Hip bursitis debunked

Oh yes, hip bursitis...that once was my worst enemy....

The hip is the body's second most mobile joint. And it is also a large one.

There are many rather complex structures surrounding the hip joint, which makes it more prone to overuse, injuries and aliments such as bursitis and tendonitis.

Types of hip bursitis

In fact, there are 18 bursae around the hip joint. Out of those, 3 are the most commonly affected by bursitis:

  1. Trochanteric
  2. Ischial / ischio-gluteal
  3. Iliopectineal / iliopsoas

Trochanteric bursitis

If you move your hand along the side of your hip, you can feel a bony knob that sticks out (= the trochanter of the femur thigh bone), which is a point of attachment of several gluteal muscles originating from the pelvis. There is also a large tendon that passes over this bony bump.

These muscles and tendons are lubricated by trochanteric bursa.

Trochanteric bursitis often occurs in avid walkers, joggers, bikers, active athletes and, on the other side of the spectrum, overweight or elderly people.

Ischial / ischio-gluteal bursitis

Ischio-gluteal bursitis (also known as weaver's bottom) causes inflammation of the ischial bursa, which lies between the bottom of the pelvic bone and the overlying muscles gluteus maximus and / or medius.

Inflammation can come from sitting on a hard surface or in one position for a long time. Cycling is also a common cause of this type of bursitis.

Iliopsoas / iliopectinal bursitis

Slightly below the trochanteric bursa, tucked into the groin area, and deep into the hip joint, is a iliopsoas bursa, the largest in the body. This sac of bursae reduces friction between the thigh bone and iliopsoas tendon.

The iliopsoas bursitis pain may extend from the thigh to the knee.

Inflammation of the this bursa can be caused by overuse or injury by walking, running, swimming, going up stairs.

On an aside, the iliopsoas area is also related to an aliment called 'snapping hip', where the iliopsoas tendon is dislocated and causes a snapping sensation.

Causes of hip bursitis

Overuse

Bursitis is often caused by repeating the same movements over and over again. That is why activities like running, cycling, walking up hill, jumping, squats and lounges, soccer or ballet are often associated with bursitis.

Pressure

Constant pressure on your hips, such as excessive sitting, standing or side-lying on hard surfaces for long periods of time and / or in one position can cause bursitis.

Injury

Sometimes a traumatic hip bursitis condition may occur after a direct blow into the hip - such as a fall onto a hard surface or a car accident.

This can cause irritation or even a tear of the sac with some bleeding into the bursa. The bleeding in itself is not serious, but the bursa may show inflammatory reaction to the blood.

Surgery

Past surgeries of the hip (e.g. hip replacement or arthroplasty) may irritate the bursa and so be a source of pain in the buttocks, hip or thigh.

Inadequate rehabilitation following a previous buttock or hip injury can have the same effect.

Anatomy

All of these conditions can cantribute to the development of bursitis:

  • Poor pelvic or core stability
  • Joint stiffness
  • Muscle tightness or weaknes in the hamstrings and gluteals
  • Poor biomechanics
  • Leg length discrepancy

Symptoms

  • Pain, aches, tenderness

Pain is different depending on the type of hip bursitis you have - hip, buttocks, thigh, groin, sometimes extending to the knee.

Pain is often worse at night and can make it difficult to sleep, especially on the aching side.

Pain is aggravated by activity, local pressure over the area, or stretching.

  • Decreased mobility

Pressing on your hip or turning your leg inward or outward as you flex your hip may make the pain worse.

The pain may be worse when getting up from a chair or out of a car.

  • Weakness

Certain weakness of lower limbs may also be felt.

  • Numbness

Numbness or tingling around the affected joint area is not unusual as adjacent nerves are compressed by the inflamed bursa.

  • Stiffness

Your hip may feel stiff and not be able to move as well as before.

  • Snapping

You may hear and feel 'snapping' or 'popping' as you try to move your joints.

Treatment

Once the initial symptoms of acute inflammation are controlled, some physical therapy, strengthening and stretching exercises may be particularly helpful with treatment of this type of bursitis.

Be prepared that it often takes weeks to months to heal hip bursitis well.

Prevention

To prevent future occurences of hip bursitis:

  • Stay at your optimal weight
  • Wear well-fitting daily footwear
  • Wear special athletic exercise shoes for your sport activities
  • Run or exercise on soft, flat and even surfaces
  • Use orthotics if needed to line up your feet, legs, and hips correctly
  • Warm up and stretch before and after excercise
  • Excercise is great for you, but there can be too much of everything



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