You’ve just been diagnosed with hip bursitis. You might be thinking,
“what is it?” “How did I get it?” “How is
it treated?” “Can I still exercise?!”
We sat down with Dr. Travis Scudday, an orthopedic surgeon at Hoag Orthopedic
Institute, to learn all about hip bursitis.
Q: What is hip bursitis?
A: Hip bursitis is inflammation of the bursae around the greater trochanter,
commonly referred to greater trochanteric bursitis. A bursa in common
terms is a fluid filled sac. It is a collection of tissue that provides
lubrication usually at a bony prominence and glides over a tendon or muscle.
It is designed to try to reduce friction over the bony prominence.
Q: How does it develop?
A: Greater trochanteric bursitis involves bursal inflammation of the muscles
and tendons as they glide past the greater trochanter. It is thought to
be an overuse condition caused by increased friction of the Iliotibial
band over the greater trochanter. This can be due to trauma, overuse,
or a change in gait mechanics. It is more common in females than males
and usually occurs between the fourth and sixth decades of life.
Q: How is bursitis of the hip diagnosed?
A: Classically hip bursitis is diagnosed by a history and physical examination.
The history should include the patient's age, chief complaint, symptom
onset, duration, course, aggravating/relieving factors, and any previous
treatment. Lateral sided pain that is worse with direct palpation, single
leg gait, resisted hip abduction and the inability to lay on the affected
side are the most common complaints. More recently MRI has become more
prevalent. This will show fluid and inflammation underneath the iliotibial
band (IT) and gluteus maximus next to the greater trochanter.
Q: How is it treated?
A: Current treatment options for greater trochanteric bursitis consists of
anti-inflammatory medications, physical therapy and corticosteroid injections.
Non-steroidal anti-inflammatories are usually the first line of treatment.
These medications such as ibuprofen and Naprosyn decrease the inflammation
around the greater trochanter. In addition to the medications, a home
stretching regimen will often be prescribed. This should include stretching
of the IT band and hip abductors specifically. If a home program fails,
often formal physical therapy consisting of stretching, rolling, strengthening
and sometimes ultrasound of the hip is useful. The last option of nonoperative
treatment is a corticosteroid injection. This attempts to reduce the inflammation
directly over the greater trochanter. They will usually improve the pain,
but it may return once the steroid wears off. Finally, in very rare cases,
surgical intervention is necessary to remove the bursa and sometimes the
IT band as well.
Q: Is physical therapy part of the treatment protocol?
A: Yes, formal physical therapy is often prescribed after a good home program
has been attempted.
Q: What exercises are best for someone with bursitis?
A: During the beginning stages of the disease hip abduction exercises and
excessive adduction stretches should be avoided. Gluteus maximus and lumbopelvic
exercises should be the focus. As this improves hip abductor strengthening
and finally IT band stretching should be added in. Each physical therapy
program should be specifically tailored to the individual patient with
the goals of the patient in mind.
Q: Are there exercises someone with bursitis of the hip should avoid?
A: General overuse with excessive hip abduction should be avoided once diagnoses
with greater trochanteric bursitis. Walking on uneven surfaces puts undue
pressure on the muscles surrounding the hip and should be avoided until
the pain begins to improve. As a simple rule when first diagnoses with
bursitis pain should be your guide and once the program begins working
you can reincorporate the more painful exercises into the workout routine.
About Dr. Travis Scudday
Dr. Travis Scudday specializes in hip and knee replacement, fractures of
the upper and lower extremities, and arthritis of the hip and knee. Dr.
Scudday is an active member of the American Academy of Orthopedic Surgeons,
California Orthopedic Association and American Association of Hip and
Knee Surgeons. He has been actively involved in community outreach and
completed a medical mission to the Dominican Republic where he performed
pediatric orthopedic surgery and community education.