Trochanteric Bursitis of the Hip: Causes and Management

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show is for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Trochanteric bursitis is the topic of the day. I'll talk about what it is, who gets it, what it feels like, what it may come from, as well as some discussion about treatment or management of it.

The good news is if you have trochanteric bursitis, it's going to get better. Most of these things do get better. And I remember talking to a physical therapist that I worked with years ago. We were discussing trochanteric bursitis and he's like, just don't do anything. It'll get better in like a month and a half. And I think he's right. You know, you don't do anything. It should get better. Now, for all of you who think that didn't happen to me, there's a chance you may not have trochanteric bursitis too, or you have something which is creating the bursitis to continue. Whenever we help people with things like hip pain and trochanteric bursitis and sciatica and neck pain and so on, you have to consider the mathematics of the whole scenario.

You need to come out positive. And so, although the treatment or management may be appropriate, sometimes what you're doing on the side is unknowingly creating the problem to continue. And I always say unknowingly because no one's doing it on purpose. I know people don't want to be in pain and have any issues like trochanteric bursitis, but the fact of the matter is, if it continues and your treatment is good, the recommendations are good and the diagnosis is good, there's something else going on too. So, a simple analogy may be like, say you have like dry skin. Like I have dry skin on my knee. I have no hair on my knees, both of them, because I work with people in a gym setting.

I'm on my knees a lot, coaching people. And because of that, and I always wear shorts, I will probably never grow hair there. It doesn't matter if you put Rogaine on it or any other type of hair management or treatment strategy, it will not matter. And in addition, my skin is dry because it keeps getting beat up every day. So, as simple as that analogy may be, I promise you that may be the most important thing that we talk about today is make sure that you're not creating your own problem. If you can't figure out what it is that you may be doing unknowingly to create your own problem, you may need someone to help assess what's going on.

And that's the value of having someone who knows what they're doing with hip problems where they can question you, watch you, and figure out what in your day-to-day or your physical activity is creating this problem to continue. Now, let's get on to what it is. So, it's single-sided side of hip pain. If you've been dealing with hip pain in the front or the groin, this is not trochanteric bursitis. If you have stuff into the adductor region, this is not trochanteric bursitis. Don't worry, we have other podcasts on these things too. Or if you ever have any questions, you can link, there's a link in the description of the show.

So, just scroll down to your podcast player, we're there too. If it's on the backside of your hip, it's not trochanteric bursitis either. It has to be on the side. It's pinpoint. You can put one finger on it. Normally, it hurts to roll over and lay on the side. It does hurt to create pressure on the spot. A lot of times people come in and start rubbing it just to show the location of pain. Well, sometimes they really have trouble finding a movement that increases or decreases it. But they tend to really note that it hurts when they lay on their side. They tend to wake up laying on it and it wakes them up in the middle of the night and they roll off of it and it improves.

Typically, the person is able to walk. It doesn't come on all at once and it tends to improve with over-the-counter medications like your Advil's and Tylenol's and Naproxen and so on. It tends to improve. The trouble is it just keeps coming back, right? So, I mentioned earlier that generally something like this does resolve on its own, but if it keeps coming back, there are other factors associated with it. You can't just keep living with it like this. I know some people who have trochanteric bursitis or lateral hip pain, they stop doing the activities they like. Like they stopped running, they stopped riding their bike because the darn thing keeps coming back.

Like they rest for like three weeks and it goes away and then it just comes back again. And so, with this in mind, we have a few different thought processes we can go on this. You can, number one, give up your activity. If you don't like it, that is fine, right? Not everyone likes cycling. Not everyone likes running. In that case, don't do it. You didn't lose anything. You just, you're avoiding the activity that bothered you. Now, some of the listeners might say, well, that's not really a good thing to say to anybody. Like, just don't do it ever again. It just depends. Like, if I never went roller skating again, I would not care.

