What is hip bursitis?
Hip bursitis is a common condition that we see here in the clinic. A bursa refers to a small jelly like sac that are located in multiple joints around the body. These small sacs are filled with fluid and sit between muscles, tendons and bones and act like a cushion, to lubricate the joints and prevent friction.
Bursitis refers to inflammation of the bursa. When a bursa becomes inflamed, friction free gliding between your muscles, tendons and bones no longer happens, and movement becomes painful.
There are two major bursa’s in the hip, which often become inflamed and irritated. One bursa, covers a bony prominence known as the greater trochanter on the side of the hip. When inflamed, this is called trochanteric bursitis. The second bursa, sits under the hip flexors (iliopsoas) at the front of the upper thigh. When inflamed, this is called iliopsoas bursitis.
What causes bursitis?
Inflammation of a bursa is often a slow process which progressively worsens over time. It can affect anyone, at any time, and often occurs due to excessive friction, overuse, direct trauma or as a result of certain systemic diseases. Bursitis can also be either acute or chronic. Acute bursitis refers to sudden pain due to direct trauma or a sudden workload spike. Pain to touch, stiffness and swelling will occur after a few days. Chronic bursitis refers to prolonged overuse and pressure on the hip. Again, the main symptom will be pain.
Listed below are some common predisposing risk factors which increase the likelihood of developing a hip bursitis;
- Gender: It is much more common in women than men due to structural differences in the shape of the hip and pelvis.
- Obesity.
- Direct trauma or previous hip joint injury.
- Hip osteoarthritis of hip prosthesis.
- Repetitive strain or dysfunction of the surrounding musculature (commonly the gluteal tendons).
- Lumbar spondylosis.
- Iliotibial Band Syndrome.
- Leg length discrepancies.
- Poorly cushioned footwear or over pronated feet.
- Inflammatory diseases (e.g. Rheumatoid arthritis of the hip).
Signs and Symptoms of Bursitis
Diagnosing hip pain can be made via a physiotherapist in the clinic. Assessment will include a review of your history, a physical examination of your hip, pelvis and spine and a review of any goals you would like to achieve.
You may experience one or more of the following symptoms;
- Pain and tenderness around the lateral hip, front of your hip or thigh.
- Pain when sleeping on your side (both affected leg on the bottom and on the top).
- Pain when getting up from a deep chair or after prolonged sitting.
- Pain when ascending stairs.
- Pain in the hip when sitting with legs crossed.
- Increased pain with walking, running, cycling or standing for prolonged periods.
- Associated lower back pain.
Physiotherapy Management
Initially, a physiotherapist will work with you to manage the pain and inflammation. Commonly, this stage of management will include education (self-help, sleeping positions, load management), soft tissue therapy, taping, shockwave therapy, laser and dry needling of surrounding musculature if requested.
Cortisone vs. Shockwave Therapy;
Commonly, clients will often discuss options of cortisone injections to quickly resolve their pain. While cortisone injections do quickly stop the pain, they are a short term fix only. Cortisone injections aim to reduce inflammation and hence pain, however, they also greatly interfere with the natural healing processes. When tissues are damaged, cells of those tissues release chemicals which recruit blood vessels and healing factors. After this, proteins and collagen are laid down to strengthen the tissue. The problem with cortisone is that it acts like a bubble around the injured area, and inhibits cellular recruitment and healing. SO once the cortisone wears off, the problem returns.
Shockwave therapy on the other hand, has proven to be very effective form of treatment. The hand held probe delivers pressure waves and aims to stimulate angiogenesis (new blood vessel formation) and promote protein changes within the tendon to encourage it to become stronger. These changes, combined with a load management and strengthening pathway, have proven to be most effective.
One the pain and inflammation has settled, a physiotherapist will then prescribe a load management and strengthening program. We need to get the tendons and muscles stronger to cope with the demands, however, we have to do it in small increments. Strength takes up to 12 weeks to develop, so a physiotherapist will usually recommend you to participate in body weight or Pilates classes 2-3 times per week. Once we have adequate strength, a graduated program will be made to get you back to doing what you love!
If you have any questions about hip bursitis, the physiotherapists at Back In Motion Como would love to help! Please feel free to contact the clinic!
Website: https://www.backinmotion.com.au/como
Phone Number: 9313 3414