Hip bursitis is a very painful condition in which a bursa sac inside of the hip becomes irritated and inflamed, affecting the bursa and the soft tissue around it. A bursa is a sac of synovial fluid, rich in protein and collagen that acts as a cushion to protect soft tissue, such as tendons, ligaments and muscle, from friction and excess pressure.
We have over 150 bursae in our bodies with most of them located in our joints. Bursae in the hip include the greater trochanteric bursa, deep trochanteric bursa, the iliopsoas bursa, gluteal medius bursa, ischiogluteal bursa, and ischial tuberosity bursa located in the back of the joint. The 3 most common types of hip bursitis occur in the greater trochanter bursa followed by the iliopsoas bursa and ischial bursa (also called the ischial bursa).
There are 2 different kinds of bursitis - "septic" and "aseptic" bursitis. If your bursa becomes infected, it's known as "septic bursitis". Septic bursitis is not something to take lightly, as an infected bursa can spread infection throughout the body and become life-threatening. Consult your physician if you think you have septic bursitis as only they can confirm the condition and prescribe proper treatment options.
"Aseptic bursitis" will happen when your bursa isn't infected but your bursitis has been caused by inflammation from another soft tissue injury. For hip bursitis this might mean that you've hurt some of the tissue around your hip from a trauma (like a fall).
Anyone can injure their hip badly, though the bursae in the hip are most often injured from overuse or as a result from excessive strain (even a traumatic accident or fall). Adults over the age of 40 most commonly get hip bursitis (reference: 1).
Poor posture, hip joint degeneration (arthritis, osteoarthritis), auto-immune disorders (gout, psoriasis, thyroid disease), previous surgical intervention, hip bone spurs / calcium deposits and and leg-length inequality (one leg is shorter than the other) are all common causes of hip bursitis (reference: 1). Basically, any type of injury or condition that alters the way you walk, stand or sit can lead to a change in the position of the bones and tissue in your hip joint - and these changes in positioning can result in hip bursitis. Hip injuries, especially degenerative conditions like osteoarthritis or arthritis, can also be hereditary, you may notice more problems with your hip if you have older family members that have suffered from hip injuries in the past.
Everyone can be affected by degeneration of their hip over time. As we age, our tissue ages too. Any repetitive or frequent movement can place stress on the bursae in your hip over the years. This includes restricted movement due to sitting at a desk job for years, or even physical activities on the weekend. You need to be aware that this injury can happen to anyone and is not just isolated to athletes!
In most cases, mild to moderate hip bursitis can be treated through conservative treatments outlined by a physician.
Recovery from hip bursitis can take a long time but proper healing is essential to regain strength and get you back to the activities you enjoy. Complete recovery can be easily delayed by re-injury to the tendons, ligaments or other soft tissue in your hip.
It's almost impossible to keep from re-injuring the soft tissue in your hip - especially if you suffer from hip bursitis due to an overuse injury. If you don't take care to modify and reduce your activities you will always be at risk of re-injury. Sometimes though, it's just not possible to stop everything and rest the injury properly. What ends up happening is we continually re-injure tissue in the hip through our work and daily activities and suffer through on-going flare-ups of hip bursitis - Further setting back our recovery.
Continuing movement means that 100% recovery is nearly impossible without a proper treatment protocol. Eventually, if left untreated, you might have chronic inflammation of your bursa and/or surrounding tissues and treatment becomes even more problematic at this point (you might need surgery to remove your bursa).
The trochanter bursa functions to prevent the iliotibial band (IT band) from rubbing against the greater trochanter of the femoral head. The IT band runs from the iliac crest (crest of the pelvis) down the side of the hip and leg, and inserts at the upper tibia (top of the knee.) It is mainly used along with the gluteus maximus for bracing the leg and knee when in the standing position. Trochanteric bursitis most often results from the iliotibial band (IT Band) tightening and rubbing against the bursa.
The IT band is made up of thick, fibrous tissue that is considered connective tissue similar to a tendon. When it becomes irritated or inflamed, it can irritate the trochanter bursa causing inflammation within the bursa. Therefore, sufferers of iliotibial band syndrome (ITBS) may experience trochanteric bursitis at the same time.
Trochanteric bursitis is often used as a general term to describe pain around the greater trochanteric region of the hip and is often confused with Greater Trochanter Pain Syndrome (GTPS). Trochanteric bursitis is ONE of many component that make up GTPS - the other notables relating to conditions that cause pain in the lateral side of the hip.To learn more about trochanteric bursitis, click here.
