Hip Bursitis

What is hip bursitis?

A bursa is a small sack of fluid which is usually positioned inbetween a bone and a muscle or tendon. The function of a bursa is to prevent friction between the bone and overlying soft tissue.

There are several bursas around the hip joint, including

• Trochanteric bursa - on the outside of the hip between the greater trochanter and the attachments of the gluteal muscles.
• Gluteus medius bursa - a smaller bursa, between the gluteus medius muscle and the greater trochanter, just medial to the trochanteric bursa.
• Iliopsoas bursa - between the iliopsoas muscle at the front of the hip joint and the underlying bone.
• Ischial bursa - Between the hamstring tendons and the base of the pelvis.

The most commonly injured bursa is the trochanteric bursa. This can be injured in one of two ways, through a direct impact to the bursa, such as a fall onto the outer hip, known as traumatic bursitis. Or through repetitive friction from the overlying muscles and tendons, usually during running. This repeated friction results in the bursa becoming inflamed and swollen. Every time the tendons then rub over the bursa, this causes pain.

Symptoms of hip bursitis include:

• Pain on the outside of the hip which is worse during activities such as running, climbing stairs or getting out of a car.
• Pain which gradually gets worse.
• Pain when you press in on the outside of the hip.
• Pain which radiates down the outer thigh.

Causes of hip bursitis

• A bone spur - a small excess growth of bone which can aggravate the bursa.
• Most cases of bursitis are due to biomechanical abnormalities.
• If you over pronate then you are more susceptible to this injury as the knee falls inwards which increases the angle at the hip.
• Weakness in the hip abductors, especially gluteus medius has the same effect.
• Tight structures surrounding the hip such as the ITB, hip flexors and hamstrings.

What can the athlete do about hip bursitis?

• Rest until there is no pain.
• Apply ice to the area.
• Run only on flat, even surfaces.
• See a sports injury professional.

What can a sports injury specialist or doctor do?

• Prescribe anti-inflammatory medication e.g. ibuprofen.
• Send you for an X-ray or MRI to confirm the injury is not as a result of a bone spur.
• Refer you for physical therapy to correct muscle imbalances.
• Use Ultrasound to help reduce pain and inflammation.
• Prescribe orthotics to correct foot biomechanics.
• Stick a needle in the bursa and drain off the fluid (aspirate it).
• Give a steroid injection followed by rest.
• Check to see if you need orthotics.
• Operate if it is a long term injury.