Wednesday, March 22, 2023

Treatment For Hip Bursitis And Tendonitis

Hip Tendonitis Exercises & Treatment

Can My Hip Pain Heal? Arthritis? Bursitis? Tendonitis?

Typically reduction of activities, physical therapy treatments, modalities and gentle stretching & strengthening will help to treat hip bursitis. Additionally, evaluating underlying biomechanical alignment issues and faulty dance techniques or movement patterns is may be important to diagnosing and treating.

If you’re experiencing hip bursitis pain or are seeking an evaluation for hip pain, contact us today.

Who Is At Risk For Developing Hip Bursitis

Although hip bursitis can affect everyone, women and persons in their middle or late years are more likely to get it. Young adults, more commonly males, are less likely to experience it. The following risk factors have been linked to hip bursitis development.

  • Overuse Damage: This can happen when the patient runs, climbs stairs, rides a bike, or constantly remains in a fixed position or posture for an extended amount of time.

  • Hip Damage: When the patient falls onto the hip, hits the hip, or spends a lot of time lying on one particular side of the body, the patient runs the risk of suffering a hip injury.

  • Spine Disease: It encompasses conditions including scoliosis, lumbar spine arthritis, and other issues with the spine that may impair the ability to walk.

  • Leg Length Inequality: Having one leg that is noticeably shorter than the other impacts how the patient walks and may cause hip bursa inflammation.

  • Rheumatoid Arthritis: This increases the likelihood of bursal inflammation.

  • Prior Surgery: The bursa might get irritated and develop bursitis as a result of hip surgery or prosthetic implants in the hip.

  • Calcium Deposits or Bone Spurs: These can form inside the tendons connecting muscles to the trochanter. They could irritate and inflame the bursa.

What Scans Are Needed For Gtps Diagnosis

In short, most cases do not require any scans as the diagnosis is clinical. That is, the doctor or physiotherapist should be able to make the diagnosis based on the story of your pain and their examination. In cases that are not classic, imaging may be required. The commonest imaging modalities used include

  • X-rays to look for other causes of hip pain such as osteoarthritis
  • Ultrasound to directly look at the bursa and the tendons. Unfortunately the bursa and the tendons can be located quite deep under the skin and the quality of the image may be relatively poor. This is a particular problem if the patient is overweight
  • Magnetic resonance imaging also directly looks at the bursa and the tendons and is less affected by patient size
  • MRI Trochanteric Bursitis
  • MRI of gluteal tendinopathy
  • Lateral hip ultrasound

Although a picture of an unhappy tendon and bursa may seem useful for diagnosis, many studies have shown that patients will have similar abnormal findings in the other hip that has no pain! This makes interpretation of these abnormal findings tricky. Hence, diagnosis is usually clinical and imaging is reserved for those with atypical cases.

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How Does It Feel

With hip bursitis, the main symptom you may experience is pain on the outer side of the hip, thigh, buttock, or outside of the leg. That pain can worsen when getting up from sitting, such as from a low chair or car seat. Pain can also be triggered by:

  • Pushing on the outer side of the hip with your fingers.
  • Lying on the affected hip.
  • Climbing stairs.

What Is Greater Trochanteric Pain Syndrome

Trochanteric bursitis

Unfortunately, the longer these abnormal / compensatory movements are going on for due to the underlying gluteal tendinopathy, the more other structures can become overloaded and painful. Gluteal tendinopathy and trochanteric bursitis often co-exist with pain from other structures around the pelvis that are also being overloaded. These areas include the sacroiliac joint, hamstring tendons and the hip joint itself. Given the typical complexity of this type of presentation, these conditions are referred to under the umbrella term Greater Trochanteric Pain Syndrome .

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How To Get A Diagnostic

Your doctor will start by asking questions about your medical history and the origin of your pain.

He will also ask you when you began to feel pain and if it is related to a specific event or if the pain increases during your activities. Your doctor will also ask if you have had surgery in the affected area.

