Hip pain and bursitis

Lateral (outer side) hip pain is all too common and leaves many people with questions about how it happened, how to avoid it, and what to do about it. One of the many diagnoses of lateral hip pain is bursitis. There are 3 distinct bursa in the hip region but the greater trochanter bursa causes pain in this specific region. How does this occur and what to do? Less common causes are a direct fall onto the outside of the hip which results in swelling and tissue damage.  Early intervention of anti-inflammatory modalities, gentle stretching and gentle exercise can help minimize long term issues. Back issues can lead to bursitis because of nerve impingement and/or abnormal range of motion. However, most often this pain comes from a chronic disuse of muscles supporting the hip, sacroiliac joint, low back and knee. Abnormal friction over the bursa by tendon attachments causes swelling inside the bursa and in the tendons. It is not uncommon for Magnetic Resonance Imaging (MRI) to show “gluteal tendonopathy” as well. This means that the gluteal tendon does not appear to be strong and healthy. Treatments such as cortisone injections into the bursa are commonly performed by physicians but the actual cause of the bursitis must be addressed. Your Physical Therapist should perform a thorough gait assessment which tells so much about muscle compensation and functional mobility of the whole lower quarter. A detailed evaluation of the back, and lower quarter (even the foot/ankle!) often guides us to the primary problem so it can be addressed appropriately the first time. Your Physical Therapist will help rule out some other structures that can result in outer hip pain-a nerve from the back, certain muscles in the hip and back, the hip labrum, sacroiliac joint, and even viscera (ie. kidney).

 

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