What is bursitis?
Bursitis of the hip is the most common cause of hip pain. A bursa (bursae, plural for bursa) is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees. When the bursa becomes inflamed, the condition is known to as ‘bursitis’. Most commonly, this is a non-infectious condition (aseptic bursitis) caused by inflammation resulting from a local soft tissue trauma or strain injury. On rare occasions, the hip bursa can become infected with bacteria. This condition is called septic bursitis.
There are two major bursae of the hip, which can both be associated with stiffness and pain around the hip joint. The trochanteric bursa is located on the side of the hip. It is separated significantly from the actual hip joint by tissue and bone.
Signs and Symtpoms
Trochanteric bursitis frequently causes tenderness of the outer hip, making it difficult for patients to lie on the involved side. It also causes a dull, burning pain on the outer hip that is often made worse with excessive walking or stair climbing. The ischial bursa is located in the upper buttock area. It can cause dull pain in this area that is most noticeable climbing up hill. The pain sometimes occurs after prolonged sitting on hard surfaces, hence the names ‘weaver’s bottom’ and ‘tailor’s bottom’.
Bursitis of the hip is diagnosed based on the history of outer hip pain, specific areas of tenderness of the outside of the hip, and confirmed by relief with local injection of anaesthetic in the doctor’s office. Patients frequently notice pain in the outer hip with stair climbing or descending and tenderness of the hip when lying on the affected side at night. Your physiotherapist or doctor can localise the tender areas to the location of the bursae of the hip. Occasionally, x-ray tests of the hip are used to rule out other conditions of the bone and joints, such as arthritis.
The treatment of any bursitis depends on whether or not it involves infection. Aseptic hip bursitis can be treated extremely successfully by physiotherapy involving deep tissue massage of the bottom muscles and ilio-tibial band, interferential therapy and a series of muscle stretches followed by strengthening for the gluteus medius muscle (a large muscle deep within the pelvis). Stubborn (usually long-term) cases may require anti-inflammatory medication, aspiration of the bursal fluid (this procedure involves removal of the fluid with a needle and syringe under sterile conditions) or cortisone injections to the region. Hence it is far easier to alleviate the problem at the early signs of onset.
Patients can often also benefit by weight reduction, and proper footwear for exercise activities. Generally, patients should avoid hills and stairs and direct pressure on the affected hip (sleep on the other side), when possible, while symptoms are present.
For more information speak to your physiotherapist or call the office between 8am and 6pm to speak with any of our physiotherapists on staff.