I have often described hip pain or the diagnosis of “hip bursitis” as an epidemic. We see multiple new patients weekly complaining of pain on the outer hip when they rise from sitting or when they attempt to sleep on their side. The tissue on the outside of the hip is extremely tender to touch. Most are told by their physician they have “bursitis” and are given anti-inflammatory medicine, or a cortisone injection. If you’re lucky this may help, but often it will mask the symptoms for a short time and soon your symptoms return. If you’ve ever seen pictures of true hip bursitis you’d realize this isn’t your diagnosis. I’ve seen it twice in my career and I’ve been working a long time. One client was part of a roller derby team and was often checked into the wall directly hitting her hip; the second was a client whose leg was dragged on the ground trying to stop a car from rolling. Both were subject to significant trauma. Their hips looked like they stuck a water balloon under the skin of their outer hip. The most interesting finding was that they had no pain when you touched on or around the swelling; they just thought it was unsightly. A bursa is a fluid filled sac designed to provide cushion around a tendon or joint. The pain generator is usually the tissues that surround the bursa, not the bursa itself.

 
So what is this pain? And how can a physical therapist assist in reducing it? The tissue tenderness is almost always the result of something else that has the tendons and muscles surrounding the hip chronically irritated. A detailed assessment of the joints and muscles of your back, hip, knee and ankle often reveals the culprit. Have you had a back injury? Are your abdominal muscles strong? Usually faulty mechanics in your back or leg are often to blame. Your hip muscles become overloaded which creates irritation. Once we find the cause of the symptoms the rest is easy, especially if you are willing to perform a few exercises along the way, and withstand some manual work that might make you cringe a time or two. So, for the future when asked, why are you limping when you first rise from sitting? Or why can’t you sleep on your side? Please don’t say I have “hip bursitis”, instead say I’ve irritated my hip muscles and I’m heading to my PT for treatment.

– Dina Kramer
Kramer Physical Therapy
Knoxville, Tennessee