Dr. McCauley May 2014
Physical Therapist Guide to Greater Trochanteric Bursitis
Greater trochanteric bursitis, also known as greater trochanteric pain syndrome, is one of the most common causes of hip pain. While greater trochanteric bursitis affects both active and inactive individuals, it is most common in moderately active, middle-aged females or those who have recently increased their activity level. In all individuals, pain on the outside of the hip from greater trochanteric bursitis can result in a limited ability to lie on the involved side, walk, climb stairs, squat, or participate in recreational activities. To treat greater trochanteric bursitis, physical therapists typically prescribe a combination of stretching and strengthening activities to decrease irritation in the hip and resolve pain.
What is greater trochanteric bursitis?
Greater trochanteric bursitis is an irritation of the bursa, a fluid-filled sac that sits on top of the greater trochanter, a bony prominence on the outside of the hip bone (femur), the most outside aspect of the hip. The bursa acts as a cushion to decrease friction between the outside of the hip bone and muscles attaching to the bone. Greater trochanteric bursitis results when the bursa on the outside of the hip becomes irritated.
Most often, greater trochanteric bursitis is the result of repetitive friction to the bursa. This repetitive friction is due to a combination of muscular weakness and tightness that causes increased friction on the outside of the hip, and is most often treated with physical therapy to decrease irritation.
Greater trochanteric bursitis may result from a combination of several different variables, including:
• Iliotibial (IT) band tightness (a thick band of tissue that runs along the outside of the leg from the pelvis to the knee)
• Hip muscle tightness
• Hip muscle weakness
• Abnormal hip or knee structure
• Abnormal hip or knee mechanics
• Improper technique with repetitive activities
• Change in an exercise routine or sport activity
How does it feel? You may experience:
• Tenderness to touch on the outside of the hip
• Pain when lying on the involved side
• Pain in the hip that may at first feel sharp, then change to a dull ache, and may radiate into the side of the leg
• Tightness in the hip
• Pain and stiffness with prolonged sitting, walking (worst with the first few steps), negotiating stairs, or squatting
How is it diagnosed?
Your physical therapist will review your medical history and complete a thorough examination of your hip, and possibly your lower back, knee, and foot. The goals of the initial examination are to assess the degree of the injury and determine the cause and contributing factors to your injury. Greater trochanteric bursitis may be the result of a single injury, such as a direct blow to the outside of the hip, but most likely is a condition that develops as a consequence of repetitive irritation. Your physical therapist will assess the mobility and strength of your hip, and may watch you walk, step onto a stair, squat, or balance on 1 leg. The therapist will also gently touch the front, side, and back of your hip to determine exactly where it is most painful.
Your physical therapist may also ask questions regarding your daily activities, exercise regimens, and footwear to identify other contributing factors to your pain.
How can a physical therapist help?
You and your physical therapist will work together to develop a plan to help achieve your specific goals. To do so, your physical therapist will select treatment strategies in any or all of the following areas:
• Pain. Many pain-relief strategies may be implemented; the most common one is to apply ice to the area. A period of decreased selective activities may also help.
• Range of motion. Your back, hip, or knee joint may be moving improperly causing increased tension at the greater trochanter. Self-stretching techniques may be applied to the lower body to decrease tension and help restore normal motion in the back, hip, and knee.
• Manual therapy. Your therapist may treat your condition by applying hands-on treatments to move your muscles and joints in order to improve their motion and strength, most likely in your back or hip. These techniques often address areas that are difficult to treat on your own.
• Muscular strength. Muscular weaknesses or imbalances can result in excessive strain at the greater trochanter. Based on your specific condition, your physical therapist will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremity. You may begin by performing strengthening exercises lying on a table (eg, lifting your leg up while lying in different positions). You then may advance to exercises in a standing position (eg. standing squats). Your physical therapist will choose what exercises are right for you based on your age and physical condition.
• Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension on the hip and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your own unique movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely.
• Patient education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as exercise selection, the amount of exercise you do, or faulty footwear. The therapist will assess you and recommend improvements, and develop a personal exercise program to help ensure a pain-free return to your desired activities.
Physical therapy promotes recovery from greater trochanteric bursitis by addressing issues such as pain and any lack of strength, flexibility, or body control. Your physical therapist may also recommend a period of relative rest, then help you slowly resume activities, and carefully guide your progression. When greater trochanteric bursitis remains untreated, however, your pain will persist and result in long-term difficulty performing your desired activities.