What is Trochanteric Bursitis?
Trochanteric bursitis (also known as greater trochanteric bursitis) is a painful condition of the outer upper leg that is primarily the result of an imbalance of the leg musculature or a sudden trauma to the bursa. Bursae are jelly-like sac filled with lubricating fluid that is found in a high-friction areas (e.g. areas home to many structures) of your body. Muscle imbalances are typically a combination of dominant, weak and tight musculature. The trochanteric bursitis exercises listed below can help to resolve this imbalance and improve the resilience of your hip to future injury.
Bursitis is frequently caused by an inflammation of the bursa in the outer hip, which is located right on the bump of the outside of your thigh (which is called your greater trochanter). Suffering individuals typically complain of hip tenderness, lower back pain and an inability to lie on the outside of the hip. It is a medical condition that is more prevalent in elderly people, women, and overweight individuals.
In order to confidently know if you are suffering from trochanteric bursitis or not, read the common signs and symptoms below. Additionally, book an appointment with your physical therapist to identify your cause of pain and design a plan to resolve your symptoms.
Signs & Symptoms
- Dominant and tight Tensor Fascia Latae (TFL). You can test the tightness of your TFL muscle this way.
- Weak gluteus medius muscle. You can test the strength of your gluteus medius this way: Lay on your unaffected side and lift your top leg up about halfway. Bend your hip back slightly (without rotating your pelvis) and get another person to put some pressure on your leg. This is a great way to isolate your gluteus medius and test its strength. Compare the strength to your other side and judge whether or not it can benefit from additional strengthening.
- Sharp pain on the outside of the hip
- Pain with ascending stairs
- Difficulty moving your affected leg in (due to the compression of the bursa)
- Snapping sensations felt on the outside of the hip
- Inability to lie on outside of the hip
- Lower back pain
- Knee pain
You can find the source of this information here.
Common Causes
- Prolonged or sudden compression / impact on the bursa / your outer hip
- Repetitive straining of your hip with faulty positioning
- Improper footwear resulting in improper alignment of your lower extremity
- TFL muscle overuse (performing too much flexion (forward bending), abduction (outside bending) and external rotation (rotating the hip out), or a combination of all of those movements)
- Previous hip conditions (e.g. hip osteoarthritis, rheumatoid arthritis, lumbar spondylosis, iliotibial band syndrome, foot pronation, leg length discrepancy, inflammatory diseases, bacterial infection) (source).
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Differential Diagnoses
1. Snapping Hip Syndrome (source)
This condition is characterized by repeated snapping or clicking sensations located on the outside of the hip with movement. It comes from your iliotibial band (more commonly known as the IT band) snapping over the greater trochanter of your femur (your thigh bone). Snapping hip syndrome is frequently just described as an annoyance, however can be painful in some instances.
2. Hip Impingement (source)
This common condition is characterized by sharp, stabbing pains all around the hip joint. The pain typically worsens with forward bending, prolonged positioning, as well as hip rotation and high impact activities. For a thorough article that I wrote about on hip impingement, check out this link.
3. Greater Trochanteric Pain Syndrome (source)
GTPS is a condition that results from a degeneration of tendons and bursa in the outside of your hip. Individuals that suffer from it typically have difficulty ascending stairs, performing high impact activities, and laying on the affected side. The true development of this condition is not completely understood.
4. Other
Trochanteric Bursitis Exercises
Reasons to Strengthen your Hip:
- Strength training of weak muscles in your hip will help to decrease the friction and thereby help to treat the cause of trochanteric bursitis.
- Stronger hip muscles will decrease the likelihood of reoccurrence of hip issues
- Improved hip stability will decrease the likelihood of falls
- Better function throughout the day, as well as greater tolerance for activities dependent on lower extremity strength and endurance
Targeted Muscles Groups: gluteus medius, gluteus maximus, abdominals, erector spinae
Gluteus Medius & Maximus
- Clam exercise (difficulty: easy)
Starting Position: Side-lying on your uninjured side with your knees bent to approximately 90 degrees
Movement: While keeping a tight core, slowly lift your knee on top up as high as you can, while keeping your heels in contact with each other. Once you have reached the top, hold this position for a count of three. Then slowly lower your knee to the starting position and repeat. You can make this exercise more challenging by adding a resistance band around your knees.
- Bum Squeezes (difficulty: easy)
Starting Position: Standing or laying on your back with your knees straight
Movement: While keeping a tight core, clench your bum cheeks together for a count of three. This is a good exercise if you are in significant pain and the other exercises are causing you too much outer leg pain or to warm up your glutes. You can make this exercise more challenging by making the squeeze more intense and holding it for longer. Additionally, you can go into a lunge position and perform the squeezes from there. Make sure to repeat it on the other side in that case.