The iliopsoas bursa lies between the front of the hip bone and the iliopsoas muscle, helping reduce friction between this bone and muscle. This bursa usually becomes inflamed due to overuse of the iliopsoas muscle. Overuse can tighten the muscle, causing more pressure on the bursa when the hip is flexed. Iliopsoas bursitis can be mistaken for tendinitis or hip arthritis because of the location of pain and other symptoms.To learn more about iliopsoas bursitis, click here.
The ischial bursa is located at the bottom of the ischium (lower hip bone). It cushions the gluteus maximus muscle from the ischium when sitting on hard surfaces or when sitting for long periods of time. Ischial bursitis may cause back pain and due to the location, it is often mistaken for sciatica pain.
Important: In some cases, an inflamed bursa may become infected with bacteria (referred to as septic bursitis) and this can quickly become life threatening! In all cases where you suspect you may have bursitis, see a physician for full diagnosis. If the bursa is septic, getting to a doctor quickly may save your life.
There are two types of bursitis: chronic and acute. Chronic bursitis is caused by overuse or repetition of a certain area or joint. It will develop over time, and will likely get better and flare up over a long period of time. Acute bursitis is often the result of a trauma to the hip, such as a fall. It can also result from a simple movement such as lifting and twisting the wrong way or may come on quickly following irritation during hip surgery.
Some suffers cannot recall what triggered the hip pain, which is why some will not seek treatment, hoping it will resolve itself. However, it is always wise to address and treat hip pain as soon as possible so that the problem does not worsen.
A healthy trochanter bursa is usually about the size of a small plum, but can swell to the size of an orange when bursitis sets in. This is what creates the soft tissue damage in the area. Other symptoms you may experience include:
Bursitis of the Hip has been found to be statistically more prevalent in cases where the sufferer is involved in, or experiences one or more of the following factors:
If you have hip bursitis, you will mainly feel pain and experience swelling right at the side of your hip. The side of your hip will feel tender at first and you may feel pain when you press on the outside of your hip. Pain can sometimes radiate down the outside of your thigh or into your butt.
The pain you'll feel for acute (short-term) vs. chronic (long-term) hip bursitis will be different. In the beginning you might feel a sharp, intense pain at your hip. The longer you have this injury the more this pain will spread out into more of an achy feeling. One clear sign that you've re-injured your hip while recovering from hip bursitis is feeling that sharp, intense pain again if you've overworked it.
If you feel more pain at night while lying on your injured hip or performing activities like walking, squatting / bending down and climbing stairs then you might have a moderate case of hip bursitis.
You may even notice an intense pain while getting up from a seated position - especially if you have a desk job, spend a lot of time seated on the couch or a kitchen chair during your "down time" or drive in your car for long distances.
Over time, if left untreated, you will start noticing more and more constant pain and have trouble sleeping at night. As I mentioned before, if this injury is left untreated you might need to get your bursa removed through surgery (a bursectomy). You might even suffer from "septic" bursitis - where your bursa gets infected by bacteria (see a doctor right away if you suspect your bursitis is septic. On-going pain, chronic swelling, or symptoms of an infection (fever or a general sick feeling) should be treated immediately by a doctor.
Time is not kind on an immobilized joint - you lose strength in your hip but worse than that, you lose the range of motion from atrophy (your flexible tendons, muscles and ligaments slowly shrink / waste away, decreasing joint elasticity). The more time that goes by with your hip immobilized, the more likely you'll wind up with a chronic hip problem (long term injury such as tendonitis or chronic inflammation / bursitis pain). Basically it means that your hip won't perform as well as it once did and it becomes more prone to injury again later on.
If you have an inflamed bursa in your hip, it's very important to heal it quickly and completely. Minimizing the healing time of your hip bursitis should be an obvious goal, as hip bursitis will limit your ability to go about your daily routine. As stated here (MedicineNet.com), if your long-term (chronic) hip bursitis is left untreated, calcium deposits can form within the bursae. These calcium deposits can lead to permanent stiffness in your injured hip.
Dealing with continuous re-injury, chronic inflammation / swelling and the possibility of getting calcium deposits means you'll have a greater chance of winding up with a chronic hip condition or a serious case that needs to be resolved with surgery.
