The Truth About Hip “Bursitis”
Lateral hip pain (pain on the side of the hip) is a common complaint in athletes and the elderly. It affects women more than men and occurs in approximately 25% of the female population aged 50-79. Until recently, it was given the term “Trochanteric Bursitis” suggesting that inflammation of the bursa (a small, fluid filled sac that reduces friction between tendon and bone) is the overriding pathology behind the pain. An initial MRI study performed on 24 females with diagnosed “bursitis” showed that only 2 out of the 24 had inflammation of the bursa. 15 of the 24 had a tendinopathy of the Gluteus Medius (degenerative tearing of the gluteal tendons). These findings have been replicated in other studies since and have confirmed that the presence of bursitis in patients with lateral hip pain is insignificant, and in some cases non-existent when compared to the amount of tendon degeneration and tearing. So what we know now is that the “bursitis” can occur as a consequence of a gluteal tendinopathy but is rarely the structure that gives patients the pain. The main cause of the pain is repetitive compression of the tendon against the greater trochanter (the bony bit on the outside of your hip). As this happens, the tendon slowly wears away and creates small tears in the tendon, weakening it and making it very painful to contract, stretch, or compress the tendon. As a result of this change in thinking, the more correct term used now is “Greater Trochanteric Pain Syndrome” (GTPS) which is an umbrella term encompassing the tendon pathology as well as an element of bursitis.
Common complaints related to GTPS
- Pain when lying on the affected side.
- Occasionally pain lying on the opposite side when the affected leg falls down and across the body
- Walking (particularly up stairs and up hills)
- Sitting long periods
- Standing with weight shifted onto one leg.
Treatment
Cortisone injections have been a popular choice in the past for “bursitis”. Cortisone will provide temporary relief for patients that have inflammation of the bursa as part of their condition, however it will not treat the underlying cause of the problem (the tendon) and so in most cases will fail to reduce the pain in the long term.
The latest research suggests that the most effective treatment is a combination of specific gluteal strengthening exercises and strategies to avoid compression of the tendon. Our physios will be able to provide you with all the information you need as well as a graded exercise program to help you reduce pain and eventually return to normal function.
by Andrew Clark
