Rehabilitating Trochanteric Bursitis

Posted On: May 21, 2020

I remember a Highland Park golfer who came to me saying, “My left hip is killing me when I follow through on my swing.” After examining him, I determined that he had trochanteric bursitis. We prescribed a course of treatment and he got back to golfing without pain.

So what did we do? First, let’s discuss what trochanteric bursitis is. The trochanter is a large prominent bump on your thigh bone, which is called the femur. It functions as a large attachment site for many of the muscles that move the hip. Because the trochanter is so large, it needs some padding to stop the tendons of muscles that attach to it from rubbing. The padding is in the form of a fluid-filled sack called a bursa. When this bursa (or bursae as there are more than one in this area) becomes irritated and inflamed, it is known as trochanteric bursitis.

For years, orthopedic surgeons have been shooting cortisone into this bursa to manage bursitis. Physical therapists and chiropractors have been rehabilitating this injury as well. I still remember being questioned about what good therapy was going to do to help an inflamed bursa. I would explain that some muscles get tight and others get weak, which sets up the bursa to get irritated and inflamed. I pointed out that stretching out the tight muscles and strengthening the weak ones would help alleviate the problem.

With the advent of the MRI, it was discovered that a majority of these cases were the result of weakened tendons of some of the muscles that attach to the trochanter. The rest of the cases are truly inflamed bursae or mixtures of both. This actually led to academic medicine changing the name of trochanteric bursitis to “greater trochanteric pain syndrome.” It also gave credence to why rehabilitation is effective at managing this condition.

Managing this condition from a physical therapy stand point requires a specific course of treatment. First you modify the activity that is irritating the area — things like limiting golf to just putting or  walking with a cane in the opposite side hand to off load the hip. Then you intermittently ice the area to control the inflammation. Stretching the tight muscles and strengthening the weak ones is imperative. Deep tissue massage stimulates the healing process and helps limit adhesions from forming between tendons and other tissues. After things have loosened up and gotten stronger, it is time to start integrating into higher levels of activity. Specific training, based on what type of activity the individual wishes to return to, is required.

To oversee and coordinate this process, it is important to see a physical therapist or chiropractor experienced in orthopedics and sports injuries. He or she will help you manage pain from trochanteric bursitis and get you back into action.

I hope this was useful.  Stay well.

Dr. J