By Dr. Brandon Clark, joint surgeon at Northern Arizona Orthopaedics (as previously posted in Flagstaff Business News, June 2018, Columnists section)
A common hip conditions that affect active people and athletes is bursitis. Bursae are small, jelly-like sacs that are located throughout the body. They are found around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid and are positioned between bones and soft tissues. The act as cushions to help reduce friction between bony prominences and the nearly by ligaments and tendons. There are two primary bursae in the hip that often become irritated and inflamed. One bursa covers the bony point of the outer hip bone; the other is located on the inside (groin side) of the hip.
If you are a physically active person and involved in activities such as running, cycling, or playing tennis inflammation around the hip bursa can happen due to the rubbing of thick tendons against bone. Running even a single mile involves thousands of strides. This repetitive action can take a toll on the body, causing runner’s bursitis, especially in the hips.
A primary symptom of bursitis is
on the outside of the hip, which is worse during activities such as running, climbing stairs, squatting, prolonged walking, getting out of a car, getting up after sitting for a while and at night when lying on the affected hip. The pain will gradually get worse over time and may radiate down the outside of the thigh. The area will likely be tender when pressing on it. In the early stages, the pain is often described as sharp and intense. Over time it may become a pain dull ache. The area may also feel warm.
Hip bursitis is most common in athletes such as runners, women and middle-aged or elderly people. Women are more prone to develop bursitis in the hip than men because women turn and rotate their hips more when active. Acute, or short-lived, bursitis is usually brought on by an accident or injury, such as a fall. Chronic, or long-term, bursitis is primarily caused by overuse, putting constant stress and irritation on the joint. Chronic bursitis can also be caused by other conditions such as arthritis, gout and diabetes. Other factors include age, weight, leg length, illness or infection such as a Staph infection, and Scoliosis.
Bursitis can be difficult to diagnose because it shares symptoms with other injuries. Getting a proper diagnosis requires getting a comprehensive exam with a physician. Imaging tests such as X-ray and magnetic resonance imaging (MRI) are commonly used to evaluate hip pain and conditions such as arthritis, stress fractures, and tendon or labral tears.
Bursitis is treatable and requires patience to heal the area. Many can experience relief with simple lifestyle changes such as:
- Avoiding activities caused and irritate the area.
- Taking non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, piroxicam, celecoxib, etc. can help relieve pain and control inflammation.
- Using a walking stick, cane or crutches to help decrease joint movement
- Working with a physical therapist to strengthen and stretch the hip and supportive muscles; massage, rolling therapy, ice, heat and ultrasound may be used.
- Steroid injections directly into the bursa can be diagnostic and therapeutic. If the injection relieves the pain, then the hip bursa was likely the cause of the discomfort and the local steroid will help calm inflammation. If pain and inflammation return, other injections may be needed.
After all non-surgical treatments have been tried, surgery to remove the bursa may be necessary. The latest surgical advancements allow the orthopaedic surgeon to remove the bursa arthroscopically through two small, quarter-inch incisions. A small camera, or arthroscope, is placed in one incision so the surgeon can see and guide the use of miniature surgical instruments that enter the hip through the other small incision. This surgery is less invasive, and recovery is quicker and less painful.
Most patients are up and walking around the evening after surgery, with rehabilitation following for a few days to weeks. The soreness usually goes away after a few days. Using a cane, limiting activity and working with a physical therapist can further promote healing and decrease future injury.
Although hip bursitis cannot always be prevented, there are things you can do to prevent the pain and inflammation from getting worse:
- Avoid repetitive activities that put stress on the hips
- Maintain strength and increase flexibility
- Lose weight if need
- Wear properly fitting shoes
Understanding and caring for your body are key components of a long and happy run and life. Don’t push through the pain; rather, see a physician who specializes in treating orthopaedic conditions.