Hip/Trochanteric Bursitis? (Watch This!)

Your hip pain is probably NOT due to bursitis. Watch the video to learn why!

Intro (0:00)

Anatomy (0:27)

Diagnosis (1:11)
Understanding the anatomy is an integral component of defining the diagnosis and outlining the appropriate framework for rehabilitation because many individuals associate symptoms here with the word “bursitis” based on what they’ve heard or read. The suffix “itis” implies inflammation of a bursa, the subgluteus maximus bursa to be exact, which then often dictates treatment - because inflammation is usually addressed with rest, ice, and anti inflammatories.

However, hip bursitis or greater trochanteric bursitis, are not the most appropriate terms to describe this lateral hip pain.

In 2001, Bird et al performed MRI examination of 24 symptomatic patients and only found bursal distention, or enlargement, in 8% of cases and it wasn’t an independent finding - meaning that it was always associated with gluteus medius pathology which was discovered in 83% of cases.

In 2003, Connell and colleagues found that 53 of the 75 patients in their study showed sonographic evidence of gluteus medius tendinopathy.

In 2008, Woodley et al. found that gluteus medius tendon pathology was more common in symptomatic hips while bursitis was actually equally prevalent in symptomatic and asymptomatic hips within the same group of participants!

In another study in 2008 titled “Trochanteric Bursitis - Refuting the Myth of Inflammation” by Silva and colleagues, the researchers removed the subgluteus maximus bursa in 5 patients undergoing total hip replacements and reported that histologic analysis showed no evidence of inflammation in the individuals diagnosed with trochanteric bursitis.

In 2010, Fearon et al retrospectively compared preoperative ultrasound imaging with surgical and histopathological findings in 24 patients who had combined gluteal tendon reconstruction and bursectomy and concluded that “there was no evidence of ongoing acute bursitis.” Therefore, they believed treatment should address the gluteal tendinopathy as a primary goal.

Finally, Long et al. in 2013 retrospectively reviewed musculoskeletal sonographic examinations performed at their institution over a 6 year period for greater trochanteric pain syndrome and found that 80% of patients did not have bursitis on ultrasound. They concluded that “the cause of greater trochanteric pain syndrome is usually some combination of pathology involving the gluteus medius and gluteus minimus tendons as well as the iliotibial band.”

So what do we do with all of this information? Well, it’s not to say that inflammation is never present or never a possible contributing factor, but it definitely doesn’t seem to be the primary driver of symptoms so we probably shouldn’t be using the term hip bursitis. The reason that this is so important is that it helps shift your mindset and guides treatment.

For example, as I alluded to earlier, if you assume that your symptoms are due to inflammation, you might take a very passive approach - rest, ice, and medication. It almost puts you in the backseat.

But, if you treat it more like a tendinopathy, managing load to the area as needed, then you’re in control. You’re in the driver’s seat and you can start taking the appropriate steps to helping yourself.

Activity Modifications (4:51)
Exercise Progressions (6:32)
Summary (9:10)

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Disclaimer: The information presented is not intended as medical advice or to be a substitute for medical counseling but intended for entertainment purposes only. If you are experiencing pain, please seek the appropriate healthcare professional.
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Видео Hip/Trochanteric Bursitis? (Watch This!) канала E3 Rehab