- Lateral leg raises (difficulty: medium)
Starting Position: Side-lying on the uninjured side with your buttocks against the wall and your heel gently pushed into the wall
Movement: While keeping a tight core, slowly lift your top leg up as high as you can. Ensure to keep your heel dug gently into the wall. Slowly lower it down, minimize your resting position and then repeat. If you are able to lay on your injured side, repeat this exercise on the other side. If you would like to make this exercise more difficult, you can add an ankle weight, reduce the speed of movement, or hold for a count of 3-5 on top.
- Fire Hydrant (difficulty: medium)
Starting Position: On your fours with your shoulders in line with your wrists and your hips in line with your knees.
Movement: While keeping a tight core, slowly lift your affected side outwards as high as you can. Once you have reached the top position, hold for a count of three and return to the starting position. Repeat for the appropriate number of repetitions and then switch legs. You can make this exercise more challenging by adding a resistance band around your knees.
- Hip bridges (difficulty: medium)
Starting Position: Laying on your back with your knees bent and your heels slightly further than shoulder width apart.
Movement: While keeping a tight core, slowly lift your buttocks off the ground by pushing up through your heels. Lift them up as high as you can and squeeze your cheeks together for a count of three. Slowly return to the starting position and repeat. If you find this exercise too easy, try a single leg hip bridge. Simply keep one leg straight up in the air while pushing through the other leg. Then repeat with the opposite side.
- Crab Walks (difficulty: medium to hard)
Starting Position: Standing with your knees and hips slightly bent
Movement: While keeping a tight core, move three steps out to the left and then three steps to the right. Ensure to not straighten out your knees or hips at any point of this exercise. To make this exercise more difficult, you can add a resistance band around your knees during this exercise.
- Active Resisted Hip Extensions (difficulty: medium to hard)
Starting Position: Standing close to a wall with a resistance band wrapped around your ankles.
Movement: Tighten your core and slowly extend one leg back as far as you can. If you can, do so without holding on to the wall. Squeeze your glute muscles for a count of three and return to the starting position. Do not place your foot back on to the ground but instead go back right away. Then repeat with the opposite leg. To make this exercise even more difficult, you can choose a tighter resistance band or squeeze for longer.
Abdominals
Your abdominals have a significant impact on the positioning of your pelvis, thereby indirectly affecting the position of your femur (thigh bone) in your hip joint. Additionally, strong abdominals will help you with your posture and resting positioning. Therefore, it is important to strengthen your abdominals in addition to your hip musculature.
- Crunches (difficulty: easy to medium)
Starting Position: On your back with your knees bent or your knees bent to 90 degrees resting on an object. Arm positioning straight in line with your body (easy), arms crossed across your chest (medium), behind your head (hard)
Movement: From the starting position, slowly lift your head (easy) and shoulder blades (medium) off the ground and slowly return. Ensure to minimize your resting position and repeat. You can make this exercise more difficult by holding a weight close to your chest
- Side plank (difficulty: medium to hard)
Starting Position: On your side propped up with your upper body either on your knees (medium difficulty) or your ankles (difficulty: hard).
Movement: From the starting position, slowly lift your hips off of the ground and hold this position for a minimum of 15 seconds. Ensure to keep breathing during this exercise and try and stay in a straight line. You can make this exercise more challenging by adding a resistance band around your pelvis or increasing the length of the hold.
- Plank (difficulty: medium to hard)
Starting Position: On your elbows with your upper body propped up, on your knees (medium) or on your feet (hard).
Movement: From the starting position, slowly lift your hips off the ground and hold the position for the specified amount of time. Ensure to keep your upper body propped up and to not let your upper body sink in. Once you notice your hips lowering down or the need to compensate, stop the exercise and repeat after a short rest period.
- Dead Bug (difficulty: hard)
Starting Position: On your back with your arms straight up in the air (hands and shoulder should be in line), your hips and knees bent to 90 degrees (knees and hips should be in one line)
Movement: While keeping a tight core, slowly lower one arm and the opposite leg down until they hover closely above the ground. Hold this position for a few seconds and slowly bring both limbs back to the starting position. Repeat with the other limbs. This exercise requires coordination, as well as core strength. To make this exercise more challenging, you can add an ankle weight and a hand-held weight or perform this exercise at a slower pace.
Erector Spinae
If your hip flexors are tight and dominant, they will put you into a forward bend position. This causes your erector spinae muscle group (a muscle group in your back responsible for keeping you erect) to lengthen and weaken. By strengthening this muscle group, you are decreasing the likelihood of your hip flexors tightening up in the future by falling into a forward bent position.
- Superman (difficulty: easy to medium)
Starting Position: On your stomach with your forehead supported by a pillow and your arms and legs straight.