After discussing your medical background, your doctor will proceed to a physical exam. He will look at the affected area for redness, heat, or swelling. Your doctor will also be looking for bumps under the skin, which could indicate bursitis. He will then gently move the affected limb to determine whether tendonitis limits your movements.

Finally, your doctor might refer you for a medical imaging examination tailored to your condition, such as an ultrasound, arthrography, MRI, or CT Scan. This examination will allow your doctor to have a clear image of your inflammation and to give you a more in-depth diagnosis.

What Are The Symptoms Experienced By Patients With Hip Bursitis

  • Hip joint pain is the primary symptom of trochanteric bursitis.

  • Usually, the discomfort radiates to the outer part of the thigh.

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  • The pain is typically reported as being severe and powerful in the early stages.

  • Later, the discomfort could expand to a wider area of the hip and turn into more of an ache.

  • The discomfort typically intensifies at night, when sleeping on the affected hip, and when rising from a chair after a prolonged period of sitting. Long-term walking, stair climbing, or crouching may make it worse as well.

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When Should You Seek Medical Advice

Most cases of bursitis improve without any treatment over a few weeks. See your healthcare provider if you have any of the following signs or symptoms:

  • You experience pain that interferes with your normal day-to-day activities or have soreness that doesn’t improve despite self-care measures.
  • You have recurrence of bursitis.
  • You have a fever or the area affected appears red, swollen or warm.

In addition, see your doctor if you have other medical conditions that may increase your risk of an infection, or if you take medications that increase your risk of infection, such as corticosteroids or immunosuppressants.

Treating Tendonitis Or Bursitis

How to Self-Treat Pain On the Side of Your Hip. (Trochanteric Bursitis, Gluteal Tendinopathy)

The treatment of tendinitis or bursitis depends largely on the site of the injury. It can be as simple as limiting activity until you heal or as complicated as surgery for more serve cases. Treatment of both conditions typically includes:

  • Resting the affected area is the first step to healing. It involves avoiding aggravating movement and may require a splint or support to ensure the area is fully immobilized. Pain is the first sign that youre not giving the injured area enough chance to rest.
  • Applying an ice pack helps control the inflammation and decrease swelling. By minimizing both of these things, the tendons and bursa can return to their normal state.
  • Nonsteroidal anti-inflammatory drugs further help alleviate inflammation and pain. Advil , Aleve , and aspirin are popular choices. The analgesic Tylenol provides pain relief but doesnt reduce inflammation.
  • Cortisone injections may be used if the symptoms are persistent. Cortisone is a powerful anti-inflammatory drug that provides short-term pain relief but tends to be less effective as a long-term therapy. While cortisone can reduce the pain and inflammation associated with tendonitis, it can also weaken the tendon, making it prone to rupture. It is important to speak to your healthcare provider about the pros and cons of cortisone injections
  • Physical therapy can strengthen the surrounding muscles, alleviate stress on the affected area, and prevent a recurrence.

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How Is Hip Bursitis/gluteal Tendinopathy Treated


Most doctors prescribe a course of anti-inflammatory medication alongside regular icing and resting of the affected area as part of treatment for hip bursitis. Modifying your activity and resting the affected area is encouraged for all joint injuries. However icing can do more harm than good. Icing can reduce the amount of oxygen and nutrients delivered to the affected area, reducing blood flow and resulting in a slowed tissue healing process. This can also prevent waste products and toxins from draining effectively.

Anti-inflammatory medication can mildly reduce inflammation temporarily initially but paradoxically also reduce the tissue healing response as well as causing a multitude of side effects in other organs systems, in the body. They should not be used for more than a few days. Read more here.

Corticosteroid injections are commonly used as a treatment for hip bursitis, but do have the potential to create side effects such as pain at the injection site, nerve damage, skin discolouration and infection and tendon damage are also possible. They also do not promote tissue healing of the underlying gluteus group of tendons which accompany the bursitis and can hinder the healing process.

Patients who seek our help have often tried all of the above, to no avail.

