Hip Bursitis

Bursae are very common structures in the human body. They are found in numerous locations including the shoulder, elbow, hip, knee, and foot. Essentially a bursa is a small fluid filled sac that is positioned between prominent bones and soft tissues to help reduce friction during movement. If a bursa becomes inflamed, the condition is called bursitis. Inflammation can occur because of trauma, but it usually results from overuse and poor conditioning. In rare cases the bursa can become infected.

Not surprisingly, runners often develop bursitis of the lower extremity and one of the most common joints affected is the hip. There are 2 major bursae that can become inflamed and irritated in the hip. The most common hip bursitis occurs near the outer aspect at the tip of the greater trochanter of the femur. This is referred to as trochanteric bursitis. The other bursa which can become irritated is deeper in the groin. It lies directly over the iliopsoas tendon, a major hip flexor, and is therefore called iliopsoas bursitis.

Symptoms

Of course, the primary symptom is pain. Usually, the pain is most notable directly over the bursa or in the groin, but sometimes it may radiate down the thigh to the knee. It may also be associated with a popping sensation. Severe cases may exhibit swelling. Typically, the pain is worse at night, and it may be difficult to lie on the affected side. Pain is often felt when rising from a seated position and it can be exacerbated by prolonged walking, running, and stair climbing.

Risk factors

Hip bursitis can affect anyone, but it is more common in women and in middle-aged or elderly people. It’s less common in men and younger individuals. Other risk factors can predispose a person to develop bursitis. These include repetitive stress (overuse) or traumatic injury. Previous surgery and obesity are also risk factors. A history of rheumatoid disease or calcium deposits can also be a risk factor. Spine disease and limb length inequality have been shown to be associated with bursitis as well.

Treatment

Once your doctor has made the diagnosis and ruled out other possible causes, treatment in most cases is non-surgical. The condition may respond to something simple like rest, but often will involve a combination of several of the following treatments.

• Activity modification – this may involve complete rest or a change in activity such as reducing amount and type of activity. Runners may need to reduce mileage and cross train for example.
• NSAID’s – anti-inflammatory medication may help but check with your doctor to make sure it’s safe because these are contraindicated in certain disease conditions or in combination with certain other medications.
• Therapeutic exercise – Some stretching, icing, and rolling techniques can be done at home. In severe cases formal physical therapy may be indicated and very helpful.
• Steroid injections – corticosteroid injections of the inflamed bursa can reduce inflammation and decrease pain. Occasionally more than one may be necessary but shouldn’t be given more than a few months apart.
• In rare cases surgery may be necessary. Typically, surgery is only indicated if all the above treatments have been tried for a long period of time and have failed.

Prevention

Bursitis of the hip isn’t always preventable, but there are things that can reduce the chance of occurrence.

• Avoid repetitive activities that put stress on the hip
• Lose weight if necessary
• Use a shoe lift for limb length inequality
• Maintain hip strength and flexibility
• Use proper technique and appropriate shoes

Author

Malcolm Stubbs, MD