And if that was the only thing that bothered me, that's the only thing whatsoever, then by all means, no big deal. However, if you're giving up an activity that you like or that you need to do for some reason, whether it be because you need to get somewhere, because it's your livelihood, or because you need to say you want to lose weight and cycling is the best thing for you at this point in time, then maybe you need to consider what can we do to make it so this problem doesn't keep coming back so you can do the activity you want or need to do. Typically, trochanteric bursitis happens in middle-aged or older people, but it's important to note that it can happen at any age.

I've heard of people even into like 13, 15 have this type of problem too. But sometimes people have a history of direct trauma in the area, like they'll fall on it, or they'll tend to immobilize the leg after that. Maybe they had to pass hip surgery, hip, I'm forgetting the word, a replacement, hip replacement. Or, again, they hit the area, they fell on the area, and they just stopped using the leg for a sustained period of time. Either way, there's a possibility that either the past trauma to the area created some problems within the bursa, or it's the immobilization. Generally, though, if we're talking about trochanteric bursitis, we should talk about the structure.

I guess I didn't really talk about that yet. The structure itself is the culprit they say is a bursa. Bursa, every time I've said bursa, I feel like people, like they stop and they're like, not a bursa. You know, because this is their first time with a bursitis. And they say, you know, they wonder what the bursa is. What's with the bursa? Well, first off, know that a bursa is normal. You have a bursa. There's a lot of bursas in your body. A bursa is, it's kind of like, consider it kind of like a water weenie. It's like a water weenie, it's like, or possibly like a water balloon. And you kind of put pressure on the water balloon and you roll it around on the table and it kind of makes movement frictionless.

So it's ascension, it's a friction system. It helps out to decrease the amount of friction between tendons going over an area and creating to, attaching to a bony region. Once the muscle and tendon goes attached to the bony region, it can then contract and then pull the bone into a movement, which creates joint movement. It creates all the movements that you want to do, such as running and cycling and jumping and so on. So the bursa itself, number one, it's normal. Everyone has bursas. Irritation to the bursa or itis is inflammation of the bursa. And so in this case, this, if this is an inflammation to the bursa into the hip, it's right over the region called the trochanter.

And so we have a trochanter bursa, but it's an itis. So it's a bursitis, it's a trochanter bursitis. And so this is considered an inflammatory component, which is of the bursa in that single region. Again, it's single-sided. If you guys have bilateral hip pain, it's not trochanter bursitis. It's probably something else. You can have spinal-referred hip pain, which I'll talk a little bit about later. And there could be fascial irritation in the region, too. There could be a lot of things going on. So it tends to worsen with prolonged activity. Again, things like repetitive movement, cycling, running, jumping activities, not long jumping per se, but like probably more like leaping, like repetitive jumping and so on, like HIITS training classes.

The reason I think these areas tend to, or these activities tend to bother it is, number one, there's repeated movement. But also, too, when you examine someone with this, you notice you have them staying on a single leg, and anything that revolves around like stabilizing the pelvis within a single leg stance, such as pick one leg up, and making them stay there will tend to create some irritation in the region. So, obviously, it's running is single leg, cycling is single leg, jumping, unless you're jumping straight up. Actually, jumping straight up can be single leg, too. But it's generally single leg if you're kind of leaping and bounding and so on.

But stabilization of the pelvis is hard for these people. It's painful. So, prolonged activity such as that, especially repetitive movement, will tend to bother them. It's interesting, though, if you think about it from a rehabilitation standpoint, or how do you improve this? If stabilization of the pelvis is hard, because it's creating bursal irritation or compression, as one of the tendons for the musculature of the hip goes over the trochanter bursa, it's creating irritation of it. It may be in your best interest to work on pelvis and spinal and hip stabilization as your rehabilitation. You don't have to do it in a single leg stance, but there's regressions of movements like single leg stance, like a side plank, is a really good idea as a regressed single leg stance.

There's various different things that we can do. It's interesting on these people, though, that you'd think like a bursitis, that most of the people are going to have some type of warmth over the area because it's an inflammatory component. You'd assume red and stuff like that, or see it over the skin. Most of the people you don't. But if you had an infection in the area, which can happen in the bursa, then you would. Some of these people might actually have fevers, aches and chills and so on, which is why it's important to talk to a healthcare provider about this type of thing. There is a ruling in and ruling out process.

