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Hip Bursitis
A common cause of hip pain
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About bursitis of the hip (Trochanteric Bursitis)

Bursitis of hipsA bursa is a jelly-like sac that protects and cushions your joints. In bursitis a bursa becomes inflamed. When inflammation occurs, movement of the joint or pressure on the bursa is painful.

You can get bursitis in your shoulders, elbows, hips, knees, heels and big toe.

Bursitis sometimes occurs in conjunction with tendinitis, which is inflammation or irritation in the cord (tendon) attaching muscle to bone.


Symptoms

The main initial symptom of hip bursitis is sharp pain and tenderness in the area indicated by the yellow arrow. Later in the course of bursitis, the pain may become more generalized and achy.

Typically, the pain is worse at night, when lying on the affected hip. It may be worsened by getting up from a chair after being seated for a while, prolonged walking, stair climbing, or squatting.

Causes

Common causes of bursitis include injuries, overuse and repetitive pressure on the bursa or stress on the joint. The pressure from standing or sitting for a prolonged time may lead to bursitis of the hip. Aging is thought to cause the bursa to break down over time. Certain diseases, such as arthritis and gout, also cause bursitis. At times the cause may be unknown.

Treatment

Rest the joint and avoid any activity or direct pressure that may cause pain as much as possible. Walking up stairs often aggravates hip pain. Change the way you do any activities that may aggravate the pain or put strain on the joint and muscles. Sitting on a cushioned chair or foam donut may help decrease the pain. Wear comfortable shoes with good support that fit you well. When the pain decreases, begin normal, slow movements.

Apply ice Local application of ice for 20 minutes as often as every 2 hours. (If ice is very cold, apply only for 10 to 15 minutes) This is very helpful in controlling pain, inflammation, and facilitates healing. It's especially helpful to apply ice after any activity that uses the affected muscles or aggravates the condition. There are a variety of ways to apply ice: ice packs or bags purchased at the drugstore are convenient, an iced towel wrapped around the elbow is effective, or even a frozen bag of vegetables works well as a last resort.

Medicine to relieve the pain and inflammation: unless contraindicated. Ask your doctor if these are safe for you

  • Over-the-Counter: For children always ask your pediatrician
    • Ibuprofen (Advil) Useful for minor arthritic pain, fever, headaches, minor aches and pain. Always take with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions dehydration, pregnancy, nursing mothers. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with ibuprofen.
    • Naproxen Sodium (Aleve) for minor arthritic pain, headaches, minor aches and pain. Should be taken with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with naproxen. Not recommended for children. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions gastrointestinal disease, liver or kidney disease, dehydration, pregnancy, nursing mothers

Gentle exercises and stretching help prevent stiffness. For exercises go to: Taking Care of your Hip from the American Physical Therapy Association.

See a physician or nurse practitioner if the above measures don't relieve the pain. Pain in the hip can be caused by a number of conditions, some which can be serious and require medical intervention. If the pain is caused by bursitis, a physician may recommend the following:

Local injection of a corticosteroid by your physician or nurse practitioner may be helpful in relieving symptoms of hip bursitis. Severe bursitis is sometimes treated by your physician by removing extra fluid from the bursa with a needle. Both of these procedures can be done in the doctor's office.

Physical Therapy: Physical therapists can be very helpful in relieving the pain and inflammation from bursitis. They might use such methods as ice, heat, or ultrasound to treat the inflammation. Physical therapists can also start you on a program of stretching and strengthening your hip muscles to relieve the inflammation and help prevent recurrence.

Occasionally bursitis is caused by an infection. In that case you would need to take antibiotics. Surgical drainage is sometimes necessary in rare cases.

Prevention

  • Avoid or modify the activities that cause the problem. Underlying conditions such as improper posture or poor technique in sports or work must be corrected. Leg length differences can cause hip and back pain.
  • Lose weight if you're overweight
  • Stretch before you exercise (see below)
  • Strengthen your muscles
  • Take regular breaks when you do repetitive tasks
  • Warm water exercise: A recent study has found that aerobic and stretching exercises in warm water can bring relief from pain and improve daily function for those with osteoarthritis of the hip or knee.
  • If one leg is longer than the other leg, a proper fitting shoe insert in the shorter leg can help hip pain. But always consult with your physician before doing this.

Stretching reduces muscle stiffness and helps keep joints flexible. Never stretch muscles when they're cold, as this can lead to injuring the muscle. Stretching cold muscle is like stretching cold gum. Either stretch after a 5-minute warm up or stretch after you exercise, when your muscles are warm and more conducive to stretching. Iif you plan to stretch only after your workout, increase the intensity of the activity more slowly than you would if you had stretched your muscles before exercising.

If you have hip pain, only do these stretches after consulting with your physician.

Thigh Stretch: Hold on to something for balance. Standing on one leg, grasp the foot of the other leg. Keep your knee pointing down. Pull up with light pressure. You should feel the stretch in the front of the thigh.  Do not arch your back. You do NOT need to pull up all the way to your buttocks. If it feels uncomfortable or painful, you are putting too much strain on the knee joint.

Hold your foot in this position, behind you for 30 seconds, then relax.  Repeat this stretch 3 times for each side. 
Thigh stretch Groin Stretch: Stand with your legs apart. Shift your weight to one side, bending your knee somewhat. Do not let your knee bend beyond your ankle. You should feel the stretch in your opposite leg, which remains extended. Both of your feet stay flat on the ground facing forward. Hold this stretch for 30 seconds then relax. Repeat 3 times on each side.
Groin Stretch


Read more about bursitis of the hip

Taking Care of Your Hip from the American Physical Therapy Association. This is a 6-page, well-illustrated educational tool including anatomy and valuable exercises for the hip.

Hip Bursitis from the American Academy of Orthopedic Surgeons This is a 5-page, patient information overview of the causes, symptoms, and treatment of trochanteric bursitis. Hip exercises are not included.

--Compiled by N Thompson, ARNP Last updated January 2008

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