What is Trochanteric Bursitis?
The muscles that surround the hips have a complicated role to play. They work to keep the pelvis level and control one of the most flexible joints of the body. They are organized in layers, and the deeper muscles are separated from the outer muscles by sheets of connective tissue, to allow easy gliding, as they interact with each other.
With all the layers of muscles working together, some points in the body are more prone to experiencing tension and friction during movement. Small sacs called bursa release a natural lubricant to allow gliding and sliding of different muscular layers and are scattered around the body at points of increased stress.
They are found all over the body and usually are quite inconspicuous, which is why most people have never heard of them. However, occasionally something goes wrong, and they become irritated and painful. This will usually happen in a few typical places in the body and one of them this over the greater trochanter, the bony part of the outer hip.
What Are The Symptoms?
The most common symptom of trochanteric bursitis is pain on the outside of your hip, which may radiate down to the knee. You can experience pain with a number of activities such as walking, jogging, climbing stairs and cycling or simply lying on the affected side.
How Does It Happen?
The most common cause for this is a combination poor biomechanics and overuse. When you have poor biomechanics, the structures around the bursa become tighter and can begin to irritate the bursa.
Some things that contribute to poor biomechanics around the hip are weak, uncontrolled muscles, tight muscles, flat feet with unsupportive footwear, a difference in leg length, incorrect exercise equipment and scoliosis. These can all lead to irritation of the bursa around the hip.
How Can Physiotherapy Help?
As there are many other conditions that can cause pain at the outer hip, correct diagnosis is essential. Once diagnosis is confirmed, the first phase of treatment is to reduce pain and irritation.
This can be done with muscle release techniques, ice or heat (depending on the case), rest, fitting you with orthotics and advice for modification to your lifestyle. Your physiotherapist will also evaluate the causes of the irritation and prescribe a suitable rehabilitation program to change your biomechanics.
Serious cases can be treated with corticosteroid injection or even surgery, but with thorough physiotherapy treatment, these are rarely needed.
What is it?
The hip adductors are a group of five muscles located on the inside of the thigh that act to move the hip inwards or control hip movements outwards. These muscles also provide stability to the pelvis while standing, walking and running. The muscles attach to the pelvis via the adductor tendon, at the base of the pubic bone. Adductor tendinopathy is a condition affecting the adductor tendon and refers to a typical pattern of pain and stiffness in the groin and inner thigh that accompany this injury.
What are the symptoms?
The hallmark of this condition is pain in the groin region with movements of the adductor muscles. There may be a feeling of stiffness or weakness and pain when pressing over the adductor tendon. The pain usually begins gradually and progresses over time. It may build up over a few months and may not go away on its own. In severe cases, the pain may impact day-to-day activities, with pain being present when walking or going up and down stairs. Tendon tears may occur suddenly, however tendinopathy is often already present when this happens.
What causes it?
Adductor tendinopathy usually occurs due to chronic overuse, particularly for runners and athletes whose sports involve regular changing of directions. Overstretching of the tendon or an increase in training intensity or type often precede the development of adductor tendinopathies. It is thought that excess forces over an extended period of time cause the tendon tissues to degenerate, becoming painful and more prone to tearing.
What is the treatment?
As many different conditions mimic adductor tendinopathy, accurate diagnosis by a health professional is essential. Certain conditions such as stress fractures of the hip, nerve entrapment or pathologies of the hip joint should first be ruled out.
Adductor tendinopathy is treated by first identifying factors that may have led to the development of the condition. Your physiotherapist may recommend a period of rest and suggest that you stop stretching. Common contributing factors are running technique, muscle tightness and/or weakness and training frequency.
Your physiotherapist is able to help you maintain your training program to the highest level without aggravating your symptoms and help support tendon healing. They are also able to provide support to unload the tendon along with manual therapy and an exercise program, particularly with eccentric exercises, which have been shown to stimulate tendon regeneration.
In most cases, conservative or non-surgical treatment is attempted as the first line of treatment. If this is unsuccessful, cortisone injections can be used to reduce symptoms. In severe cases where the pain persists despite all other attempts at treatment, other medical interventions can be attempted. Once the pain has subsided your physiotherapist is also able to help prevent any further recurrence.