There is nothing exclusively like you have pain on a single side of the hip with single leg stance that increases when you roll on it and takes it away when you stop and worse with cycling. And all of a sudden, this is only trochanter bursitis. It's not. This is why, in my opinion, AI medical will never work because there's much more than just that. There's an art form into diagnosis and treatment. Now, the things that cause it, as I mentioned, we said microtrauma, which is repetitive overuse type of scenario. I tend to think a way to get around that and improve that from coming back, other than just disuse or inactivity or avoiding activity, is going to be stabilizing the pelvis, the core, and getting the hip to work really well and strengthen the hip.

That will tend to work very well, but quite honestly, I have not met a lot of people that have done it. A lot of times, people just rest this thing away. I'm assuming if you're listening to this podcast, this is either your first time with it or you've had it way too many times and you're just tired of it. If this is your first time with it, I'd encourage you to manage the pain as you probably are and take some time off, but you need to get to the root cause of this thing. The fact of the matter is the repetitive movement, you had that same amount on the other side. You ran and you had it on both sides.

You only have a single-sided hip pain. Why is the other side okay? There's imbalances and other stuff that happens in the region, so you might as well just deal with it now. The other possibility is you have blunt trauma, like you fell on the spot. In that case, there's nothing really to, you can't prevent that fall probably, but when people fall, sometimes they stop using the region and then it can still weaken and so on. Like same scenario, different onset. And then there's idiopathic. Idiopathic is we don't know what causes it, which they woke up with it. It slowly started to come on and so on.

I tend to think that there are probably other associated signs and symptoms with these people. Like if you notice, like I've met a few people with lateral hip pain that they said, oh, I just woke up with the darn thing. Well, so have you had any hip pain before? Well, I had a hip pain on the other side. What happened there? Oh, I had a labral tear. What happened? Well, I had it repaired. Okay. So let me see you squat. You see them squat and they just dramatically load into the opposite side of the past labral tear and into the symptomatic leg. And so in this scenario, it's not idiopathic. Like there's a clear process what's happening.

They had a past hip issue on the other side, which was a pretty challenging one to overcome. And they dealt with it, but they didn't really fully recover from it because they didn't reinstall load back in the hip. They didn't get function back. Because of that, they're putting more load into the other hip, more workload in the other hip. And then you have your repeated microtrauma, blah, blah, blah, same thing. And so that's what I tend to think more of the idiopathic or I woke up with the type of thing is from. It's from past other problems like opposite knee, opposite foot, opposite plantar fasciitis, past back issues, repetitive strains on the opposite hamstring, or maybe even the same side.

And so the body's, it's not inefficient. It's pretty efficient. It shares load. If one limb can't take it or one joint can't take it, it'll push it somewhere else, which eventually over time could create repetitive microtrauma. So gradatrochanteric prasciitis is, it's thought to be more common in women than men. They say middle-aged women are the most affected, but it can, again, it can happen at any age. The reason why they think females are so, a little bit more prone to it is because we call Q angle. We're talking about the angle of the hips as they exit the pelvis. There, supposedly it leads to tighter musculature of the pelvis and the thigh, like the ITVM, as it travels down.

This is the same argument that they say that women are more susceptible to ACL injuries of the knee too. It's from Q angle, but there's a lot of other factors too. There's been a lot of research done over the years about ACLs. And although Q angle is a part of it, there's also hip strength, there's core strength, and there's even, as obscure as it might sound, menstruation cycle, so period cycle, where you're at in that. And so there's a lot of different parts to it. And I'm sure trochanteric prasciitis is the same, but we haven't really gotten that deep into it, at least that I've seen. Interesting, I had a colleague that had a diagnostic ultrasound.

He saw a lot of people with lateral hip pain. And so one of the differential diagnosis is a glute medius tear or tendinopathy. And so the glute medius is a muscle that has a tendon, which goes into the region. It goes right over the bursa and inserts into the greater trochanter. It's an accessory muscle of the hip. It's a stabilizer group, synergistic muscle, if you will. And so he did a bunch of images on people with lateral hip pain. And he said, I just, all I'm seeing is tendinopathies and tendinopathies and tears. Like it's just a bunch of gluteal, like muscle tendon problems. And so, and that would make sense.