You need to avoid chronic inflammation and the potential for developing calcium deposits. If you don't, your hip bursitis injury may plague you forever. This is why it's so important to continuously use conservative treatment tools to heal any recurring soft tissue damage and swelling from your bursa before it can build into something big. For any hip bursitis sufferer, having the right tools makes all the difference.
Relieving the symptoms of bursitis initially focuses on keeping the pressure off the bursa. Surgery may be required if your bursa irritation is a result of a bone formation problem, such as a bone spur. If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and prescribe antibiotics to treat the infection. For non-infectious bursitis, the preliminary treatment starts with non-operative options such as cold compression via use of a Cold Compress or Ice Pack.
The most important factor in healing bursitis is resting your hip. This can be difficult when you have to carry on with daily activities, but resting whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that stress your bursa until your pain and inflammation settle.
Treatments should involve decreasing swelling, relieving stress on the hip joint, correcting any bio-mechanical dysfunction (uneven leg length, bone spur, etc.), treating scar tissue, and then finally restoring strength and movement in your leg and hip. T•Shellz Wraps® are recommended once inflammation has been calmed as these wraps are intended to enhance localized blood flow (the conduit for the body's internal soft tissue healing mechanism) and the warmth generated from the wrap is intended to increase flexibility of soft tissue in the treatment area as well.
To decrease inflammation and relieve the pain of trochanteric bursitis doctor's recommend cold. Applying cold to your inflamed bursa is the first step in treating bursitis - basically it gets the swelling down.
Once the inflammation of your bursitis has been reduced with cold it is time to take the next step in bursitis treatment. Use a Back/Hip T•Shellz Wrap® to improve blood flow while simultaneously helping surrounding soft tissue to become elongated and more elastic. What this means is that not only is increased blood flow helping the bursa and surrounding soft tissue to heal, the tendons/muscles/ligaments that were rubbing on your bursa are now longer and more elastic. The T•Shellz Wraps® are basically the perfect bursitis treatment - helping reduce friction and rubbing on the bursa while healing at the same time!
NSAIDs, non-steroidal anti-inflammatory drugs, can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties and increase the risk of cardiovascular disease. The T•Shellz Wrap®, when used in conjunction with NSAIDs can greatly improve the effect of the medication; this can not only help you heal quickly but also reduce the amount of NSAIDs that you ultimately may require.
Your doctor may aspirate your inflamed bursa. This involves removing the extra fluid that has built up with a needle. Sometimes, the fluid will be tested at a laboratory to rule out infection.
If your bursitis does not get better with conservative treatments, the bursa may be surgically removed. Usually this is done by hip arthroscopy, which is a surgical procedure where tiny incisions are made and a pencil-sized camera is inserted into the hip. A small shaver is inserted into another incision, and is used to remove the swollen bursa all together. The surgeon will then look for any damage to the hip and make repairs if necessary. This is also done to remove any bone spurs.
Recovery time for the surgery will depend on a number of different factors including your healing ability, diet, rest and how many procedures were done in your surgery.
Post-op recovery time can be reduced with the use of Cold Compress or Ice Pack and a T•Shellz Wrap® following surgery. Cold compression is recommended by doctors after surgery to treat your pain in a natural, non-addictive way and to reduce swelling. Once the incision has healed, speak with your doctor about the use of a T•Shellz Wrap®. The T•Shellz Wrap® encourages more oxygen and nutrients to flow to the area to speed healing and improve the strength of the soft tissue in your hip. Using the T•Shellz Wrap® as soon as you can following your surgery will help prevent and minimize the scar tissue that forms as you heal. Treating scar tissue is the most important step following surgery, especially in a joint, to improve the range of motion in your hip. Leaving the scar tissue untreated can lead to stiffness, chronic hip pain, osteoarthritis or other chronic conditions.
Read more about Bursitis Surgery here.
PT is a beneficial way to restore atrophied muscles and improve strength and mobility after treating bursitis. The type of PT and the duration will be dependent on the tissue damage and your symptoms. When you are treating or recovering from bursitis, it is important to ensure you do not perform any exercises that will further irritate the bursa.
Once your pain starts to diminish, a physiotherapist will set up an individualized strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return to performing your normal routines.
Individuals will often lift weights on their own, to try and build up their strength. However, in doing so, they can do more damage to their joint. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is appropriate and effective. For best, long term results use T•Shellz Wraps® at home, in conjunction with PT and an exercise program.
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