Hey runners! Here’s how you get rid of your trochanteric bursitis for the long “run”
Do you get outside hip pain while running or walking? This is an incredibly common pain spot in runners. Your physician or physical therapist has probably called it trochanteric bursitis, which it can be. But there are other diagnoses that cause similar pain presentations. Fortunately the most common causes, including external snapping hip, and strains or tears of gluteus medius/minimus, labral tears and even lumbar disc degeneration are all treated similarly initially.
Why does this pain occur?
A common cause is not having enough core and hip strength to control hip motion during the running movement. Add in some increased running volume or intensity, which we’ve all been guilty of, and a disaster can await.
Initially, inflammation around the bursa can make this quite a painful condition. Down the road, scarring about the bursa can be a source of long-term discomfort. In reaction to the pain, hip muscles excessively tighten to try to reduce the friction to the bursa causing even more delayed healing.
What Should You Do About It?
If you have no suspicion of a stress fracture, be wary of an MRI recommendation out of the gate. MRI is typically reserved for cases that have failed physical therapy first. Save time and money.
If the pain level is above 7 out of 10 (with zero being no pain and 10 being excruciating), rest, ice/heat, and massage to adjacent tissues with no pressure over the painful region is warranted and helpful. A single corticosteroid injection has been shown to provide moderate improvement in symptoms (lustenberger). Shockwave therapy has also demonstrated favorable response (lustenberger).
If you’re out of the acutely, sharp painful phase, where the pain is more dull and less than 6/10, then you should begin mobilizing the hip to get your full hip range of motion. It’s quite possible, even likely, that even before you hurt, you didn’t have full hip range of motion. A big risk factor in recurring hip pain is not regaining full range of motion.
How do you know if you have true full hip range of motion? This requires the skill set of a musculoskeletal clinician (either a PT or chiropractor), specifically one that specializes in runners, to make sure the hip is providing all of the necessary motion and you’re not compensating, or cheating, with your back, pelvis or knees.
Except for the hypermobile “loosey goosey” person (most know who you are), range of motion isn’t ever really ‘done.’ Keep working on it through stretching, yoga, lacrosse ball smashing, massage and mobilization by a PT or chiro. This will only lead to better running performance for most runners.
Phase 2 is strength and motor control. Do you have the hip strength and endurance to prevent friction in the bursa? Even more importantly, can you fire the hip muscles in a coordinated pattern so the bursa slides by other tissues unfettered? This is not strength; this is motor control and it keeps all the hip parts moving in an orchestrated pattern.
This is the long-term solution to hip bursitis.
Now, improving hip motor control is not unlike learning piano. Someone needs to teach you and you need to practice. A lot. Either through a running-specific local clinician (be picky!!) or through our online running analysis, sure someone needs to see how coordinated your hip is. A few simple corrections, practiced regularly for 2-3 months, and your bursa will be much, much happier in the long “run.”
Research supports receiving a comprehensive running analysis and undergoing physical therapy for six months without definitive success before any consideration of surgical treatment. Odds are greatly in favor of success with an analysis with possible PT treatment as needed.
Lustenburger DP, Ng VY, Best TM, et al. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sports Med 2011; 21 (5): 447-453.
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