What Are The Symptoms Of Hip Tendonitis

  • Tenderness/pain along the area of the tendon
  • Hip stiffness in the morning or after prolonged rest
  • Pain when utilizing the muscle that is attached to the tendon i.e. going up stairs
  • Pain may occur after progressing an exercise routine to quickly
  • Pain that may lessen early on in the day with movement, but then will get worse by the end of the day.

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Secrets To Get Rid Of Hip Bursitis Quickly And Naturally

By Dr. Brent Wells, DC

If you or someone you love have bursitis in the hip , you know how painful this condition can be.

Chances are that the only thing you are really thinking about is how you can stop the pain of bursitis quickly but naturally. No one wants to pump their bodies full of chemicals they dont need.

Today, we are going to talk about what bursitis is, why it hurts like the dickens, and best of all, little known ways that you can stop bursitis pain quickly, without resorting to pharmaceutical drugs.

Symptoms Of Hip Bursitis/gluteal Tendinopathy

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Symptoms may vary but generally include localised pain, tenderness and an inflamed sensation in the soft tissues of the buttock and over the hip bone, the bony prominence on the upper outer thigh. Pain can be sharp of searing, or a dull ache. Pain can worsen rising from sitting or lying, getting in and out of the car, climbing stairs or hills, and lying on the affected side causing disturbed sleep.

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What Is Hip Bursitis Or Greater Trochanteric Pain Syndrome

Hip bursitis, now termed Greater Trochanteric Pain Syndrome is part of a problem involving inflammation of the bursa and injury of the related gluteal tendons. The hip bursa is small fluid-filled sacs that separate and reduce friction between muscle and tendon around the hip. The bursae that are most commonly inflamed are the trochanteric bursa, ischial bursa and the iliopsoas bursa. These usually become inflamed as a result of the associated muscles and tendons of the hip becoming strained and injured.

Physiotherapy Exercises And Advice For Hip Pain And Bursitis

If you are experiencing pain on the outside of your hip, you may have been told that you are suffering from bursitis.

This is the term given to pain caused by irritation of the bursa, a fluid filled sac that sits on the outside of your hip between the tendons of your buttock muscles and the place where they attached to your thigh bone:

Traditionally pain felt over the outer hip is often diagnosed as bursitis but its actually far more common for the pain to be coming from tendons of the buttock muscle themselves.

This is a condition called gluteal tendinopathy, where accumulative strain builds up overtime in the tendons until the outer hip becomes painful.

If you are experiencing discomfort on the outside of your hip that has come on over time and causes pain on walking, climbing stairs, standing, siting with your legs crossed or sleeping on your side then its likely that you have gluteal tendinopathy. That said, its possible to experience both tendinopathy and bursitis of the hip at the same time. Fortunately the advice and exercises are the same for both conditions.

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What Is Tendonitis Of The Hip

Hip tendonitis is an inflammation injury that affects the hip flexor tendons. The tendons affected typically lie in the front of the hip. Although athletes and non-athletes can sustain various hip tendon injuries, it is most common with athletes who are dancers, cheerleaders or gymnast.

Hip bursitis is often developed from repetitive kicking type movements or strains. This is common with dancers who extend their leg out in front, to the side and/or way up in the air. These extreme movements have a tendency to create a pinching type affect which can cause injury or irritation in the hip.

Conservative Interventions For Hip Bursitis

Hip Pain Rehab Video – Hip Tendonitis and Hip Bursitis

Hip bursitis generally responds to self-care measures, such as rest, ice, and taking over-the-counter medications. However, if you cant get relief from any of these, your orthopedic specialist will turn to any or a combination of the following options to mitigate your symptoms:

  • Antibiotics- In addition to prescription anti-inflammatories, your orthopedic specialist may also give you antibiotics if your hip bursitis is caused by an infection.
  • Physical therapy- Your orthopedic specialist may refer you to a physical therapist, who will employ a combination of stretching, strengthening, and movement retraining activities aimed at relieving pain and helping restore normal function in your hip.
  • Cortisone shots- Your orthopedic specialist may also administer cortisone shots, possibly as an adjunct to your physical therapy program, to achieve the best results. Cortisone shots usually work quickly. In many cases, one shot is all you need.
  • Assistive device-Your orthopedic specialist may also recommend that you use an assistive device, such as a cane, to help reduce the pressure on your hip.

