Hip Bursitis – Diagnosis and Treatment
Have you got a sharp pain on the outside of your hip? It could be trochanteric bursitis.
Let's start with a quick anatomy lesson. The bit of bone that sticks out at the side of your hip joint is called the "Greater Trochanter"
A bursa is a small sack of fluid that provides a cushion and reduces friction between the surfaces of a bone and soft tissue. You have a lot of bursa dotted around the various joints in your body.
A bursitis - means that a bursa is inflammed and swollen (and usually painful).
There is a bursa on the outside of your hip called the Trochanteric Bursa. It is often simply referred to as the "hip bursa"
The trochanteric bursa can become inflammed from a variety of different potential causes, the main three being
- Poor running technique
- Poor hip and pelvis stability
- Tight quad, hip flexor and glute muscles
The ITB is a thick band of fascia (fibres) that originate from the gluteus maximus and tensor fasciae latae (hip flexor) muscles. When these muscles are overused, or not used correctly, they can cause the ITB to rub on the bursa which is what causes the bursitis and the pain.
If you're wondering whether this is the correct diagnosis for your hip injury, then it should be fairly easy to work out. There is usually a specific tender spot right on the bony bit on the outside of your hip. They usually hurt to lie on, because they don't react well to the direct pressure. It often feels like a sharp or stinging pain, a bit like you are pushing on a bruise.
How do you fix it?
Because there are a number of different potential causes of hip bursitis, there isn't a one-size-fits-all cure. You have to be able to assess your individual strengths and weaknesses and work out which areas of your body need to be addressed. It might be your running technique, it might be lazy glutes, it might be stiff ankles, or it might be a little bit of everything.
There are a series of self- tests that I recommend runners undertake to help diagnose an ITB injury. Because a trochanteric bursitis is effectively caused by the ITB, then the same series of tests are equally relevant.
TEST 1: RUNNING TECHNIQUE
One of the biggest contributing factors to hip pain and bursitis is poor running technique.
The three most important aspects of running technique that you should be aware of are:
- Stride Length
Posture: You should stand up tall when you run and avoid bending forward from the hips. Standing tall helps to shorten your stride length, and also improves your ability to breathe as it opens up the chest and allows your diaphragm to work more efficiently.
Cadence: Cadence refers to the number of steps per minute you take. There is a range of cadence which is thought to be most efficient for humans. This range is between 175-185 steps/minute. Read THIS ARTICLE about cadence, to learn more, and to find out exactly how to measure and improve yours.
Stride Length: By stride length, I am referring to where your foot first contacts the ground in relation to where your bodyweight, or centre of mass, sits. One of the most common running technique faults I see is “overstriding” which means running with your foot landing out in front of your body.
TEST 2: SINGLE LEG STABILITY
Does your pelvis stay level when you bob up and down on one foot? If your pelvis drops and/or rotates when you bob up and down on one foot, then here is a good chance the same thing happens when you run. It just happens too quickly for it to be obvious.
- Watch THIS VIDEO which defines “core stability” or “pelvis stability” in a runner.
- Try the easy test in the VIDEO in this article to test your own pelvis stability and learn how to improve it.
TEST 3: STIFF ANKLES AND/OR CALF MUSCLES
Stiff ankles and/or very tight calf muscles can restrict how far forward your knee is able to travel over your toes when you run. If the range of movement through your ankle is limited, then once you reach that limit, it can make your knee drop inwards which in turn causes your pelvis to drop.
Having one ankle stiffer than the other is probably the single biggest biomechanical trait I see in runners which causes ITB and hip pain. One ankle might be stiffer due to an old ankle sprain or a calf muscle injury for example. It doesn’t have to be a recent one either. I often see runners with an ankle that was sprained 20 years ago who are completely unaware that it is stiff, let alone causing their injury.
Watch this detailed video on ankle mobility so you know how to test your own mobility and learn how to fix it.
TEST 4: TIGHT QUADS
Tight quad muscles, especially the lateral quads which run down the outside/front of your thigh, can contribute to ITB problems and lateral knee pain.
TEST 5: LAZY GLUTES
Our modern lifestyle where the bulk of our day is spent sitting, is a huge contributing factor to the muscular imbalances that occur in our body. These imbalances tend to lead towards the combination of lazy glute muscles and overactive and tight hip flexors and quads.
Think about your average day. How many hours do you spend sitting? Try and work it out. How many hours do you spend sitting:
- During breakfast
- Commuting to work
- At work
- At lunch
- Commuting home from work
- At dinner
- On the sofa watching TV or reading?
How many hours do you spend running, walking or moving every day?
It is often a scary ratio.
Our bodies are incredibly efficient at adapting to our environment. If you spend 10 hours per day sitting, and two hours per day moving, then your body is gradually going to become better at sitting than standing. This process starts from a surprisingly young age. The flexibility in the average 9-10 year old child I have treated is significantly less than the flexibility of the average pre school child. By the age of 9 or 10, sitting has already had an effect on the hamstrings, hips and ankle flexibility. Imagine what has happened by the age of 40 or 50!
You can do an easy test to find out if your glutes are “lazy”. Being able to “switch on” your glutes is essential if you are going to try to correct any imbalance which exists between your glutes and your quads.
Watch THIS VIDEO to learn everything you need to know about activating and strengthening your glutes
Before you start on any sort of glute strengthening program you need to master this glute activation exercise and learn to tell the difference between using your glutes and using your quads. A lot of health care professionals and personal trainers prescribe glute strengthening exercises like squats and lunges to people who are not actually able to consciously activate their glutes. This often exacerbates ITB and hip pain because the squats and lunges, in this case, add to the glute/quad imbalance rather than help it.
TEST 6: STIFF HIPS
Another common side effect of our modern lifestyle is stiff hip joints. Too much time spent sitting, and not enough time spent getting into positions which open up and stretch the muscles, ligaments and fascia around the hip joint (like the HG Squat for example) has led to stiff hip joints. Stiff hips can lead to further muscle imbalances which affect the ITB.
We have a number of stretches and exercises on The Locker Room dedicated to improving your hip mobility. You can learn all of them during a FREE 7 Day Trial
Our 3-Minute Morning Stretching Routine will also help to improve your hip mobility.
How quickly can you return to running following an ITB injury?
The answer to this question will differ from person to person depending on the severity and duration of your symptoms. Read THIS ARTICLE to find out how to reintroduce running in a safe a graduated fashion, to ensure you don’t accidentally return to quickly an undo all of the hard work you have achieved by identifying and eliminating the cause of your hip pain.
We also have a 10-Week Return to Running Program which includes everything you need to make a fast and safe return to running from hip pain.