Hip Pain Due To Trochanteric Bursitis

I am often treating distance runners with complaints of hip pain that leads to an active Trochanteric Bursitis.

First the anatomy: The bursae live under the Iliotibial band and over the Greater Trochanter. You can see in the illustration that the Gluteal muscles insert into the hip and iliotibial band. The role of the Bursae is to act as a lubricator for motion of the ITB (iliotibial band) over the boney prominence of the hip so that there is no deterioration of the ITB during motion.

The ITB is the cause of bursitis in my opinion. Typically, a shortened ITB increases the stress of the bursae and with repetitive tasks, like distance running, the bursae can become inflamed. This is what is referred to as Trochanteric Bursitis.

The Iliotibial Band Syndrome is a companion to Trochanteric Bursitis, and we often see them hand in glove. While ITB syndrome typicall causes pain in the ITB and at the knee, a tight ITB leads to increased pressure on the bursa and often causes it to become inflamed.

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It is easy to see the relationship between the hip and the ITB in this illustration which demonstrates the typical sight of pain at the knee in the case of ITB syndrome.

But even if you do not have a true ITB syndrome, you most probably have a tight ITB that causes excessive friction over the bursae leading to trochanteric bursitis.

We treat the bursitis as follows:

• Ultrasound over the bursae to increase circulation around the bursae
• Occasionally, with a prescription we might employ phonophoresis or iontophoresis - both cortisone delivery mechanisms - to help reduce inflammation.
  
• Ultrasound over the tightened spots of the ITB to soften the ITB
• Myofascial release therapy over the ITB using one of our tools like The Stick for instance. The Stick is also very useful at home. See my earlier blog on the use of The Stick to understand how best to use it
• Ice and Electrical Stim over the bursae to reduce edema and pain
• Orthotics to improve the biomechanics
• Kinesio Tape to lift the skin up over the bursae
• Stretching of the ITB
• Strengthening of the Gluteal muscles
• Introduction of cross training strategies for distance runners (running, cycling an swimming are all unidirectional activities - you need to introduce true cross training - ie lateral and rotational activities.
• We also encourage outpatients to take NSAID's as prescribed - but at least at a therapeutic dose - and to discuss this with their doc if the dose prescribed is less than a therapeutic anti inflammatory dose
  

One consideration for runners is that the knee does not really straighten while running, so flexibility of the hamstrings and of the ITB are important to pay attention to in order to avoid both ITB Syndrome and Trochanteric Bursitis.

You can read more about biomechanics on our website