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Greater Trochanteric Bursitis Physiotherapy

Greater trochanteric bursitis, also known as greater trochanteric pain syndrome, is one of the most common causes of hip pain.

Yes, even though greater trochanteric bursitis affects both active and inactive individuals, it is most common in

• moderately active, middle-aged females or
  
• those who have recently increased their activity / exercise levels

That being said, pain on the outside of the hip from greater trochanteric bursitis can lead to a limited ability to lie on the involved

• side
• walk
• climb stairs
• squat or
  
• participate in recreational activities

To treat greater trochanteric bursitis, our senior physiotherapists focus on pain relief using combination of

• manual therapy
• stretching
• cold therapy
• heat therapy
• ultrasound therapy

and prevention with strengthening activities to decrease irritation in the hip and resolve pain.

What is Greater Trochanteric Bursitis?

Greater trochanteric bursitis is an irritation of the bursa, which specificly refers to a fluid-filled sac that sits on top of the greater trochanter, a bony prominence on the outside of the hip bone (femur), the most outside aspect of the hip.

The bursa acts as a shock-absorbing cushion that serves to decrease friction between the outside of the hip bone and muscles attaching to the bone.

Greater trochanteric bursitis results when the bursa on the outside of the hip becomes irritated.

Most of the time, greater trochanteric bursitis is the result of repetitive friction to the hip bursa. This repetitive friction is due to a combination of

1. muscular weakness
   
2. muscle tightness

that causes increased friction on the outside of the hip, and is most often treated with physiotherapy to decrease irritation.

Greater trochanteric bursitis may result from a combination of several different variables, including:

• Iliotibial (IT) band tightness (a thick band of tissue that runs along the outside of the leg from the pelvis to the knee)
• Hip muscle tightness
• Hip muscle weakness
• Abnormal hip or knee structure
• Abnormal hip or knee mechanics
• Improper technique with repetitive activities
• Change in an exercise routine or sport activity

How Does it Feel like?

Patients  may experience:

• Tenderness to touch on the outside of the hip
• Pain when lying on the involved side
• Pain in the hip that may at first feel sharp, then change to a dull ache, and may radiate into the side of the leg
• Tightness in the hip
  
• Pain and stiffness with prolonged sitting, walking (worst with the first few steps), negotiating stairs, or squatting

How Is It Diagnosed?

Our senior physiotherapists will review your medical history and complete a thorough examination of your hip, and possibly your lower back, knee, and foot.

The goals of the initial examination are to assess the degree of the injury and determine the cause and contributing factors to your injury.

Greater trochanteric bursitis may be the result of a single injury, such as a direct blow to the outside of the hip (such as falls, blows or motor-vehicle accidents), but most of the time, it's likely is a condition that develops as a consequence of repetitive irritation.

Our senior physiotherapists will assess the mobility and strength of your hip, and may watch you walk, step onto a stair, squat, or balance on 1 leg.

We will also gently touch the front, side, and back of your hip to determine exactly where it is most painful.

We may also ask questions regarding your

• daily activities
• exercise regimens
• footwear to identify other contributing factors to your pain.

Imaging techniques, such as x-ray or MRI, are typically not needed to diagnose greater trochanteric bursitis.

How our senior physiotherapists can help you

We will work together to develop a plan to help achieve your specific goals. To do so, we will select treatment strategies in any or all of the following areas:

• Pain Relief
  
  Many pain-relief strategies may be implemented; the most common one is to apply cold therapy , manual therapy (see below), radio-frequency Indiba physiotherapy and ultrasound therapy to the area. A period of decreased selective activities may also help.
  
  
• Range of motion
  
  Your back, hip, or knee joint may be moving improperly causing increased tension at the greater trochanter.
  
  Stretching techniques may be applied to the lower body to decrease tension and help restore normal motion in the back, hip, and knee.
  
  
• Manual therapy
  
  Our senior physiotherapists may treat your condition by applying hands-on treatments to move your muscles and joints in order to improve their motion and strength, most likely in your back or hip.
  
  These techniques often address areas that are difficult to treat on your own.
  
  
• Muscular strength
  
  Muscular weaknesses or imbalances can result in excessive strain at the greater trochanter.
  
  Based on your specific condition, we will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremity.
  
  You may begin by performing strengthening exercises lying on a table (eg, lifting your leg up while lying in different positions). You then may advance to exercises in a standing position (eg. standing squats).
  
  We will choose what exercises are right for you based on your age and physical condition.
  
  
• Functional training
  
  Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities.
  
  To minimize the tension on the hip and your risk of repeated injury, it is important to teach your body safe, controlled movements.
  
  Based on your own unique movement assessment and goals, we will create a series of activities to help you learn how to use and move your body correctly and safely.
  

Physiotherapy promotes recovery from greater trochanteric bursitis by addressing issues such as

• pain
  
• any lack of strength, flexibility, or body control

We may also recommend

• a period of relative rest (from sports/activities)
• regular deep tissue release massage therapy
• and then help you slowly resume activities
• and carefully guide your progression.

When greater trochanteric bursitis remains untreated, your hip pain will persist and result in long-term difficulty performing your desired activities, including even walking and moving about.