Trochanteric Bursitis

What is a bursa?
A bursa is a small fluid-filled sac lined by with a membrane that produces a lubricating fluid. It provides a cushion between bones and tendons. This helps to reduce friction between the bones and allows free movement. Bursae are found throughout the body.

What is trochanteric bursitis?
Trochanteric bursitis is inflammation of a bursa on the outside the hip. The femur (thigh bone) has a large bump on outside of the hip that serves as an attachment site for muscles and tendons. This bump is called the greater trochanter. To protect these tendons, a bursa is located adjacent to the bone. Pain is located on the outside of the upper thigh or hip. The pain is aggravated by running, walking, bicycling, and walking up or down stairs. Pressure against the bursa will cause pain as well and this is common during sleep in some individuals. Poor alignment of the pelvis and leg can create excess pressure against the bursa as can weak hip muscles.

What causes trochanteric bursitis?
Trochanteric bursitis occurs when excess friction or pressure against the bursa creates inflammation in or around the bursa. It develops slowly with activities such as running, cycling, sometimes walking, and with jumping exercises that require hip flexion and extension.

How is trochanteric bursitis diagnosed?
Clinical examination and patient history are typically sufficient to make the diagnosis of trochanteric bursitis. Pain at the bursa with pressure is diagnostic in most cases. An x-ray may be used to rule out other problems such as bone spurs, stress fractures of the femur, and arthritis in the hip joint. On occasion, an MRI is needed to more fully evaluate the hip and upper thigh region.

How is trochanteric bursitis treated?
Treatment for trochanteric bursitis focuses on two main problems: inflammation and biomechanics. Inflammation is best treated with ice, non-steroidal anti-inflammatory drugs (NSAIDs) and rest from activities that aggravate the pain. Alternative training activities can give the hip region a chance to rest and inflammation to resolve. Physical therapy can help reduce local inflammation and improve the strength and flexibility in the hip and leg region. A cortisone injection can reduce inflammation when other treatment methods are not working.

When can I return to running?
The goal of rehabilitation is return you to running as soon as is safely possible. If you return to a full training load too soon, the injury may return or worsen. Everyone recovers from injury at a different rate, so don’t compare your rehabilitation to other runners. Returning to running is determined by how well your hip responds to treatment rather than a set number of days or weeks. In general, the longer you have had the symptoms, the longer it will take you to recover. Here are some general guidelines for a full return to running. Keep in mind, some runners may not have to completely stop running, but merely reduce their training load (distance, intensity, frequency) during the rehabilitation process.

• You should be able to bend and straighten your hip without pain.
• Your hip should not be swollen.
• You should be able to jog in a straight line without limping.
• You should be able to sprint without limping.
• You should be able to perform 45-degree and 90-degree cuts without difficulty.
• You should be able to jump on both legs without pain.
• You should able to jump on the injured leg without pain.

What can be done to reduce the chances of developing trochanteric bursitis?
The most important factor in preventing trochanteric bursitis involves addressing the root causes. So what are the root causes? It is generally accepted that more than half of all running injuries involve errors in training. This could include total mileage, running intensity, increasing the intensity and mileage too quickly, and finally the physical terrain (hills, trails, etc.). Improving areas of biomechanical deficiency also is important. This involves consistent focus on strength and flexibility of the hips and legs.

Exercises and stretches

1. Quadriceps stretch: Stand an arm’s length away from the wall, facing straight ahead. Brace yourself against the wall with the hand on the uninjured side. Using the hand on the injured side, grasp the ankle on the injured leg and pull your heel toward your buttock. Keep an upright posture with the hips straight forward and the knees close together. Hold the stretch for 30 seconds. Repeat 3-5 times.
2. Hamstring stretch (lying down): There are two versions of this stretch. Version one is performed by lying down with buttock against the wall close to a doorway. Extend the injured leg straight up the wall. The opposite leg should extend through the doorway flat on the ground. Hold the stretch for 30 seconds. Repeat 3-5 times. Version two is also performed while lying on the ground. Lie with your back on the ground and both legs extended straight. Bend the knee of the injured leg and grasp behind the knee or the front of the shin. Bring it toward your chest. Hold the stretch for 30 seconds. Repeat 3-5 times.
3. Hamstring stretch (standing): Place the heel of the injured leg on a stool or chair anywhere from 12-24 inches high. Keep your hips straight forward. Bend at the hips and lean forward. Hold the stretch for 30 seconds. Repeat 3-5 times.
4. Piriformis stretch: Lie on your back with both knees bent and the foot of your uninjured leg flat on the floor. Cross the leg of the injured leg over the opposite leg. Grasp behind the thigh of the uninjured leg and pull it toward your chest. You should feel a stretch in the buttocks and sometimes on the outside of the hip of the injured leg (the one you crossed over). Hold the stretch for 30 seconds. Repeat 3-5 times.
5. Iliotibial band stretch (Standing forward-lean): Cross your legs with the uninjured leg in front of the injured leg. Bend down and touch your toes, or go as far as you can reach. Move your hands toward the hip of the uninjured side. You should feel a stretch on the outside of the injured hip and thigh. Hold the stretch for 30 seconds and return to the starting position. Repeat 3-5 times.
6. Iliotibial band stretch (standing side-lean): Cross the foot of the injured leg behind the uninjured leg. Lift the arm on the injured side up over your head and lean toward the uninjured side. If you are are unstable, modify the stretch by holding onto a wall without lifting an arm over your head. Hold the stretch for 30 seconds. Repeat 3-5 times.
7. Gluteus maximus strengthening: Lie on your stomach with your legs straight. Tighten your buttock and lift the injured leg off the floor 6-8 inches. Keep the knee straight. Hold this position for 5 seconds. Relax and return to the starting position. Repeat 10 times. Perform 3 sets.
8. Gluteus medius strengthening: Select a resistance band appropriate for your strength. Secure one end of the band to a chair or other heavy object and loop the other end around the ankle of the injured leg. While keeping the leg straight, lift the heel upward and back at a 45-degree angle. Slowly lower the leg to the starting point. Each direction should take to a count of two. You should feel the outside, back corner of your buttock tighten. Repeat 10 times. Perform 3 sets.
9. Hip abductor strengthening: Select a resistance band appropriate for your strength. Secure one end of the band to a chair or other heavy object and loop the other end around the ankle of the injured leg. While keeping the leg straight, lift the heel upward and to the side of your body. Slowly lower the leg to the starting point. Each direction should take to a count of two. You should feel the outside, back corner of your buttock tighten. Repeat 10 times. Perform 3 sets.
10. Hip external rotator strengthening: Select a resistance band appropriate for your strength. Secure one end of the band to a chair or other heavy object and loop the other end around the ankle of the injured leg. Stand in front of a chair and place the knee of the injured leg on the chair. Your hips should be straight while your knee is bent at 90 degrees and the foot is lifted from the floor behind you. While keeping the knee bent at 90 degrees and resting on the chair, pull the heel of that foot toward the other leg. This will externally rotate your hip. Slowly rotate the hip to the starting point. Each direction should take to a count of three. You should feel the outside, back corner of your buttock tighten. Repeat 10 times. Perform 3 sets.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.