It’s not hip to have hip bursitis
Have you noticed pain in the side of your hip? Is lying down on your side painful at night? Perhaps standing up after you’ve been sitting for a while is painful and stiff? If any of the above ring true, you may have hip bursitis. Although there are many reasons for hip pain, hip bursitis is one of the most reasons patients seek treatment.
What is hip bursitis?
A bursa is a small sac of fluid that is usually located in parts of the body where a lot of movement occurs. The bursa acts as a cushion and reduces friction within the body, allowing tendons, ligaments and muscles to glide over bones and other structures when we move. Occasionally, the bursa can become irritated and inflamed if there is excessive movement or pressure around it, leading to bursitis.
However, recent research has shown that the inflammation may only be part of the problem, and that some patients have little to no inflammation at all. The pain may also be due to other structures like the muscles and tendons becoming overly sensitive to movement and pressure. As such, we favour the term greater trochanteric pain syndrome (GTPS) to describe pain on the outside of the hip.
What does hip bursitis/GTPS feel like?
Patients with hip bursitis often report the following:
· Pain when going up or down stairs
· Pain when lying on the affected side
· Pain with prolonged standing or walking
· Pain when sitting cross-legged
· Tenderness when pressing against the hip bone
· Pain and stiffness when moving after sitting for long periods
If you’re nodding along to each point above, you may have hip bursitis! Activities such as walking, going up or down stairs, and standing require contraction of the muscles on the side of the hip. This places a lot of tension on the tendons and can increase pressure on the bursa. If one or more of these structures is sensitive, this can lead to pain with those activities.
Should I get a scan?
That depends! In order to diagnose bursitis, you need to know that there is inflammation of the bursa. An ultrasound or MRI scan are the most common ways of investigating this. However, imaging is not necessary to finding the solution to your hip pain. That’s because you are more than just your scans, and the inflammation is only one piece of the puzzle. Sometimes, there are other issues that need to be addressed such as muscular strength or endurance, range of motion deficits, and load management.
What should I do?
Seeing a physiotherapist to have a thorough assessment is a good first step to managing your issue. Your physiotherapist will ask you questions about what activities bring on your hip pain, the duration of the problem, and questions to rule out other conditions. A physical assessment will also be performed, which involves looking at your movements and measuring things like hip strength and range to see if they need to be addressed. Having all this information will help your physiotherapist identify what’s contributing to your condition and what solutions you require to successfully address your hip pain.
What does treatment involve?
Your physiotherapist may recommend small adjustments to your daily activities to help reduce pressure on the hip. This may include sleeping on the unaffected side with a pillow between the knees, or sitting with your feet flat on the ground instead of crossed over. These small changes can sometimes make a big difference and provide effective short-term pain relief!
We also recommend an exercise-based treatment program to help work on the muscles on the side of the hip. Whilst doing exercise may seem like the opposite of what you want to do with a painful and sensitive hip, we make sure to choose exercises that are tailored to your level. Making the right exercise choice can make a big difference by allowing you to strengthen the hip whilst also reducing pain and discomfort!
What about a corticosteroid (cortisone) injection?
Some patients may have been recommended a cortisone injection by their GP to help reduce inflammation. Whilst research suggests that cortisone injections can provide better short-term relief compared to exercise, exercise is superior in the long-term (Rompe et al., 2009).
Corticosteroid injections have also been shown to result in some negative side effects such as early degeneration of tendons. As such, we don’t recommend cortisone injections as first line treatment for this type of hip pain given the available research and guidelines.
When will my hip pain get better?
The short and long answer to this question is: It depends. How long you’ve had your pain, whether it affects one or both sides, your occupation, activity goals, and many other factors will affect how you respond to treatment. It typically takes time for muscles and tendons to become stronger, so sticking with a program for at least four to six weeks is a good idea.
This sounds a lot like my hip problem!
If your hips aren’t lying to you, or if you’re unsure and would like a thorough assessment, call us now on 1300 738 609 or book online with one of our physiotherapists! Let us help you find your Solution!