If you stand on a single leg, the glute med is one thing that does the work, but also the glute max and the glute minimus and the whole hip. But glute medius is one of them that does take a fair amount of work. There's even like a test, a single leg test called Trendelenburg test, which is supposed to identify problems with the glute medius. But truth be told, even the core has a function in single leg stance testing. So it's not only the glute medius, but it would make sense that as it starts to slowly fatigue with increased time under tension, that it starts to hurt too. And so I found it interesting when I was talking to him about it, because I'm like, huh, it would make complete sense.

Like you'd think a bursa, if it's inflamed and has an itis, like an inflammatory component, you'd think that it would have redness and swelling, but they don't. And so it kind of makes me feel like there's a possibility that a lot of the research's been done on trochanteric brusitis is not actually on trochanteric brusitis. It's on just lateral hip pain, which could be a lot of things. You'd have to verify it. And if you can't see it, if there's no imaging to really see it, like you can do an MRI and you might have some findings into the bursal region, but who's going to be able to do MRIs on everybody?

Like that would have to be, I mean, if there's a study out there on this, I would love for someone to shoot it over to me. I'd love to see it too. However, I question to see that if a lot of the research over the years has actually been on different things other than just trochanteric brusitis unknowingly, it's just more on the presentation of trochanteric brusitis, which could be a lot of things too. So treatments, common treatments is like I said at the beginning, my buddy's like, just don't do anything. They'll go away. Just rest it. If that doesn't work, a lot of times people will venture into things like over-the-counter anti-inflammatory medications, which will work most of the time.

But if you take them too long, then your belly starts to get pissed. And there's been a lot of research on GI ulcers starting from too longstanding use of anti-inflammatory medications, physical therapy, chiropractic, stretching, strength training programs. Even I've heard of some people getting so far, and if they don't get better, where they actually have the bursar removed. Personally, I think that, I don't know the results of how successful that is. That's pretty far. Most of these things are treated very, very well with conservative care or even just let it go away type of approach, which I think just takes the trigger away.

It takes the gun away, but it doesn't take the fuel away necessarily. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar, and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working. And we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. Some treatments that I tend to think that work really well are if you really do have an inflammatory component, instead of taking your NSAIDs, just use some ice. The important thing with ice is don't burn yourself. And some people think that more is better with ice. I think it's the opposite. I think you cycle it. I wouldn't go any more than 10 minutes. Obviously, don't burn yourself. So put something between you and the ice, but you don't want to go longer because if you do, it actually brings blood into the area.

And so the point is you're trying to take it away. Although over the years, the validity of ice has been a little questioned because if you're trying to take away an inflammatory component, like the, like the inflammatory component is a normal healing process. Like that's what the body does to heal the area. So if you're arresting it, then it won't get better, but it helps out with pain. Pain is just one part of the inflammatory process. It's also redness and swelling and so on. There's other parts. And so, but again, the funny thing is most people that have it don't have redness and swelling.

So is it really inflammatory? You know, if I'm confusing you guys at all and make it, yes, I'm not meaning to, but this is really, this is the trouble sometimes when, when people don't get better is you have to question really, is it really what you think it is? You need someone to decipher the history, the onset, what makes you, what makes the area feel worse, what makes you feel better? And then developing a program around that. I tend to think things like support of the, of the core and torso works really well. I know if you listen to my other podcast, you say, oh, he, he always says that. Well, yeah, I think it's really, it works for a lot of things.

And I'm not going to say passive care doesn't work like stretching the area, foam rolling, soft tissue mobilization, acupuncture, medications, chiropractic adjustments. They are very good, you know, and it helps reduce pain. It makes you feel better, but does it, does it address the reason why it happened in the first place? If your problem was that the core stability was bad, like none of these things address that. These are just pain management strategies. And I think people sometimes lose the, they lose focus. They're so focused on the pain at some point where they're like, I don't want this to come back.

