Hip Bursitis

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What Is Hip Bursitis?

If you suffer from pain or tenderness on the outside of your hip that gets worse when walking or running, you may be suffering from hip bursitis.

Hip bursitis is a painful condition that is quite common. It is characterized by the inflammation or irritation of a fluid-filled sac called a bursa. This structure encases the hip joint. In doing so, protects the tendons and muscles that are attached to the hip bone. In addition to the hips, bursitis develops quite often in the elbow and shoulder, but it may also develop in other joints.

There are two major types of hip bursitis: trochanteric bursitis and iliopsoas bursitis.

Trochanteric bursitis is primarily diagnosed in older adults. It is commonly caused by trauma or the degenerative effects from aging. However, differences in prevalence or incidence of trochanteric bursitis based on gender have not been identified.

On the other hand, iliopsoas bursitis occurs when the bursa that is connected to the iliopsoas tendon becomes inflamed. This form of bursitis is common in young adults and adolescents, especially women. It is referred to as the snapping-tendon syndrome. This is due to the abnormal movement of swollen muscles in the hip region that cause snapping which can be felt or heard when the hip flexes.

Hip bursitis video

Hip Bursitis Risk Factors

This condition is usually the result of a serious injury, a work-related accident, or overusing the hip joint. As individuals age, soft tissue that surrounds the hip joint becomes less flexible and durable. Serious injuries and repetitive movements worsen the condition of soft tissue and increase the risk of developing bursitis. Rheumatoid arthritis is another common cause of bursitis as the chronic arthritic inflammation of the hip joint may also cause adjacent structures to begin to swell and become irritated.

In rare instances, bursitis may develop in conjunction with a systemic disease such as a bacterial or fungal infection, tuberculosis, or gout. Diabetes and thyroid disease may lead to the development of bursitis as well. Additional risk factors that increase the incidence of bursitis include:

  • Age
  • Poor posture
  • Overtraining
  • Repetitive activities
  • Gait abnormalities
  • A sedentary lifestyle
  • Inadequate or improper stretching before physical activity

Arthritis of the hip joint

Iliopsoas Bursitis

The two forms of bursitis that have been described above usually have similar causes:

  • Blunt trauma
  • Sports injuries
  • Work-related accidents

Furthermore, wear and tear of the iliopsoas tendon due to repetitive hip movements can also damage the surrounding bursa. When this occurs, tendinitis in the iliopsoas, in addition to bursitis, may occur. This form of bursitis typically develops in individuals who engage in regular activities such as running, resistance training, rowing, and other competitive field and track events.

Symptoms associated with iliopsoas bursitis include the audible snapping of the hip as well as pain in the pelvic region that often radiates into the thighs and knees. Pain may also be experienced while climbing the stairs, putting on shoes in a seated position, and sitting for prolonged periods. The diagnosis of iliopsoas bursitis generally involves a Thomas test, which involves an individual engaging in a snapping-hip maneuver that allows a physician to assess whether a palpable or audible snap is occurring.

hip pain

Trochanteric Bursitis

The second form of bursitis, known as trochanteric bursitis, is typically caused by repeated blunt trauma to the hips or an acute trauma that may occur due to improperly lifting or carrying a heavy load. Trochanteric bursitis is also often referred to as the greater trochanteric pain syndrome because it may occur in conjunction with ischial band syndrome or ischial bursitis and gluteal tendinitis.

Moreover, this form of bursitis is more commonly associated with age-related changes and arthritis than iliopsoas bursitis, but it often resolves on its own over time. Other risk factors that increase the occurrence of trochanteric bursitis include:

  • Starting new exercise routines that are very vigorous
  • Abnormal gait patterns
  • The overuse of the hip joint or repeated strains
  • Rheumatoid arthritis
  • Fibromyalgia
  • Differences in leg length
  • A total hip replacement
  • Lumbar spondylosis

Individuals who develop this type of bursitis often experience palpitations and lateral hip pain when pressure is placed directly on the joint such as while sleeping on one side. The hip joint may also become swollen, stiff, and achy during movement, especially if the hip is extended past the normal range of motion.

