What is trochanteric bursitis?
Trochanteric is a common cause of lateral hip pain that occurs when the trochanteric bursa is inflamed. The trochanteric bursa is a fluid filled sac that functions as a gliding surface to reduce friction between the greater trochanter and the overlying musculature. Trochanteric bursitis can also be referred to as greater trochanteric bursitis or greater trochanteric pain syndrome.
What causes trochanteric bursitis?
The cause of trochanteric bursitis can be repetitive microtrauma, blunt trauma, or idiopathic. Overuse of the surrounding musculature leading to tendinopathies of the gluteus medius and/or minimus may occur. Repetitive hip abduction seen in stair climbing or cycling can contribute to an inflammatory cascade of the bursa. Older patients who sustain falls directly over the bursa can initiate an inflammatory cascade within the tissue. Sedentary or bed bound patients are also prone to trochanteric bursitis as constant pressure over the greater trochanter can also initiate the inflammatory response of the bursa. (Seidman & Varacallo, 2021).
Common signs and symptoms:
Individuals with trochanteric bursitis likely present with pain over the greater trochanter which may extend into the lateral thigh. Pain may also tend to be episodic and progressively worsen over time and be worsened by knocking or lying on the affected bursa. Pain may also be exacerbated with or following weight-bearing activities such as running or climbing stairs.
Risk factors:
Trochanteric is highly prevalent amongst athletes who participate in sports which involve lots of running. Other risk factors that make individuals more susceptible to trochanteric bursitis include older age, being overweight, previous injury, previous hip surgery and inflammatory conditions such as rheumatoid arthritis. Bone spurs or calcium deposits in the tendons which attach to the greater trochanter may increase risk of irritation to the trochanteric bursa.
Differential diagnosis:
Possible differential diagnoses may include iliotibial band syndrome, glute medius tendinitis or tear, snapping hip syndrome (iliopsoas tendinitis), fracture of greater trochanter or femoral neck or meralgia parasthetica (Chamberlain, 2021)
Treatment:
Phase 1: Manage pain and inflammation:
• Behaviour modification:
o Rest only from aggravating activities.
o Avoid lying on affected side.
o When lying on unaffected side, place pillow between knees to relieve pressure on bursa.
• Anti-inflammatory medication – to reduce pain and inflammation.
• Ice
• Dry needling
• Soft tissue massage
• Monitor load on affected side
Phase 2. Restore strength and range of motion:
• Isometric hips exercises:
o Abduction vs wall or clam (against gravity only). 3×3 +3sec hold each exercise. Progress volume if responds well the following day.
o External rotation (seated). 3×3 +3sec hold each exercise. Progress volume if responds well the following day.
o Wall sit approx. Perform 3 times and progress duration as tolerable.
• Glute bridge (knees shoulder width apart to reduce adduction) 3×6
• Single leg balance. 3×20 seconds and progress as able.
• Stationary bike – progress duration, volume and resistance as able.
Phase 3. Progress strengthening exercises and developing neuromuscular control:
• Weighted squats
• Lunges/Bulgarian split squats
• Band resisted crab walk / clams / band resisted standing hip abduction
• Single leg balance +/- perturbations
• Resisted knee flexion and extension
• Slow eccentric lower from step +/- weight in hands
• Step ups – increase volume and height as appropriate
Phase 4. Aim pain free return to sport/activity:
• Slow return to straight line running (progress volume, speed and distance as appropriate)
o When able to sprint in straight line pain and limp free, may be appropriate for directional change when running. Gradually progress to high speed cutting
• Lateral / forward and backward bounding
• Squat jumps +/- single limb landing
• Box jumps
• Jump and land with external perturbation +/- single leg landing
References:
1. Seidman AJ, Varacallo M. Trochanteric Bursitis. 2021 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30860738.
2. Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis. Am Fam Physician. 2021 Jan 15;103(2):81-89. Erratum in: Am Fam Physician. 2021 Mar 1;103(5):263. PMID: 33448767.
3. Reid, D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. Journal of Orthopaedics, 13(1), 15–28