Just, just deal with the pain. Those are different things. Step one is reducing pain. Step two is, is supporting the area and making sure it's like your, you know, removing root cause. It just, things don't come out of nowhere, but in medical, we have this, this term called idiopathic. It just comes out of nowhere. I don't think things really come out of nowhere. Like there's signs of it. There's signs. Like you see, you see a storm coming, like you can see, you can feel it in the air, you know, like there's a stickiness. You can see the clouds change. Like there's signs. You just, people just probably weren't paying attention.

So it's hard to report on it. One concept that really works well for people, which if you want to try this, you can, but obviously I'm not medically advising you, but I'll just, there's something called skin rolling. Skin rolling has been, been around for a long time, but it was brought to my attention by Philip Snell and Justin Dean, they're chiropractors. And so they, they showed this concept of skin rolling and she has grabbed the skin around the region that irritates you and you lift the skin and you kind of, you don't pinch it, but you roll it and you roll the skin around the trochanter bursa, as well as the top part of the hip, like around the crest of the hip.

And I think I've noticed that half the people, their problems just go away. Like, don't get me wrong. It hurts like hell. It really hurts. And most of the time, like when, so we have some self-instructional videos that we send to people and they, quite honestly, they don't do it. Like they come in and they, they let us look at them and work with them. And, and we say, so did you, did you try that skin rolling? And they said, no, I, I, I mean, I tempted it, but it hurt so bad at it. I stopped. And so lo and behold, we made you skin rolling in there as a treatment for them. And they move around after they do a single leg stance and their problem goes away and they start running and it's okay.

And again, this is a pain management strategy. It's not an end all be all. It's not stabilizing the pelvis, but pairing a really nice pain management strategy with a supportive strategy is actually really, really helpful in these scenarios. And then you return to your activity. Things that I'd send to find work really well in regards to pain management. Again, is, is ice dosage is important. Skin rolling on a daily basis for about a week usually works. Okay. Unless you're on blood thinners, then don't do it. And then side stretching, like kind of stretching your hip that there's various ways to do that.

I've seen people stretch the IT band this way against the wall, kind of cross the legs, like symptomatic leg behind the other and just kind of lean into the wall. I've seen them do the other way where they flip legs the other way. I've seen people do it to where they're laying on their side and just over a BOSU, not a BOSU ball, a Swiss ball. But I tend to find it really works. It just opening up that whole side. Something else that works too is increasing hip mobilization, mainly an extension. And so endorsing the hip to find new hip extension range before you actually challenge it tends to work really well.

Something like a really deep hip flexor stretch for repetitive reps tends to work really well. And a lot of people that I've met have found that there's a, there's a very significant reduction of their symptoms with climbing stairs after doing repeated hip extensions, even within the same visit. The other things we like to start people off with is some form of glute facilitation and also something like a version of a front plank challenging the anterior chain of the body, which is the, it's, it's the abdominal wall in the front, but not via sit-ups and crunches and boat pose and Russian twist, mainly doing something like a front plank, like a, like an isometric exercise.

We call them anti-extension exercises, meanings if you fail the exercise, you'll extend your body. So the, the exercise is to fight extension. And so glute facilitation exercises, this can be something like a really, really hard clamshell. It could be something like glute bridge. It can be a lot of things. And so even if you are pretty well versed in weight training, it can be a single leg RDLs. It can be hip thrusters, barbell or dumbbell, or even kettlebell swings. There's a lot of different things you can do for glute facilitation, but generally you kind of wake those babies up and then you challenge hip extension.

And so I know that I may not be going particularly in the reasons why these things work in too, in too much depth, but I can tell you a step-by-step approach is number one, you find something that reduces your pain at will. I mean, it will like, like it hurts right now to do single leg stands for like 10 seconds. And you know what I did 10 hip flexor stretches and all of a sudden I can do it now for 30 seconds. That's significant. That's really significant. I don't know the percentage, but isn't it 200% more that you can do just after 10 hip extensions? So that's something that reduces pain. That's important because if you don't reduce pain, then it corrupts your movements.