In order to diagnose trochanteric bursitis, a physician evaluates possible gait abnormalities and tries to locate the region in the hip where the pain appears to be originating through palpation or by observing the position of the pelvis while the patient shifts body weight from one leg to the next.

Treatments For Hip Bursitis

Rest and refraining from repetitive activities that may be irritating the hip joint is the primary form of treatment that is recommended for hip bursitis. As the pain begins to subside, strengthening exercises and gentle stretching techniques may also be recommended. Gentle stretches may include gluteal stretches and iliotibial band stretches. If cleared by your doctor, hip bursitis exercises may include:

  • Straight leg raise: Lying on your back, bending one knee so the foot rests on the floor, and then lifting your other leg straight off the floor eight inches, for two sets of 16
  • Side leg lift: Lie on your side and lift one leg eight inches off the ground, repeating 16 times for two sets
  • Normal and side planks: These can be done while resting on your forearms, and work up to holding each pose for up to 60 seconds

If your physician suspects that postural problems or a gait abnormality is the underlying cause of the bursitis, then corrective measures will need to be made through a therapeutic regimen such as physical therapy or chiropractic intervention. Physical therapy helps strengthen the muscles in the hips, improves posture, and increases the flexibility of the hip joint, thereby relieving friction and tension on the bursa. Similarly, chiropractic intervention can help correct a gait abnormality, especially if differences in leg length may be contributing to the condition.

Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin may be taken in order to help relieve the inflammation and pain that is associated with hip bursitis.

Hip Bursitis | PainDoctor.com

Interventional pain management 

In more chronic and severe cases where exercise and over-the-counter medications haven’t worked for your hip bursitis, a pain doctor may recommend some interventional pain management strategies for reducing pain. A direct injection of steroids into the hip joint (also called a hip injection) can be used to treat persistent hip bursitis. It is minimally-invasive and provides temporary pain relief, for up to a year. A hip injection is best used in combination with exercise. An injection can give you more pain-free time to resolve the underlying causes of your hip bursitis through exercise or therapy.

If the hip bursitis is unresponsive to different types of treatments, then the damaged bursa may be removed through a surgical procedure. This is called a bursectomy. Additional surgical procedures that may be performed involve removing debris from the hip joint that may be causing irritation or repairing muscle tears. Moreover, the condition of the gluteal tendons can be assessed during surgery. If detachment or degeneration has occurred it can be repaired during the procedure. Surgery is more invasive, however, so it should only be tries after other pain management options have been attempted.

Conclusion

Hip bursitis is a painful, inflammatory ailment that mainly affects adults between the ages of 40 and 60.

Performing a proper warm-up before engaging in vigorous physical activities and gradually starting a new exercise routine can help prevent the occurrence of hip bursitis. Lifting and carrying heavy objects properly and refraining from sitting for extended periods also reduces the incidence of bursitis.

Common treatment approaches include resting temporarily, taking pain relievers, and surgical procedures such as a bursectomy.

If you’re suffering from severe hip bursitis pain, it may be time to talk to a pain doctor to learn what treatments could help you find relief. Click the button below to find a specialized pain doctor in your area.

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References

  1. Crespo M, Pigrau C, Flores X, et al. Tuberculous trochanteric bursitis: report of 5 cases and literature review. Scand J Infect Dis. 2004;36(8):552-558.
  2. Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN. Greater Trochanteric Pain Syndrome Negatively Affects Work, Physical Activity and Quality of Life: A Case Control Study. J Arthroplasty. Nov 5 2013 (Epub ahead of print).
  3. Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med. 1998;25(4):271-283.
  4. Klauser AS, Martinoli C, Tagliafico A, et al. Greater trochanteric pain syndrome. Semin Musculoskelet Radiol. 2013;17(1):43-48.
  5. Roberts WN, Williams RB. Hip pain. Prim Care. 1988;15(4):783-793.
  6. Schmalzried TP. The painful hip: diagnosis and deliverance. J Bone Joint Surg Br. 2012;94(11 Suppl A):55-57.
  7. Toohey AK, LaSalle TL, Martinez S, Polisson RP. Iliopsoas bursitis: clinical features, radiographic findings, and disease associations. Semin Arthritis Rheum. 1990;20(1):41-47.

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