We’ve done a previous blog on bursitis, but thought this time we’d dive into a fairly common one at the hip, which is (currently) called greater trochanteric pain syndrome.
To recap from a previous blog, a bursa is a fluid-filled sack that sits between different layers of body tissue (be it tendon and bone, or different layers of muscles) – their function is to act as a cushion and to reduce friction, therefore preventing subsequent inflammation. However, they can sometimes become inflamed and that is exactly what the suffix ‘-itis’ means – so bursitis literally means ‘inflamed bursa’.
In greater trochanteric bursitis this normally relates to the gluteus medius, as it is the bursa of this tendon that is commonly affected.
From the animation you can see where the gluteus medius inserts into the bony bit on the outside of your hip.
However, whilst the bursa does a fine job in providing this cushioning effect, if it gets squished too much, either from direct trauma to it e.g. a fall onto the outer part of the hip, or just a repetitive cumulation of squishing over time, the bursa can eventually say enough is enough and become inflamed.
So why might this happen.
It can happen in several ways, but to take a specific example we’ll use gluteus medius weakness. The gluteus medius has an important role to play in walking and running, keeping the pelvis fairly level and ensuring the knee doesn’t fall in and the hip doesn’t fall out. If there is weakness, one or both of those things can happen, and because of where the tendon runs over the greater trochanter it gets stretched, which then squishes the bursa. This can initially lead to some structural change in the tendon, called a tendinopathy (details of which can be seen in our previous blog), and the thickening associated with these structural changes can lead to an increased pressure on the bursa, the result of which can be inflammation of that bursa.
The symptoms tend to present around the outside of the hip but can also refer down the outside of the thigh.
What can we do about it?
It’s usually very simple to treat and tends to involve some fairly basic strengthening exercises. This side leg lift, or abduction, can be done for 1-2 minutes every other day and you should notice an improvement in a 2-4 weeks. However, it will be worth continuing this until the symptoms have gone completely and you’re back to your normal activity
These single leg squats can also be used as they will work more functionally – the key is to try and make sure you keep a straight line down the outside of the leg, ensuring the knee doesn’t fall inwards and the hip doesn’t fall outwards
As always, if you have any questions on this just let us know