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Aging & ArthritisExerciseHipPain

Hip Bursitis

I probably see four or five patients with this every day. It’s either the primary reason they come to see me, or they mention it at the end of the visit, as a scourge they’ve been bothered with for a long time. I’ve had it too…in both hips, and many women are going to get it. Ninety percent of the people who get it are women. It’s hard to get rid of. It’s very painful.

Sometimes doctors tend to kind of ignore it because it is simply hard to get rid of and because it’s not really a destructive process. We just hope it will go away! You’re not going to die from it. You’re not even going to get arthritis from it. But you’re going to suffer quite a lot, and in some cases, it’s going to consume your days and nights with pain.

First let me define it and make sure we’re all on the same page. Hip bursitis or greater trochanteric bursitis causes pain on the outside of your hip. It’s right over that large bump (the greater trochanter) on the lateral side of your hip. You can put your hand on it and it’s usually tender to touch. Most people think that place is “the hip” and they think they have arthritis of the hip. But your hip joint is actually deep in your groin area, and not around that bump on the outside of the hip. This pain usually doesn’t radiate down the leg. I say “usually,” because sometimes it can go down the outside of your leg, but it would not go past the knee.

So, if you’re a woman (usually over 40) with pain over that bump that sticks out at the side of your hip, and it’s painful to touch, or to sleep on, or to get in and out of chairs, or the car, and it doesn’t go down your leg and it’s not in your buttock or your groin, then it’s probably greater trochanteric bursitis, and so now we’re on the same page.

The rest of you listen in, because I want YOU to recognize it on the first day you have it. We’ve got this ridiculous, painful condition because our iliotibial band has to make a long excursion around that big bone that sticks out, mostly because we’re women and our hips are wider in order to have babies.

And if you’re like me (an orthopedic surgeon or a woman who has read this blog), then you know you’ve got it within about 2 days of its onset. But most people don’t realize what they’ve got until they’ve had it for 6 months. You think it’s just one of those things that will go away on its own, or that it’s arthritis and there’s nothing you can do about it. And you would be wrong. But no matter how long you’ve had it, this is what you need to do, and the sooner, the better.

  • Try to figure out why you have it, besides just being a woman. And trust me, some people have it for only that reason. And occasionally, men get it too. Did you get a new car that requires you to scoop your leg under the steering wheel in order to get in and out? Did you start a new exercise program? Running with some strange newfangled shoe? Did you develop an ingrown toenail which has caused you to limp? Are you alive and breathing, because seriously, I think that’s all it takes in some cases? Most of you are going to be unable to name a causative factor, especially if you’ve had it for a while. But if you can, then make changes. If it’s your car, sell it. Well, I guess you could try to raise the steering wheel or put your seat back further and then once you’re in, move it up. If it’s your ingrown toenail, get it well. If it’s a certain shoe, change it.

 

  • Once it’s dug in, it really doesn’t matter how you got it. Now you have to figure out how to keep it from hurting and you have to look at this situation like it’s a cut on your finger tip. You won’t get it well if you keep hitting it on things. If your hip is painful to sleep on it at night, then quit sleeping on it at night. Sleep on the other side. If it’s both hips, then you’re up the proverbial creek. Sleep on your back or your tummy. Put a pillow between your legs. Get a nice, thick memory foam mattress topper for your bed in order to cushion that hip.

 

 

  • Sit Like A Man. (S.L.A.M.) If it hurts to get in and out of a chair then figure out how you can do that without hurting it, just like you’d figure out how to type without using your cut finger. I found that when I got in and out of a chair more like a guy, my pain got better. In fact, suffering from hip bursitis is how I figured out my Sit Like A Man program. So how do you do that? Sit with your legs and feet in the 11:00 and 1:00 positions, and stand up without letting your knees come in. Just watch guys getting up from a chair and then watch how gals do it. Our knees always come together because they naturally tend to do that, but mostly because we’re taught to keep our legs together. This habit just increases the distance that tendon has to go and grinds it across that bump (the greater trochanter). Use the arms on the chair to help push yourself up. Remember, sitting lady-like is not natural for women. It’s a modern necessity, due to rising skirt hems. I promise that cave ladies sat around with their legs apart. Look at the picture above to assure yourself that even in the days before short skirts, women sat with their legs apart. Don’t you think Queen Victoria would have had her legs together, if it had been de rigueur for the times?

