Trochanteric bursitis and outer hip pain: three practical tips

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host. Good morning, everybody. It is Sebastian, your co-host with the Restoring Human Movement podcast. Thanks for joining the show with me. I'm enjoying the drive here to work, and I got some coffee, so if I take a couple sips and pause, that's why. We're going to cover lateral hip pain today, cantoric bursitis. I'll describe it a little bit to you today, as well as give you some tips for active individuals who want to keep doing things like running and hiking and so on. If you have first jumped on this podcast, you haven't heard another one before, we specialize in helping people with lower extremity conditions, especially lumbar spine, sciatica, hip impingement, sports hernias, or everything down the leg all the way to the plantar fascia, which what we call lower quarter conditions. So we specialize in helping people with our telehealth platform, as well as in-person.

Now, trochanteric bursitis, I will tell you, in a textbook fashion, it is side of the hip pain, the outer side, and it needs to have swelling or puffiness. If it doesn't, it doesn't mean you can't have irritation to the bursa, but it's really not that bad. Bursitis is irritation to a bursa, which means that it's probably swollen or it has an itis or inflammatory aspect of it. Now, if you don't have actual swelling, there's other things that can be happening there as well, such as gluteal tendinopathy, referred symptoms from the back as well. But a lot of these tips that I'm going to be giving you today can help out with actually a lot of these. But if you want to know exactly what you have, that's why a physical exam is so important. But also seeing all the clues, they call it signs and symptoms. Hurts when you walk, hurts when you step, hurts when you do more running or more hiking. Sometimes it'll click over the area. But again, that's swelling and redness is more classic of a new condition of trochanteric bursitis. Now, the first tip I want to give everybody is that whatever you're doing, which is bothering it, say you're a runner or a hiker, consider not doing that for a little bit. And this is, I don't want to give the advice that everybody hates is, you know, I went to the doctor and they said, I have this. And they said, stop running. So I just didn't listen. And I've heard that a lot over the years. And there's a lot of people who don't trust their health care provider because it's not really in accordance to their wishes. And I completely understand that. And I'm the biggest fan of having people do all the things that they love, but also there's being reasonable with it. There is taking away the trigger. Now, if running or hiking is your trigger, you can get creative about this and keep doing it while you're healing. But for most people who are not observing enough to really see that there's a commonality with how long they're running or hiking, the speed or pace, the terrain, the shoe type, the time of day, all these things are factors that can be manipulated. And when you customize care for somebody, a lot of times you'll manipulate these factors to keep them running if you can. Because one of the biggest problems with having them not run or hike for a long period of time is they get physically deconditioned, they get depressed, they get upset at us as the provider. And there's a chance of other injuries that come up as they start to spike their activity once they do feel better again. I think the easiest way that I would try to manipulate some of the variables that could affect somebody's pain with running or hiking is just changing the train or the trail. So if you do this one trail all the time, and you notice it comes on very quickly, consider maybe doing the trail, especially if it's a loop trail, do it backwards.

Do the other part first, because a steep incline may affect you differently than somebody who does a flat. You'd be surprised how many people actually have more on set with flats versus inclines. You'd think the incline would be worse because it's more load and harder. But that's not always the case. You can also change pace. Instead of running as fast as you can, maybe do it at a half pace. Or you'd be surprised that actually doing it with a little bit more of a pep in your step can actually help out with decreasing symptoms too. This supplies more tension to the hip area, which can provide support. There's also more core support a lot of times with more intentional steps or better leg drive. So those are variables to change. But number one, if you feel like you're really suffering with things, consider taking like two weeks of, we call it strategic rest. Like don't rest everything. Just do the things that feel good. Don't do the things that feel bad. And circle back to them in a couple weeks. The second tip that I can give people is lifestyle wise. If you're not doing any resistance training, then I would really start to consider adding that in. If you feel comfortable doing some of your own exercise programming, the sets and reps, as well as the weights. Some people are deathly afraid of actually doing weight training period because they've had a bad experience with it. If that's you, you need a coach. Like you need someone to show you how to do it properly. I've met many people who end up having a repeated onset with lateral hip pain, trochanteric bursitis, or gluteal tendinopathy when they're actually running, but they go to the gym and they do everything but leg exercises. They kind of use the running or hiking as their leg exercises and they do arm stuff and core stuff and so on and they see the value in that, but also they don't feel like they really need to do the other part. So I would say to this, like the people who don't want to do it, I would think about the intensities that we're talking about here. So remember, if we're talking about building endurance, multiple steps is the way to go, like running, hiking, so on, right? But if you're trying to build strength, strength is really only developed when you're moving something heavy.

