Hip Bursitis, What is it?
Not many people know what Hip Bursitis is. The hip joint consists of two primary bones: the pelvis and the femur. As the largest joint in the body, the hip attaches the legs to the torso and allows for mobility and shock absorption. The femur and the pelvis are considered a “ball-and-socket” joint where the “ball” of the femur glides and rotates in the “socket” for leg movement. This joint tolerates a lot of stress, but despite how well it is designed, hip pain is common.
The femur is a large, long, and dense bone that extends from the knee up to the pelvis. At the top of the femur is the femoral head, a rounded “ball” that fits snugly into the part of the pelvis called the acetabulum, which is concave and commonly called the “socket” of the hip.
Each side of the pelvis consists of three bones which are fused together: the ilium, ischium, and pubis. The ilium is the largest and is felt when one “puts hands on hips.” The ilium bones are connected on the back side by the sacrum, another bone that connects to the spine. Dense connective tissue keeps this area connected and solid. The ischium is the part of the pelvis on which people sit. Finally, the pubic bone is in the front, and is connected by a disc of cartilage between the two sides.
Very powerful muscles are in the posterior pelvis and hip area. The gluteals are among the strongest muscles in the body, and consist of three different gluteal muscles. The gluteus maximus, medius, and minimus work together but also have different roles in controlling movement and stability of the pelvis and hip. These are not the only muscles involved with movement of the hip, and several others located on the inside and outside and front of the leg are important to movement and control as well.
Cartilage is connective tissue that protects the acetabulum and femoral head from wear and tear. In the hip, this is called the labrum. Together with ligaments, it also helps keep the femoral head and the acetabulum connected.
Two bursae sacs within the hip act as cushions and shock absorbers. The more common culprit of pain issues is the trochanteric bursa. When this is irritated, pain is felt on the outside of the hip.
The iliopsoas (ill-ee-oh-so-as) bursa is the front part of the hip and is rarely responsible for hip pain. If this sac becomes inflamed, pain is felt in the front of the hip and groin area. When a bursa is irritated and inflamed, it is called bursitis.
What causes hip bursitis?
Hip bursitis usually results from another structural issue within or around the hip joint and pelvis causing irritation of the bursa. Women are impacted more than men, and middle-aged people more than youth. Underlying conditions noted below can contribute to symptoms of bursitis.
- Muscle weakness or imbalance can cause either unwanted movement or restriction of movement, affecting the balance of movements within the hips, pelvis, and legs, resulting in structural, or mechanical, stresses
- Muscle strain or ligament sprain where a traumatic event affecting the hip area may cause overstretched or torn muscles, tendons, and ligaments
- Arthritis degenerative changes in the hip can impact the movement quality of the joint
- Leg-length discrepancy, a condition in which one leg is shorter than the other, can result in imbalance and stress on the connective tissues
- Previous hip surgery
- Poor posture
- Tendinitis irritation and inflammation of the tendons (where the muscle attaches to the bone) often goes along with bursitis
Symptoms of Hip Bursitis
Hip bursitis pain most commonly occurs on the outer side of the hip or buttock area. Pain may feel achy or sharp, and may worsen with certain activities like prolonged standing, walking, running, sitting cross-legged, or lying on the affected hip. Often changing positions, like going from sitting to standing, will bother it as well.
Iliopsoas bursitis pain is more likely to be in the front of the hip groin area. Tenderness in the upper quadriceps (thigh muscles) may also be present.
How is hip bursitis diagnosed?
A physical therapist (PT) is a trained expert in the musculoskeletal system. A complete evaluation of the hip can determine the factor contributing to pain in the hip and if the bursa is irritated. If the PT suspects there is a medical condition which needs to be addressed by a physician, he or she will communicate with both the patient and physician his/her findings and concerns.
All states have direct access to a physical therapist, meaning patients can go directly to a physical therapist without a physician order. Each state has different guidelines, however, and can be found on the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
In some cases, diagnosing the origin of hip pain requires more information. The hip is a large, complex joint, and some circumstances do occur when an image may be needed. A physician may order an X-Ray if he or she suspects there is a bone fracture, spur, or some other bone structure issue. An MRI (magnetic resonance image) may be ordered to look for both bone and soft tissue injuries, including cartilage and labral tears, nerve impingements, and other connective tissue concerns.
Treatment of Hip Bursitis
Most hip bursitis cases can be resolved with conservative care such as physical therapy. Before starting any treatment, a PT will complete a full hip examination which begins with reviewing the medical history and asking specific questions about the symptoms.
After completing an evaluation, the PT will establish a plan that best addresses the structural cause of hip bursitis. Determining the cause of the symptoms and working with the patient to make long-term changes is key to lasting improvement. The physical therapist will work with the patient to develop a plan of care specific to each individual patient, with consideration of each patient’s goals and clinical findings.
Movements of the hip are symmetrical and work collectively together; therefore, restoring the balance of the hip is critical. Generic exercises may not be of help, and in fact, may irritate the problem further. A PT will progress the patient in the proper individualized program to not only recover from the current problem, but also to minimize the risk of future problems.
In rare circumstances, conservative care does not resolve the bursitis symptoms. An injection may be considered, and this is best discussed with a physician. Although an injection may reduce the pain symptoms, PT is still recommended, as it will address the structural cause for what brought about the bursitis in the first place.
In the even more rare instance that a surgery is required, the risks, benefits, and types of procedures are best discussed with an orthopedic surgeon. Physical therapy will likely be a major part of a post-operative recovery plan as well.
Early intervention with any form of hip pain is best for effective conservative care, and possibly even avoiding hip bursitis altogether. Seeking a consultation with a physical therapist is a great start to identifying and treating the condition.
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