Exercises for hip bursitis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally-known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Bursae are small fluid filled sacs that help cushion joints. Several of these bursae are located near the greater trochanter. The greater trochanter is an area of bone where multiple muscles that are responsible for hip abduction (moving the leg away from the body) and hip external rotation attach. Inflammation of the trochanteric bursae is a very common cause of lateral hip pain.
Possible causes of trochanteric bursitis include:
Repetitive stress (overuse) injuries.
• Lumbar spine disease
• Leg-length difference
• Inflammatory forms of arthritis
• Lying on one side of the body for an extended period of time
• Stress on the hip from standing too long.
• Previous surgery in the hip.
Trochanteric bursitis is more common in women and the middle-aged or elderly than in men or younger people. The main symptom is pain.
•Aching pain is usually noticed on the outside of the hip
•Pain may radiate down the outside of the thigh as far as the knee.
•Pain is worse with lying down or rolling onto the affected side.
•Climbing stairs, sitting or standing too long and walking may all be painful.
•Pain at night is common
Other types of bursitis in the hip that are common include iliopsoas bursitis which causes pain in the front of the hip and ischiogluteal bursitis which causes pain in the buttocks. Another less common form of bursitis involves bursae that cushion the adductor muscles, the muscles that draw the leg towards the body. Regardless of the type of hip bursitis, the diagnosis and treatment plans are similar in objective.
The primary diagnostic test is the physical examination. Other imaging such as MRI or diagnostic ultrasound may be helpful.
If the bursitis is caused by overuse, the first step for treatment is rest. Other conservative treatments include:
•Ice (apply for 15 to 20 minutes, two or three times a day; do not apply ice directly to the skin).
•Non-steroidal anti-inflammatory drugs.
•Stretching exercises, especially for the lower back and hip muscles.
•Weight loss, to reduce stress on the hip.
•Exercises to strengthen the muscles.
•Using a cane to reduce weight on the hip.
•Using a lift in your shoe if one leg is different in length than the other.
If conservative treatment does not relieve the pain, an injection of a corticosteroid may relieve symptoms. A better option for chronic bursitis may be ultrasound-guided injection of platelet-rich plasma (PRP)
Three steps you can take to prevent hip bursitis from returning are:
1. Avoid prolonged standing or repetitive tasks that involve the hip.
2. Strengthening and stretching the muscles in the hips and low back.
3. Be sure to see your physician or physical therapist before beginning any exercise program.
When muscles weaken because of pain from bursitis, other muscles may cause an imbalance. These imbalances change the way the joints usually work, leading to problems like a hip bursitis.
Problems with alignment of the pelvis, hips, or knees can affect the balance of muscles and tendons. Exercises to help strengthen weakened muscles of the hip and buttocks areas can get the hip back in balance.
An exercise program will be advanced as symptoms improve. Exercises will be given to help improve motion, strength, and endurance in the hip. The program will address key muscle groups of the abdomen, buttocks, and thigh. Other exercises can be used to simulate day-to-day activities such as stair climbing, pivoting, and squatting.
Progressive resistive exercises or PREs include pulley systems, free weights, rubber tubing, manual resistance, and computerized exercise devices. Using PREs is a way to apply graded resistance to muscle groups to gradually help them with endurance and strength. These exercises start with light weights with many repetitions. As endurance increases, more weight is gradually used with fewer repetitions.
Stabilization exercises are designed to strengthen core muscles. Core muscles act as stabilizers. The job of these stabilizers is to put the joints in the right position and to steady them with different activities.
Training the stabilizers of the buttocks, hip, and thigh help with posture and alignment.
Closed chain exercises are exercises in which the foot is kept on the ground while movement and resistance take place in the joints and muscles located more proximally. These exercises are important because they simulate routine activities. For example, a partial squat exercise is the same action as lowering one's self onto a chair or couch. A leg press is similar to going up a stair or step. These exercises add strength and stability around the muscles and joints of the hip.
The final step is a home program.
For more information on bursitis and tendonitis, visit our sister site:
Tendonitis Treatment Tips
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