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Trochanteric Bursitis / Gtps Exercises And Physiotherapy

Physiotherapy treatment should be focussed upon reducing compression of the gluteal tendons and improving the capacity of the degenerated tendons.

To reduce compression and offload tight lateral hip structures, soft tissue techniques can be used. Techniques such as self trigger releases or dry needling may be effective in the short term but should never be the sole treatment. The best outcomes are achieved through addressing poor postural and movement habits and correction of muscle activation patterns. Treatments that have limited supportive science in the treatment of trochanteric bursitis include ultrasound, ice therapy, TENS and stretching of the ITB. Although stretching of the ITB sounds helpful in theory, anatomy lab studies have shown that the ITB cannot be stretched. To increase the length of the ITB it must be cut surgically. Furthermore, manoeuvres aimed at stretching the ITB can result in more compression and worse symptoms.

How To Treat Trochanteric Bursitis / Greater Trochanteric Pain Syndrome

GTPS is a stubborn problem with no quick fix, especially as most of us put up with symptoms longer than we probably should! GTPS can be effectively managed though but this often requires a longer timeframe than many musculoskeletal injuries. The most important part of management is a good assessment to determine which structures are involved and how they became injured. Then its necessary to establish a specific treatment plan to address these issues. Each individual is unique in their presentation so they will need a program designed for their particular set of symptoms and circumstances.

Understanding the why is very important. Usually there is a need to reduce load on the affected tissues by adjusting exercise or postural loads. For example, any activity that can be completed without causing pain is fine to continue. These activities range from working out at the gym to doing the grocery shopping. However, if symptoms are increased the next morning then this indicates that the load/activity needs to be adjusted to a more manageable level. Likewise, certain postures such a prolonged sitting, particularly in a low chair or couch, or propping on one hip while standing or holding a young child, place additional stress on the outer hip and can cause symptoms to persist. Even sitting or lying in bed with legs crossed over the midline will contribute to compressive loads and exacerbate symptoms.

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Heat And Cold Therapy

The Cleveland Clinic recommends both heat and cold therapy for tendonitis, depending on what outcome you are seeking. Heat therapyfor example, using a heat pack or wrapis better at relieving persistent, aching pain. Cold therapywhich can include anything from an ice pack to a bag of vegetables wrapped in a towelwill numb pain for short-term periods.

Be careful when using heat or cold therapy so that you dont accidentally worsen your pain. Placing the source of heat or cold directly against your skin, or leaving it in place for too long, can lead to burns. Generally, apply cold therapy for ten minutes at a time and heat therapy for twenty minutes at a time, unless a physician advises you otherwise.

Tips For Knee Bursitis Relief

What exercises should you do if you have hip pain?
  • Rest and avoid activities that aggravate your symptoms. Pain is a sign that you should stop what you are doing. This will help reduce inflammation and allow your body to heal.
  • Apply ice to your knee for 20 minutes at a time several times a day to reduce swelling and pain. Do not apply ice directly to the skin. Wrap it in a towel first or use an ice pack, which you can place directly on the affected knee.
  • Take over-the-counter anti-inflammatory medications such as ibuprofen or naproxen to reduce inflammation and pain. Be sure to only take them as directed. If you have any medical conditions, check with your doctor before taking these medications. People with heartburn, ulcers, GERD, kidney disease, heart disease, or high blood pressure should use these medications only under their doctors supervision. Long-term use of NSAIDs may lead to gastrointestinal bleeding, therefore it should only be used in the short term.
  • Use compression bandages around your knee area during periods of activity to limit stress on the knee. Compression sleeves and bandages can reduce friction between surfaces and cushion the knee.
  • Elevate your leg above heart level whenever possible. This helps gravity drain excess fluid from the joint and reduce blood flow towards it, which minimizes swelling.
  • Perform gentle physical therapy exercises approved by a physical therapist that strengthen the knee and keep the muscles flexible.
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