Movement: From the starting position slowly lift your arms and legs from the ground and hold for the specified amount of time. Ensure not to overextent and to keep your head in a neutral position throughout the full duration of the exercise.
- Good Mornings (difficulty: easy to hard)
Starting Position: Standing straight while holding a weight (medium-difficult) or without holding a weight (easy).
Movement: From the starting position, slowly bend from your hips down until a maximum of 90 degrees. While ensuring a smooth transition, slowly lift your upper body up until you are fully straight, letting your hips and back extensors do all of the work. Ensure that you are not bending through your lower back during this exercise.
How Frequently Should I Perform these Exercises?
Talk to your local physical therapist about the appropriate exercise parameters (i.e. the amount of repetitions, sets, intensity, load and frequency) for you. Everybody is different. The exercise program should be individualized to your needs so that you can achieve optimal results with your strength training program.
Ensure to keep up your home exercises by building it into your regular routine. Try your best to perform the exercises and stretches at least three times per week.
Generally speaking, this was a list of appropriate exercise to perform if you are suffering from trochanteric bursitis. However, everybody is different. For a more individualized approach, and to identify whether or not you would benefit from strengthening any other muscle groups, I recommend that you seek a physical therapist to determine the best exercises for you following your physical examination.
Hip Stretches
Beside performing hip strengthening exercises, I also recommend that you perform the following stretches in addition to the stretches from your local physical therapy clinic. The reason you will benefit from stretches is because this condition is commonly caused by a muscle imbalance. This means that some muscles are tight, thereby increasing the amount of friction on the bursa.
- Standing hip flexor (TFL, iliopsoas) stretch
Starting Position: Standing straight with a wall nearby (if needed for balance)
Movement: From the starting position, slowly lower yourself down into a lunge position, with your good leg out in the front. Your opposite leg should be extended back. If you are experiencing a stretch of sufficient intensity (i.e. it should feel like a tolerable discomfort), then hold this position for at least 30 seconds and repeat. If you do not feel a stretch, try and put the unaffected leg in a stool and gently push your hips forward (without rotating your pelvis).
- Hip flexor (quadriceps) stretch
Starting Position: Standing straight with a wall nearby (if needed for balance) or side-lying (as shown in the picture)
Movement: From the starting position, slowly bend your knee on the affected side and grab your ankle with one hand. Bend your knee as much as you can while bringing your foot up. From here, slowly move your knee back until you feel a gentle stretch in the front of your hip. Hold for at least 30 seconds and repeat.
- Gluteus maximus stretch
Starting Position: Laying on your back with your knees bent and arms by your side
Movement: From the starting position, slowly bend one knee towards your chest, reinforcing it with both hands. From here, pull your knee towards the midline of your body until you feel a gentle stretch in your gluteal area. Hold for 30 seconds and repeat on the other side.
Ways to Reduce Your Pain
- Ice packs: If currently, or following the exercises you are in pain or you notice some swelling around your hip, it may be a good idea to place an ice pack onto the painful area. Ice helps reduce swelling and to temporarily numb the area, so you experience less pain.
- Book a Massage: Sometimes, just performing stretches is not enough to get tight muscles to release. You may benefit from a therapeutic massage by a registered massage therapist. Talk to your health care provider to determine if this is the appropriate option for you.
- Avoid aggravating activities: Avoid laying on the affected side and moving your affected leg to the opposite side of your body. Additionally, you should avoid any other activities that cause your pain to worsen.
- Anti-inflammatory medications: Talk to your family doctor about the best choice of pain-relieving medication for you.
- Steroid injections: If your condition is chronic and it is deemed appropriate by your health care provider, steroid injections may be an option fo you. Talk to your family doctor about whether or not this is an appropriate option for you.
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Conclusion
Trochanteric bursitis is a painful condition of the outer thigh that is often a result of direct trauma or a muscle imbalance created by a tight, dominant TFL, as well as a weak and long gluteus medius muscle. To resolve this imbalance, it is important to strengthen your gluteal musculature, as well as your abdominals and back extensors to decrease the likelihood for future re-occurrence. Additionally, you should perform regular hip flexor stretches to optimize your posture and reduce your pain.
You can reduce your pain levels by applying an ice pack to the injured area, by booking a massage to work out tight muscles, avoiding aggravating activities (i.e. laying on your affected side), and by taking anti-inflammatory medication as directed by your doctor. I highly recommend that you seek your local physical therapist for a thorough physical examination to determine the best exercises for you. Ensure to check out my blog to keep you happy and fit during your recovery phase and let’s get your hip back in optimal shape!
Are you ready to say goodbye to your hip pain?
Autumn
Very informative! The graphics are great!