 

  • Stretching the iliotibial band can help, but sometimes it can cause more pain, so often when the condition is in a dire state (and believe me, sometimes it is), I don’t recommend stretching. Wait until it calms down first. Sure, there are gentle stretches and you can start doing them, but go easy at first.

Wall Stretch: Stand about a foot from the wall with the painful side toward the wall. Cross the bad leg over the outside leg and slowly lean into the wall. Extend your arm up the wall to support yourself. (picture)

Bed Stretch 1: Scoot to the edge of your bed and roll onto your side, with the painful side up.  Try not to fall off. Then slowly swing your top (painful) leg over the side of the bed and let it hang down. Try to keep your knee straight when you do it.  (picture)

Bed Stretch 2: In a face-up position bend your hip and knee and cross them over the other leg by pulling with the opposite arm.  (picture)

Bed Stretch 3: Get on your side (painful side up again). Move your bottom leg forward to get it out of the way of your upper leg. With your upper knee bent, slowly lower your leg to the bed.  (picture)

While doing these stretches, you should feel some tension across that hip. If it is too painful, then back off. Either lessen the amount you do it or stop altogether, until you have more control of your pain.

  • I call this next suggestion, “Squaring Up.” It basically means to square up your movement. I use this recommendation for many conditions, including low back and sacroiliac joint pain. It helps for knee and hip arthritis too. It means to stand up straight from a seated position. If you get up from a chair and need to go to your right, then face straight ahead and then stand up. Don’t twist from the seated position as you’re standing. When you get out of a car, if you’re able, swing your legs around, and then stand up. This diminishes stresses across your iliotibial band and therefore your greater trochanteric bursa.

 

  • Once greater trochanteric bursitis is in full bloom, you might want to add some anti-inflammatories to the equation. If you’re working on this on your own, then over-the-counter (OTC) non-steroidal anti-inflammatories (NSAIDs) are what you can use. Aleve and Advil are useful for me, and as long as you have no medical reasons not to use them (liver, cardiac, or kidney disease, history of stomach ulcers), they will help. I would have to tell you here, that it’s wise to check with your doctor when you decide to use medications. But you can’t use medicines alone and expect to get well. You’ve got to address the mechanical issues as well.

If you go to your doctor for treatment, then you can get prescription level doses of NSAIDs, and they might recommend short courses of prednisone or even a cortisone injection. These are often very helpful and can even “cure” the condition, but don’t be surprised if it comes back. Unless you’ve addressed the causative or mechanical factors involved, this will often be the case. It’s for this reason that I usually don’t recommend an injection to my patients first thing.

  • There are some other causes of lateral hip pain. And between you and your doctor, you should make sure you don’t have one of them. Things such as herniated discs, chronic tears of the gluteal tendon, and piriformis syndrome, can cause lateral hip pain. The biggest difference between these conditions and hip bursitis, is that they are usually not tender directly over the lateral side of the hip, right on that prominent bone to the side. Sometimes, your doctor might order an MRI, to make sure you don’t have a chronic tear of your gluteal tendon. They might evaluate your back. It’s hard to diagnose piriformis syndrome with any test, so it’s often what we call, a diagnosis of exclusion, meaning that everything else is ruled out. And sometimes, unfortunately, a patient might have all of the above. Sadly, for all of us fragile people, having one condition does not preclude you from having another.

 

  • When all else fails, you must resort to your wonderful brain to help you. And frankly, I’m not sure that you shouldn’t do this first. Be mindful. Think about, and appreciate the times that you are pain free, and try to reproduce those moments. If sitting on your couch with your legs spread wide apart, and a bowl of ice cream in your hand, is a period of painlessness, then do that more often. If getting up and down from your very low chair at work is painful, then figure out how to do it less and perhaps raise your chair.

 

And last, but not least, have peace with your pain. Greater trochanteric bursitis is a relatively benign, painful condition. In almost everyone, it eventually resolves. I never have seen an eighty-year-old woman who tells me she has had hip bursitis for 20 years.