Sometimes if you don't reduce pain in the beginning, it's doing something like glute facilitation. It just creates pain or you do a front plank and it creates pain. And so there's no reason to do that. And so we can just chill the area down, create a little bit of a reset button, and then we just challenge the areas we need to challenge. Now, I tend to give people a general context of when they're looking for the right pain management strategy. I, and I've told people this over the phone just so they understand, but quite honestly, I don't know if they believe it because I've had people come back to our office before.

I remember the, the, the last person I worked with, it was for, it was for sciatica. He had pain down and down into his leg. And so we were, we were talking about it and actually I'll tell you a different story. That's a good story, but that's within a single session. So this other gentleman came in, he was referred by somebody that, someone that, that I know really well. And so he came in, he had some back pain, long history of back pain. And so we established something that I think that would work for him really well in regards to pain management because he was in pain daily. And so we gave him something to do.

And so he came back the next week and I said, how's everything going? And he's like, well, I'm kind of pissed. I said, I said, why are you pissed? And he's like, cause I thought you guys are full of crap. I said, what do you mean? He said, you said, I'd feel pretty good this week. And I do, I feel really good. But I didn't want to believe you because the timeframe seemed too short. I said, so if I would have told you it would have taken a month to feel this better, you would have believed me? He said, yeah. And so I've told people on the phone before that, that you need to give each treatment that you're, if you're committing to a treatment with somebody, you're letting them work with you.

You need to give them at least three weeks, at least mainly because they may, you might have a troublesome case and they, they need to troubleshoot you a little bit. If you were simple, someone else would have figured it out. I always tell them. So you need to give them a chance. Once they figure out what they want to do with you, you need to give them that two to three weeks to see if what they're suggesting actually works. In this scenario, I talked about this guy, he had a significant reduction in a week. I told him a week because I felt confident in it, but I've told people on the phone and I said, look, I know you may not come here.

You may go where you're going to go, but I want to tell you that you need to give them three weeks. And if they can't find something in three weeks, then it's the wrong thing. And I don't know if they really hear it or believe it or not, but I strongly, ah, that is the, that if I could change one thing about culture regarding musculoskeletal injuries and pain is that most people within two to three weeks, they will find something that reduces their pain by over 50%. I know it's going to sound extreme, but I'm telling you they're out there. Whether it be a surgery or whether it be a simple stretch or it be tissue work or skin rolling or whatever it may be, you, there will be something that will be lasting and nearly immediate and lasting for most people.

If you've ever had a surgery before, you've been around anyone who had a surgery, they're a perfect example of finding the correct intervention for the problem. And I don't want to say I'm a proponent of surgery because I'm not for most people. I tend to think most people don't do, they have not found something that they have not been offered something that was, that works well for them, or they have not tried something that they, that will, that may work because they're so, they may be married to the idea that I, I, I, I'm not going to do core work. I'm going to do like stretching. Like they just don't want to do it.

And either way, they either, they didn't accept what was given to them or they were not given any suggestions of what may work. Those people should go to surgery on think, unless they have red flags, but either way, let's get back to the, if, if somebody walks in, they go into a surgeon, they can barely walk and they come out and they feel significantly better. And that surgery was only 45 minutes. That is the same thing. In that case, it required a surgical intervention to make it so pressure was taking off something. So it feels better. But if we can take pressure off of the bursa and make it feel better within 45 minutes, that is the same thing, except for it doesn't require surgical intervention.

And most people don't require surgical intervention. They just need the right thing. So if you guys are looking for help, we can certainly help you. Our link is in the description of the podcast, or you can email us info at p2sportscare.com or call us 714-502-4243. I always make sure that everyone understands that I think there's a difference between cockiness and confident, right? And I know probably at the end of the podcast, I might've sound more, hopefully more confident, but it might've been cocky. I am confident in saying that people with trochanteric bursitis, they are so, like, if you've had it for like months, you are so close.

Like within a couple of weeks, you could be life-changingly different, life-changingly different, significantly different. If you find the right thing, if you're not found the right thing, let us help you find the right thing. It may not be us, but it may be, you may be real closer than you think. So in the U S and we add more states every year. Thanks for listening. Subscribe to the show and we'll see you in the next one.