Moving something heavy usually means more than your body weight and as a general rule, we say strong people can't count above 10. So if you're doing more than 10 steps, those steps are not heavy enough and then you need external weight, which is why weight training exists. Strength is one of the biggest factors that we can look at to decrease re-injury rate. Like hip extension strength, not just mobility, but strength can help out a lot with decreasing knee conditions. It can help out a lot with decreasing lower back pain. And we see people with conditions like hip impingement or again, trochanter bursitis, we see that the glute max a lot of times is very deficient. The hamstring is deficient. Hip extension strength overall as a whole, again, it's not just one muscle, it's many, is deficient. And the way you would get that is with exercises like deadlifting, heavier, with good form. If your back hurts, then again, you need a coach. So that circle back on that second tip is to make sure that you're actually doing a good program overall. You need to incorporate weight training into your program. It can't just be running or hiking. We've had various people who we've seen on our tell-all platform that they just have a big old hole in their weight training program. I remember one guy, he had hip pain and he was doing arm stuff. He was doing some light jogging, cardio. He loves surfing. And so he was very content doing those things, but also like he wasn't able to run with his wife. And so he said, well, why don't we do some weight training? And so we only did about four weeks of weight training with him so far. And he said, this is the best he's felt in literally decades. Like he's had, he's had problems for years.

And so he's not really running yet, but the steps to get him to, um, to more of a tissue capacity to running is going to be hopping. So we got him hopping in bursts of 10 or so in case you're running what like hopping, basically landing repeatedly for how many, how many hops or steps are in a run of a mile a lot. So we're breaking these up. So we build tissue capacity. We're giving him breaks between basically 10 steps or 10 hops. So there's ways to build it back up in case you're having trouble. The third thing is, and this is going to be, I don't want to say it's going to be really easy to apply, but I've seen many people over the years who, um, make this way too complicated and they're very smart individuals. Um, some of the easiest people to rehab out of their problem are people who, um, don't ask a lot of questions. They just do things. Um, some of the harder people are the problem solvers, the super intelligent ones, the ones that become super educated in that. And if you guys already know the term anterior tilt or patellar tendinopathy or valgus collapse or hip drop, like these are the people who have already dug into the weeds and they start to see the parts that are relevant to how to solve the problem. Uh, a lot of times people who have been doing this, uh, have been, uh, unfortunately failed by, uh, people giving them advice because they feel like they need to be their own self advocate. And so they become self educated, which again is a great thing, but also it's a bad thing too. The problem with this is, um, and I know that from going to, um, college and grad school, I really didn't understand like the, the complexity, but also simplicity of how to address things until probably about five years after grad school. I felt super educated and knowledgeable in grad school. Like I knew all the human anatomy, I know physiology, I knew energy systems, I know all that stuff. And I probably know it a lot better than, than I, than I actually do now. Like I couldn't tell you the, the Krebs cycle right now, but also like that amount of detail makes you look in almost like with a microscope. Like you lose, you lose the ability to see everything as, uh, working together.

Uh, and I forget who said it. I was sure it was a wise man. Uh, maybe it was Yoda or Benjamin Franklin. Um, but for someone who becomes a master of things, they see that there's very few solutions, um, to that problem, or there's a simple solution to that problem. And someone who's a novice sees there's many, many different solutions and makes it a little bit more, quite a bit more complex. So people like this know enough to be dangerous, but also they can't, they haven't, a lot of them haven't had the ability to tie the things together. And so they start thinking about things a lot. They start thinking about, is my knee in the right position? Am I bracing my core properly?

