Why your hip bursitis isn’t just a bursitis

When patients suffer with lateral hip pain, a really common diagnosis is something called Bursitis.  This is most commonly diagnosed after a patient visits their GP, and after looking at the results of an Ultrasound Scan.  

If you are diagnosed with an inflamed bursa, it would make sense to just get rid of the inflammation and things will be better, right?  It seems obvious but it’s not what it may seem.  We know now that treating just the bursa with medication or a cortisone injection is like dealing with the smoke without putting out the fire.  

This “medicine-only” approach has the potential to make you feel hopeless, like the problem will never get better, because a lot of the time, it can mask the symptoms for a while, but then they come right on back!.  It can seem like anytime you try some treatment for bursitis, you get only temporary relief, with no real long-term improvement.

Why is this happening?

Well the real underlying issue, when you have pan from a hip bursitis, is actually the tendons of the buttock muscles called your Gluteus Medius and Minimus.  Increased load on those tendons, creates thickening and degeneration of the tendons, and this can cause some really irritating pain – affecting walking, sleeping and feeling things feel hopeless.  These changes are commonly caused by a sudden change in activity, a weakening of muscles, and even some hormonal changes that are related to menopause.

It is actually that thickening and degeneration of the tendon that irritates the overlying bursa, causing pain and inflammation in the bursa itself.  If you are just injecting the bursa, it isn’t dealing with the tendons – which means the bursa will be good for a little while, but just come right on back again. 

The evidence now shows that the most effective treatment for lateral hip pain is two-fold – specific exercises to calm the tendon and bursa, and then to strengthen the surrounding muscles in a way that doesn’t cause extra pain.  Because of how painful it can get, it’s important to learn the correct exercises to do, to get the best result with only a minimal risk of flare-up.  

Modification of your current activity load is also a very important factor, as doing too little, too much or the wrong type of activity will hinder your progress.  Everyone is different, and there is no “one-size-fits-all” strategy.  A physiotherapist skilled in assessing the hip and lower back is crucial to getting the best outcome. 

When this is managed correctly, you will feel empowered and confident of a long-term solution, and get back to doing the things that you want to do.  In the short term, there will be a good reduction in pain levels, which means a steady improvement in your function and activities.  Over several months, you ability to do things will continue to increase, to the point where your activity level will return to where you would like them to be.

By Nikki Rathbone - APA Titled Sports Physiotherapist

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