Understanding Trochanteric Bursitis

Trochanteric bursitis, also known as greater trochanteric pain syndrome, is a common condition characterized by pain and inflammation in the outer part of the hip. This condition can affect individuals of any age but is most prevalent among middle-aged or older adults, especially women. Physical therapy plays a crucial role in managing and recovering from this condition.

Here, we’ll delve into the symptoms, causes, diagnosis, treatment options, and detailed physical therapy interventions for trochanteric bursitis, including step-by-step exercises.

What is Trochanteric Bursitis?

Trochanteric bursitis occurs when the bursa, a small fluid-filled sac located on the outer part of the hip (the greater trochanter), becomes inflamed. This bursa acts as a cushion to reduce friction between the hip bone and surrounding soft tissues. When it becomes irritated or inflamed, it results in significant discomfort and pain.

Symptoms of Trochanteric Bursitis

The primary symptom of trochanteric bursitis is pain in the outer hip and thigh area. This pain can range from sharp and intense to dull and aching, often exacerbated by activities such as:

• Walking or running
• Climbing stairs
• Lying on the affected side
• Standing up from a seated position
• Prolonged standing

Pain may also radiate down the thigh to the knee, and the affected area may become tender to the touch.

Causes and Risk Factors

Several factors can contribute to the development of trochanteric bursitis, including:

1. Repetitive Stress: Activities involving repetitive hip movements (e.g., running, cycling) can irritate the bursa.
2. Injury: Direct trauma to the hip, such as a fall, can cause bursitis.
3. Overuse: Prolonged standing or walking can lead to inflammation.
4. Poor Posture: Improper posture or gait increases stress on the hip bursa.
5. Underlying Conditions: Rheumatoid arthritis, osteoarthritis, or previous hip surgery can elevate the risk.
6. Muscle Imbalances: Weak or tight hip muscles can alter hip mechanics, contributing to bursitis.

Diagnosis

A healthcare provider can diagnose trochanteric bursitis through a combination of medical history, physical examination, and diagnostic tests. During the physical examination, the doctor will look for tenderness over the greater trochanter and may perform specific movements to reproduce pain. Imaging tests such as X-rays, ultrasound, or MRI may be used to rule out other conditions like fractures or hip osteoarthritis.

Aggravating and Alleviating Factors

Aggravating Factors:

• Activities that involve repetitive hip movements, like running or cycling.
• Prolonged standing or walking.
• Direct pressure on the hip, such as lying on the affected side.

Alleviating Factors:

• Rest and avoidance of activities that exacerbate symptoms.
• Ice application to reduce inflammation.
• Pain relief medications.
• Stretching and strengthening exercises under the guidance of a physical therapist.

The Role of Physical Therapy in Treating Trochanteric Bursitis

Physical therapy is a cornerstone in the treatment of trochanteric bursitis. A physical therapist (PT) will design a comprehensive treatment plan to reduce pain, improve hip function, and prevent recurrence. Here’s a detailed look at the role of physical therapy:

1. Assessment and Diagnosis:
   • A PT will conduct a thorough assessment, including a physical examination and a review of the patient’s medical history.
   • Specific tests may be performed to reproduce pain and assess hip range of motion.
2. Pain Management:
   • Initial treatment focuses on reducing pain and inflammation using modalities such as ice therapy, ultrasound, or electrical stimulation.
   • Pain relief strategies may also include manual therapy techniques like soft tissue mobilization and gentle stretching.
3. Strengthening and Flexibility Exercises:
   • Strengthening exercises target the hip abductors, extensors, and core muscles to improve stability and support for the hip joint.
   • Flexibility exercises help in relieving tightness in the iliotibial band, hip flexors, and gluteal muscles.
4. Gait and Posture Training:
   • PTs provide guidance on improving posture and gait mechanics to reduce stress on the hip.
   • Customized orthotics or footwear recommendations may be made to address underlying biomechanical issues.
5. Education and Prevention:
   • Patients are educated on activity modification to avoid exacerbating symptoms.
   • PTs offer advice on ergonomic adjustments for daily activities and work environments.

