The trochanteric bursa is a fluid filled sac located on the outer side of the hip. This bursa provides cushioning between the bony prominence of the femur (thigh bone) known as the greater trochanter, and the muscles and tendons running over it. It assists in reducing friction between these structures.
During contraction of the gluteals and muscles overlying the hip, friction is placed on the trochanteric bursa. When these forces are excessive due to repetitive activities or high force, irritation and inflammation of the bursa may occur. This condition is known as trochanteric bursitis.
Causes of Injury
Trochanteric bursitis is generally an overuse injury, caused by repetitive or prolonged activities that place excessive strain on the trochanteric bursa. This particularly occurs due to repetitive running, jumping and walking activities or due to prolonged pressure on the bursa (such as excessive side-lying particularly on hard surfaces). Occasionally the condition may occur suddenly after a direct blow to the hip. There are a number of factors that can increase a person’s risk of developing trochanteric bursitis. These include:
- Participation in sports such as running, hiking or those with contact such as rugby and football.
- Abnormal biomechanics of the knee, feet or hips
- Lower limb muscle imbalance, particularly weakness of the gluteals or hamstrings
- Tight muscles around the hip joint, particularly the gluteals or muscle along the outside of the leg (ITB)
- Stiffness of the hip joint
- Poor training technique such as lack of warm up and cool down or excessive training
- Pain and tenderness on the outer aspect of the hip and possibly radiating down the outer aspect of the thigh to the knee.
- Aggravated by lying on the affected side, running, jumping, climbing stairs, sitting cross legged or walking/standing for prolonged periods
- Restricted range of movement in the hip due to pain or muscle tightness
The primary aim of treatment is to reduce associated pain and inflammation and to address any underlying cause to avoid symptoms reoccurring. Treatment and management options include:
- Sufficient rest from any aggravating activities (no side-lying, no prolonged standing or walking)
- Reduce inflammation through rest, ice, physiotherapy. Anti-inflammatory medication as recommended by a doctor or pharmacist may also assist in the healing process.
- Physiotherapy– massage, ultrasound, joint mobilisation, stretching, strengthening of the muscles around the hip and core muscle, sport specific training and correction of any biomechanical abnormalities with orthotics and taping.
- Education and advice regarding appropriate warm up and cool down, regular stretches and any technique corrections
Return to Activity/Sport
Most individuals recover well with a physiotherapy guided program and gradual return to activity is achieved once pain free. This could take a few weeks to several months.
Despite appropriate physiotherapy management, some patients with this condition do not improve adequately. In persistent cases, a corticosteroid injection into the bursa may be required. This condition rarely requires surgery, however with severe cases the bursa may be removed or the muscles released to reduce tension on the bursa.