Like, where should my position or pelvis be when I'm running or hiking? Like, these are all things that like, shouldn't be thought of like human movement or we're coaching human movement. Want to make things as simple as possible. Such as if you were going to run fast, we would just tell you to run quickly through the finish line. Like we wouldn't tell you to put one foot after another and lift your knee and flex your hip flexor and lean forward. And it's just too much. It makes it so the, the, the body corrupts the movement and it also makes you perform poorly. And if we're trying to get a certain response out of an exercise, like a deadlift or, or running or so on, like, do we just have to coach it more simply? And so I don't mean saying this in a negative way by any means, but I'm just telling you, cause I see this quite often because we see people with complex conditions that have not, they don't feel like they've resolved. So we get a lot of people like this.

I love talking to them, but I also give them a choice. I said, you've been dealing with this for a very long time and you're very educated about this. We have an hour. And so you're, you're basically paying for our time for an hour. Do you want to use it talking about it? Or would you like to use it doing something or experiencing something about it? And I'll just show you what we would probably do. Cause there's a, there's a ton of things we can do in theory. There's a lot of very, very smart, intelligent people, whether they be engineers or medical doctors, uh, or, or surgeons who have ongoing pain, like they're educated, they know what they're doing, but also sometimes thinking about it and theorizing about it for a really long time doesn't, and they don't actually do any work to figure out and test those theories. It doesn't get them anywhere. Uh, so I'll give you an example. We can talk about, uh, trochanter bursitis in regards to like the glue not working because the muscles over the trochanter are rubbing too hard or so on.

Right. Let me talk about a lot of stuff. Now, if we don't actually test that, we won't really know. So one easy test to do is that we can see, oh, by the way, a second thing is that maybe the core isn't doing its job to hold the pelvis into a slight, like neutral position. It's too much rubbing in an anterior tilt. So it could be the glute, could be the, could be the ab wall. One way to do this is to, you have them do a single leg bridge. If they, if they can start pumping out single leg bridges, like for a minute or so, and they feel eventually their glute max starts to burn and not their hamstring, not their back, not their symptom, then you can reasonably say that's probably not the thing.

Theory though, wise, yeah, we can talk about the glute max and do glute exercises all day, but if it's showing that it's working, move on to the next thing. But again, you could talk about it for hours. If you want to test the ab wall, you would have them do something like, um, uh, like a posterior tilt plank. I say posterior tilt plank because people do an anterior tilt plank all the time. They can hold it forever. Uh, and, but it also duplicates a lot of their symptoms. So doing like a posterior tilt plank or a neutral one helps identify, um, if they can do it for generally normal amount of time. Um, I think there is a paper out there that basically says that if you can't do a plank for, I believe it's, it's more than 60 seconds, but we'll just say 60. If you can't do a plank for 60 seconds or your symptoms pop up in that time, like there's, there's an issue with the frontal plane. Now we can make it super complex. The frontal plane, what is that? It's the ab wall, it's internal pressure. It's the hip flexors. It's the quads. Uh, it's all the way down actually into the toes because you're planking on the toes. So, but the simpler thing to do is if, is if one of these things is deficient, maybe we just start working on it and then we get back, get you back into activity as soon as possible and see how it fares. So I hope this was helpful. At least these three parts, if you guys are looking for help from us, again, we have telehealth sessions and we are licensed in different States. Uh, we also have online, uh, an online platform. We show all the exercises that we do, um, for hip conditions. Uh, and it works out really well, but again, if you're a DIY problem solver, you may like something like that, but if you just want to know exactly what to do, discuss it a little bit, um, I think you just work with someone directly.

Again, if you're looking for help, 714-502-4243, or our contact is below p2sportscare.com. Take care.