Comprehensive Guide to Trochanteric Bursitis (TBC)

Are you experiencing pain in your hip that is making it difficult to move pain-free? Does it hurt when lying down in a certain position? If you answered yes to either of these, then you might be suffering from trochanteric bursitis. 

Bursitis is a common musculoskeletal condition that affects various parts of the body, such as the shoulder, elbow, hip, foot and knee. However, many signs and symptoms can be easily mistaken for other issues and conditions.

Whether you have had prior bursitis episodes or are experiencing bursitis symptoms for the first time, this blog will provide you with the necessary information to understand and manage your condition effectively. 

With the right care and management, you can get back to doing what you love and enjoying a more comfortable life.

What is Bursitis and What Causes It?

Bursitis, although a common condition, can be debilitating and interfere with your ability to enjoy many everyday activities. But what exactly is it? And what causes it to occur? 

Bursitis is the enlargement or irritation of a bursa, a fluid-filled sac-like structure that facilitates the movement of tendons over bony prominences and reduces friction. 

Trochanteric bursitis is also known as greater trochanteric pain syndrome (GTPS), which is now recognised as a condition that involves not only bursitis but also gluteal tendon pathology. 

While it is not a life-threatening condition, it can significantly affect your ability to perform daily activities, engage in physical activity or sleep, and negatively impact your quality of life.

It can be caused by overuse, infection, trauma, or inflammatory disorders. By identifying the specific cause of your bursitis and implementing targeted treatment strategies, you can effectively manage the condition and get back to doing what you love.

 Luckily, there are many ways to treat bursitis, and the sooner you take action, the easier it will be to manage.

Bursitis is relatively common in both males and females, affecting up to 8% and 15% of the population, respectively. 

The location of bursitis can vary between genders, with women more likely to experience hip and pes anserine bursitis, while men may be more prone to knee and elbow bursitis.

While bursitis can affect individuals of all ages and backgrounds, certain factors may increase the risk of developing bursitis. These include:

• Overuse: Engaging in repetitive activities or putting excessive stress on joints and tissues can lead to bursitis. Sports and occupations that involve repetitive motions or prolonged pressure on certain joints can increase the likelihood of developing bursitis.
• Age: As you get older, the bursae become less elastic and more prone to irritation. This can make older adults more susceptible to developing bursitis.
• Joint Problems: Certain joint conditions, such as osteoarthritis or rheumatoid arthritis, can contribute to the development of bursitis.
• Previous Injury: A previous injury or trauma to a joint can increase the risk of bursitis in that area. Any irritation to the bursae or the surrounding structures can disrupt their normal functioning.
• Inflammatory Disorders: Certain systemic inflammatory conditions, such as gout or lupus, can increase the risk of bursitis. These conditions can cause inflammation throughout the body, including the bursae.

It’s important to note that while these factors can increase the risk of developing bursitis, anyone can be affected by this condition. 

If you are experiencing symptoms of bursitis, such as joint pain, swelling, or limited range of motion, your next step is  to consult with a healthcare professional for an accurate diagnosis and appropriate treatment

Diagnosing Trochanteric Bursitis

The gold standard for diagnosing trochanteric bursitis is a physical examination by a physiotherapist. Imaging, such as X-rays or MRIs, is not always necessary and may not change management if bursitis is suspected. Your healthcare provider may consider imaging if there are concerns about underlying pathology.

Trochanteric (Hip) Bursitis

Trochanteric bursitis, often mistaken as the main cause of pain in the lateral hip region, is now recognised as part of a condition called greater trochanteric pain syndrome (GTPS). Recent studies have shown that gluteal tendon pathology often accompanies trochanteric bursitis.

The exact cause of greater trochanteric pain syndrome is still under investigation. However, certain factors are believed to contribute to its development. These may include repetitive overuse, injury, poor biomechanics, muscle imbalances, obesity, and certain medical conditions such as rheumatoid arthritis or hip osteoarthritis.

Surgery is generally considered a last resort and is reserved for cases that do not respond to conservative treatment. Surgical options may involve removing a portion of the bursa, repairing or releasing the affected tendons, or addressing any other specific underlying issues contributing to the pain.

Risk Factors and Symptoms of Trochanteric Bursitis

Several risk factors may contribute to trochanteric bursitis or GTPS, including inflammatory disorders, osteoarthritis, obesity, poor pelvic control, mechanical overload, and direct trauma. 

Symptoms of trochanteric bursitis or GTPS can include pain on the outside of the hip, pain referring to the thigh or knee, pain while lying on the affected side, pain with specific activities such as walking or climbing stairs, and weakness in the gluteal muscles.

Physiotherapy Management of Trochanteric Bursitis

Conservative management, including physiotherapy, is the first-line treatment for trochanteric bursitis. The focus of treatment is initially on reducing acute symptoms, followed by a gradual loading program to build tolerance to activity.

Physiotherapy management may involve:

• Activity modification: Reducing activities that place a load on the gluteal region, such as walking on unstable surfaces or excessive standing on one hip.
• Anti-inflammatories: Depending on the extent and type of symptoms, anti-inflammatories may provide relief, particularly in cases of primary bursitis without tendon involvement.
• Education: Understanding proper load management and adopting an active approach to therapy.
• Exercise: Starting with light exercises, such as isometric or static strengthening around the hip region, and gradually progressing to glute strengthening, lumbopelvic control, core strengthening, and motor control of the hip and lower limb.
• Gradual reintroduction of loading: Once symptoms have subsided, a controlled return to activities such as walking or running may be recommended.

Other Management Options

In cases where conservative therapy fails, cortisone injections may be used to settle symptoms or allow a return to normal activity. 

Platelet-rich plasma (PRP) injections have limited evidence to support their use for bursitis-related pain. Surgical intervention, such as bursectomy or release of the iliotibial band (ITB), is rarely required for bursitis symptoms.

Get The Help You Need

Early assessment and treatment improves outcomes, therefore it is important to consult with a healthcare provider. A proper diagnosis and individualised treatment plan can help manage trochanteric bursitis effectively.

Remember, prevention and early intervention are key in managing bursitis. Maintaining a healthy lifestyle, practising good posture, and avoiding repetitive motions or activities that put excessive stress on your hips can reduce the risk of developing bursitis. Don’t let hip pain limit your daily activities. Seek appropriate treatment and get back on track to a pain-free life at Coast Sport.