Trochanteric hip bursitis is an overuse injury at the hip which is common in runners. Bursitis is a
condition which can occur at many locations throughout the body. “Bursitis” basically means inflammation of a bursa. Bursa’s are small sacks of fluid which are found between bones and overlying soft tissues, particularly tendons. Their job is to protect the soft tissue from the repeated friction of rubbing against the underlying bone. But because of this, the bursa itself can sometimes become inflamed.
There are numerous bursa’s around the hip joint, but probably the most commonly injured is the Trochanteric bursa which sits on the outside of the hip, towards the back – over a bony lump known as the greater trochanter. It separates this bony protrusion and the IT band which lies over the top.
Symptoms of trochanteric hip bursitis
Symptoms may include pain on the outside of the hip which is worst after running for a while and after a run. It may even be bad for a few days after. The pain sometimes radiates down the outside of the thigh and it is often tender to press into the outer / back hip area. Other than running, climbing stairs and laying on that side may cause a problem.
The cause of trochanteric hip bursitis is usually overuse and repeated friction, often as a result of faulty biomechanics. Occasionally it can be caused by a sudden impact to the hip such as a fall when skiing or playing other sports, or during accidents. But, on this website we’re talking about running, so in this case it’s an oversue injury!
As with many running injuries, hip bursitis is more common in women and is once again down to our child bearing hips! The wider pelvis causes a biomechanical difference in our running pattern when compared to men which tends to result in a knock-kneed appearance known as hip adduction (this is where the hip allows the thigh and knee to fall inwards). Because we have wider hips, women need strong hip abductors to prevent this excessive hip adduction! By the way, this can also apply to men! It is not exclusive to women, just more common!
So a reduced hip abduction when running due to weakness in the hip abductor muscles tends to result in an increase in tension in the IT band, which, as discussed lies over the top of the trochanteric bursa. An increase in tension here can result in additional compression and so friction on the bursa and hey presto – the bursa becomes inflamed!
There are other factors which can contribute to the development of this condition, such as overpronation, leg length differences, running on cambered surfaces etc, as well as the good old “too much, too soon” mantra.
Treatment of trochanteric hip bursitis should as usual focus on resting and reducing inflammation, followed by correcting the cause of the injury.
If you suspect this injury is the cause of your pain, rest from running and seek medical attention from a sports injury specialist. In the meantime, you can apply an ice pack regularly to help ease pain, warmth and inflammation.
If your specialist agrees that the cause of your pain is trochanteric hip bursitis, then there are numerous treatments they may provide and suggest to you:
- Anti-inflammatory medications on a short term basis
- Stretching and foam rolling the IT band
- They may also perform myofascial release to the ITB
- Some therapists may use acupuncture which can be effective
- Hip abduction exercises such as the clam
- Gait analysis is often a good idea to check running shoe suitability
- Non-weight bearing exercises can be performed to maintain fitness
Returning to Running
Only consider returning to running once the hip is pain free on a daily basis. Ensure you have seen improvements in the hip abductor strengthening exercises and you have had your leg length and running gait assessed. When you do return, only run on flat surfaces.
As with most injuries, it is a good idea to start running again on a treadmill or at a track, if possible. This is because it allows you to stop immediately if you do feel any pain without having to worry about running home!
Start with a very short run, say 10 minutes. Then rest for 2 whole days and continue with strengthening / stretching exercises. Provided there was no pain at the time of running and the injury does not flare up again, try another 10 minutes. Rest for a further 2 days and if all is still well, try a little longer – 15-20 minutes. Continue in this manner, with at least 2 days rest inbetween runs and only gradually increasing the time spent running, until you are back to your full routine without pain. If you feel any pain, stop and go back to the rehab phase!