Step-by-Step Exercises for Trochanteric Bursitis

Here are some key exercises that a physical therapist might include in a treatment plan, with step-by-step instructions:

1. Hip Abductor Strengthening (Side-Lying Leg Lifts):
   • Step 1: Lie on your unaffected side, keeping your legs straight.
   • Step 2: Slowly raise your top leg to about 45 degrees.
   • Step 3: Hold for 2-3 seconds, then slowly lower it back down.
   • Step 4: Repeat 10-15 times, for 2-3 sets.
2. Clamshells:
   • Step 1: Lie on your unaffected side with knees bent at a 90-degree angle.
   • Step 2: Keep your feet together and lift your top knee as high as possible without moving your pelvis.
   • Step 3: Hold for 2-3 seconds, then lower your knee back down.
   • Step 4: Repeat 10-15 times, for 2-3 sets.
3. Bridges:
   • Step 1: Lie on your back with your knees bent and feet flat on the floor.
   • Step 2: Raise your hips towards the ceiling, squeezing your glutes and core.
   • Step 3: Hold for 5 seconds, then lower your hips back down slowly.
   • Step 4: Repeat 10-15 times, for 2-3 sets.
4. Iliotibial Band Stretch:
   • Step 1: Stand upright and cross your unaffected leg behind your affected leg.
   • Step 2: Lean towards your unaffected side until you feel a stretch along the outer hip and thigh of the affected side.
   • Step 3: Hold the stretch for 20-30 seconds.
   • Step 4: Repeat 2-3 times.
5. Hip Flexor Stretch:
   • Step 1: Kneel on your affected leg, with the other leg bent in front of you at a 90-degree angle.
   • Step 2: Push your hips forward until you feel a stretch in the front of your hip.
   • Step 3: Hold for 20-30 seconds.
   • Step 4: Repeat 2-3 times.

Treatment Options

In addition to physical therapy, other treatment options include:

1. Medications: Over-the-counter pain relievers such as ibuprofen or naproxen can help alleviate pain and reduce inflammation.
2. Corticosteroid Injections: In some cases, corticosteroid injections may be recommended to provide temporary relief from pain and inflammation.
3. Assistive Devices: Using a cane or crutches can help reduce stress on the hip during the healing process.
4. Surgical Intervention: Rarely, if conservative treatments fail, surgery may be considered to remove the inflamed bursa.

Prevention

To prevent trochanteric bursitis, consider the following tips:

• Maintain a Healthy Weight: Excess weight can put additional stress on the hips.
• Exercise Regularly: Engage in regular exercise to strengthen the hip muscles and maintain flexibility.
• Warm Up and Stretch: Always warm up before exercise and incorporate stretching into your routine to prevent muscle imbalances.
• Wear Proper Footwear: Choose supportive shoes that provide adequate cushioning and support during activities.
• Modify Activities: Avoid repetitive hip movements and take breaks to prevent overuse.

Conclusion

Trochanteric bursitis can be effectively managed with a comprehensive physical therapy program. By addressing pain, improving muscle strength and flexibility, and correcting biomechanical issues, physical therapists play a crucial role in the recovery and prevention of this condition. If you experience persistent hip pain, consult a healthcare professional for an accurate diagnosis and a tailored treatment plan.

For more information or to schedule a consultation, contact our physical therapy team today. We’re here to help you achieve optimal hip health and overall well-being.

References

1. Kluge, R., et al. (2017). “Greater trochanteric pain syndrome: A review of diagnosis and management in general practice.” British Journal of General Practice, 67(663), e438-e439.
2. Segal, N. A., et al. (2016). “Greater trochanteric pain syndrome: Epidemiology and associated factors.” Archives of Physical Medicine and Rehabilitation, 87(3), 328-334.
3. Reid, D. (2016). “The management of greater trochanteric pain syndrome: A systematic literature review.” Journal of Orthopaedic Surgery and Research, 11(1), 1-8.
4. Tortolani, P. J., et al. (2002). “Greater trochanteric pain syndrome in active adults.” American Journal of Orthopedics, 31(9), 484-489.
5. Lustenberger, D. P., et al. (2011). “Greater trochanteric pain syndrome: Evaluation and management.” Journal of the American Academy of Orthopaedic Surgeons,