Hip bursitis or trochanteric bursitis is a very common cause of pain on the outside the hip! Now medically known as greater trochanteric pain syndrome (GTPS) it is most prevalent in 40-60 year old women and has a strong correlation with obesity.
GTPS involves gluteal tendinopathy +/- bursal irritation around the hip bone. It was originally thought that bursitis was seen as the main pain source. Recent studies have now found that the swelling around the bursitis rather exists because of gluteal tendinopathy. Therefore managing the tendon load should take priority over all treatment.
Causes:
- Overuse or increase stress on the hip after periods of rest: i.e. long walks, long periods of standing
- Acute injury such as falling onto the outside of the hip
- Medical conditions such as infection (rare)
Symptoms:
- Typically involve pain with:
Lying directly over the affected hip
Prolonged sitting
Climbing stairs and hills
High impact exercise
- Stiffness through the joint
- Click/catching sensation
The research encourages non-surgical rehabilitation as the first line of treatment.
Goals of rehab include:
Activity modification / load monitoring. Tendons respond to different loads (amount/stress of activity). As mentioned earlier, GTPS is rehabilitated by targeting the tendon.
Reduce irritability and compression of the structures around the hip. This is done through monitoring postures, positions and general activity. As a general rule, tips include:
Sitting with crossed legs
Sitting on low chairs (use pillows to make it taller if needed)
Do not lie on the sore side
If lying on the opposite side put a pillow between your legs
Strengthening of the gluteal muscles. In particular the gluteus medius and minimus muscles. These muscles play an important role in hip stability and single leg control.
Losing weight and optimising general health
Adjuncts to physiotherapy may include corticosteroid injections and shockwave therapy. It is recommended that these are used as a second line intervention after trailing physio rehab as they have limited evidence for the long term!
For (very) rare cases that don't respond to Physio, surgery can be explored. Visit your physiotherapist to chat about your treatment options and to ensure your diagnosis is clear!
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