Hip bursitis is one of those vague diagnoses that frustrates a lot of people who receive it (most often women over 40). It’s my hope that this article can help debunk some of the myths surrounding hip bursitis and give you actionable strategies for alleviating pain.
UNDERSTANDING HIP BURSITIS
What is a bursa?
Think of bursae as little water balloons that sit at specific points in your body to provide cushion between muscles, tendons, and bones. They’re essentially space fillers and shock absorbers.
The Trochanteric Bursa sits right near the Greater Trochanter…a prominent bony point on your femur (upper leg bone), that is located at the outside of the hip (hallmark pain point for “hip bursitis”) and serves as the attachment point for numerous hip muscles.
Classic thinking for people with pain on the outside of hip, is that increased stress causes the bursa to become inflamed (“bursitis”)…leading to pain.
However, most people diagnosed with hip bursitis actually don’t have bursitis at all!
In fact, recent studies have shown that very few people (<10-20%) with pain over their greater trochanter (outside of hip), actually have inflammatory changes in the bursa when examined with diagnostic ultrasound.
That’s why in recent years, hip bursitis has actually become more widely referred to as “Greater Trochanteric Pain Syndrome”.
SO IF IT’S NOT THE BURSA, WHAT IS CAUSING PAIN??
To answer this question, we have to split things into right and left.
If you have read either of the first two blog posts in this series, you have been exposed to the idea that all of us as humans (whether right or left handed) have a tendency to favor our right sides.
From left-brain dominance (left brain controls right side), to the way our organs are arranged, to the fact that your right diaphragm is bigger than your left…we all have an easier time getting our bodies over our right legs.
This isn’t meant to be a bad thing…but in our high-stress world of sport-specificity, sedentary jobs, and television people tend to fall too far into a right-dominant pattern, and it causes problems.
(Or, a better way of putting it…it causes predictable muscle imbalances that in turn lead to very predictable problems)
RIGHT TROCHANTERIC PAIN SYNDROME
One of the imbalances that occurs in people who are stuck in this overly-right dominant pattern is that the right gluteus maximus (the biggest glute muscle) loses it position for optimal function.
When this happens, the smaller gluteus medius and minimum, as well as the small deep rotators in the hip (ALL OF WHICH ATTACH TO THE GREATER TROCHANTER) become overworked.
Overtime, the increased workload on these smaller muscles leads to irritation.
And whether the bursa become inflamed as part of that irritation or not…you have to turn off the trigger, which is a malpositioned and underactive right glute max.
Here are some exercises we typically use to restore optimal the right glute max’s mechanical advantage and strength:
Hooklying Right Adductor Magnus Inhibition with Contralateral Adductor Magnus Contraction:
Left Sidelying Right Resisted Glute Max:
90/90 Hip Shift with Left Hemibridge
Left Sidelying Left Flexed Adduction with Right Extended Abduction:
Left Sidelying Knee Towards Knee:
LEFT TROCHANTERIC PAIN SYNDROME
Another typical imbalance we see in people stuck in an overly-right dominant pattern is a tight TFL and IT Band on the left side.
The TFL is a small muscle on the outside of the hip that feeds into the IT Band, the thick, inert fibrous band of tissue that runs down the outside of your thigh (any runner reading this has probably heard of the IT Band).
The TFL/IT Band runs right over the greater troachanter, and when it becomes tight, compressive forces on the greater trochanter increase, and pain can results.
Again, whether the bursa becomes inflamed as part of that irritation or not…you have to turn off the trigger, which is a tense TFL and IT Band.
We’ll probably do a post on this at some point…but foam rolling your IT Band is not going to loosen it.
You’d be better off trying these exercises we typically use to help people get into their left hip, which takes the tension off the TFL and IT Band.
90/90 Left Hemibridge:
Right Sidelying Hemi 90/90 with Left FA IR:
Scissor Slides with Left FA IR:
Left Sidelying Knee Towards Knee:
TAKE HOME POINTS
Hip Bursitis usually isn’t bursitis at all…<10-20% of people diagnoses with Hip Bursitis actually have inflammatory changes when examined with diagnostic ultrasound
Numerous hip muscles, including the gluteus medius, gluteus minimus, and deep hip rotators attach to the Greater Trochanter…the hallmark site of pain in people diagnosed with “Hip Bursitis”
All of us as humans (whether right or left handed) are designed to favor our right sides and have an easier time getting onto our right legs. Runners with pain in the outside of the hip have usually fallen too far into this pattern.
Falling too far into this pattern, causes the right gluteus maximus to lose optimal position for function, which leads to the smaller aforementioned muscles becoming overworked…which leads to increased stress on the greater trochanter…which leads to pain.
On the left side, this pattern causes the TFL and IT Band to become tight, which increases compressive force on the greater trochanter…which leads to pain.
Whether the bursa is inflamed or not…you have to remove the trigger!!
Stay tuned for next week! We'll be cover Runner's Knee!
Please feel free to reach out with questions. You can comment below, or email me at firstname.lastname@example.org.
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