hip" symptoms.
Treatment for Trochanteric Bursitis (Hip Bursitis)
As with other types of bursitis, trochanteric bursitis tends to be easily treatable. Identifying the reason for symptoms of the problem is key to effective treatment. Otherwise, the condition tends to get continually irritated and gradually worse. It is quite common to see "chronic" cases of hip bursitis in an MSK therapy clinic. People may often think that such problems will resolve naturally or manage/mask the symptoms with pain killers. Hence, symptoms may have existed for months before seeking any hands-on treatment. Once a condition has become chronic (over three months), it can often prove slightly harder to resolve. Chronic or Persistent Pain creates changes in how one moves, resulting in soft tissue adaptations and subconsciously learnt movement patterns. Hence, in chronic cases, one has to address the original injury, the soft tissue adaptations and re-learning of correct movement patterns. Hands-on treatment works extremely well at addressing soft tissue adaptations due to the original injury and changed movement patterns. Prescriptive exercises aim to build on the positive changes made during hands-on treatment. Prescribed exercises are useful for strengthening and stretching soft tissue structures and developing correct movement patterns. Hence, the importance of completing any assigned prescriptive exercises cannot be understated. The type of prescriptive exercise given will depend on the desired outcome, and exercises can change according to stages of progress.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
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About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.
The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.