Hip Pain or Trochanteric Bursitis
Pain at the side of the hip is a relatively common complaint in both people who are mostly sedentary and people who have active and sporting pursuits, with somewhat more women complaining of it than men. The initial diagnosis was that of inflammation of the bursa just over the large bony lump at the side of the upper thigh, the greater trochanter. The pain is typically at the side of the hip and can radiate down the side of the thigh, although the hip joint itself is not implicated in this condition.
Typical athletic pursuits which can lead to trochanteric bursitis are running and contact sports, with activity on a sloping surface or lunges also possible contributors. The bursa between the bone and the overlying may become inflamed due to the repetitive back and forth movement of the tissues over the bone in sports such as running. But due to the inflammatory part of the diagnosis being questioned and new theories for the problem being formulated, the condition is now more commonly known as greater trochanteric pain syndrome. Recent ideas are tending towards the problem being one of tendinosis in the abductor tendons, a degenerative tendon condition.
Tenderness over the greater trochanter is the typical sign found by a physiotherapist and the patient may avoid lying on that side at night and might be awoken by pain if they do so. As the physio examines the area this may cause pain to radiate down the thigh. The physio will push the bent hip over the patient''s body to stretch the area which might elicit pain, as might asking the patient to push the hip outwards against the physio''s resistance. Acute treatment might involve frequent icing of the area, moving on to mobilising and stretching the muscles which are involved, the hip abductors and the tensor fascia lata and its tendinous extension, the ilio-tibial tract.
The physiotherapist will give the patient a regime of stretching the tendon areas for periods of 15 to 30 seconds at a time with a variation in hip position to target the specific parts of the tendons required. Steady, slow stretches can be taught for lying and in standing and need regular performance for the best effect. As the pain settles the physio will advise a return to normal and sporting activities with a view to the biomechanics of the original problem and how that might be avoided.
Author: Jonathan Blood-Smyth