Trochanteric Bursitis

What Is It?
A bursae is a fluid filled sac that is in position in an area of great friction. For example, between a bone and a tendon muscle. A Trochanteric bursitis is the inflammation of the bursae that lies between the femur (the large bone of the upper leg) and the large tendon of the TFL (tensor fascia late) muscle.
How It Happens
Trochanteric bursitis is the most common bursae in the hip. There are many muscles such as gluteus maximus, tensor fascia latae, and the iliotibial band that surround and overly this bursae. Irritation of the bursae will occur if any of these structures become tight and cause excessive pressure directly on the bursae.
  • Localized pain over side of upper thigh at the hip joint
  • Gradual onset of pain
  • Pain with daily activities such as climbing stairs, crossing legs, sleeping on the affected side
  • Increased temperature in the local area
  • Painful to move leg out to side

X-rays would be negative. If the signs and symptoms of the bursitis were not presenting a clear diagnosis, an MRI would show an inflamed bursae, however this test is expensive and it is very rarely used to diagnose a trochanteric bursitis.

What Causes It?
  • Decreased flexibility of the iliotibial band. This is a band of connective tissue that spans
    from the bones of the pelvis to the outside of the knee
  • Habitual standing on one leg
  • An imbalance between the muscles that work to pull the leg out to the side (gluteus medius)
    and the muscles that work to pull the leg in towards the midline of the body. (adductor magnus, adductor longus, adductor brevis, gluteus maximus, quadratus femoris)
  • A broad pelvis
  • Running sports such as soccer that requires repeated movements of the leg toward the
    midline of the body
Why Does It Hurt?

There is either too much flexibility or too much rigidity in the foot. Both conditions result in localized inflammation at the heel that is "squeezed out" with weight bearing.

At night or rest, inflammation in absorbed into the area, pushing on sensitive nerve endings. The first morning steps are very painful and stiff until the inflammation is squeezed out and scar tissue is stretched. Once the inflammation and scarring are present they are difficult to remove. The longer the condition runs its course without intervention, the more difficult it is to rehabilitate.

What Should You Do?
Trochanteric bursitis appears gradually. If you are starting to develop any or all of the symptoms listed above it is important to avoid the activities that aggravate or worsen the injury. As well, ice may be applied directly to the painful area for no longer than 15 minutes at a time to help reduce the pain and tenderness.
Will Physiotherapy Help Me?

There are a variety of causes that may contribute to a trochanteric bursitis. A physiotherapist is skilled in assessing the possible causes of the injury. A proper treatment plan will be designed to address the cause and help the healing. Modalities can be used to decrease swelling and increase healing. Also, exercises will be prescribed to decrease the chance of a re-occurring injury.

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