Hip pain that is on the side of your hip is one of those things that gets misconstrued all the time as something it is not, BURSITIS. Lateral hip pain that is labelled as bursitis is ALMOST never actually bursa related.
So what is a bursa? It’s a fluid-filled sac containing fluid. The role of bursae in the body are to reduce friction in areas of high friction, for example between muscles and bones, to allow freedom of movement. The trochanteric bursa in particular acts to reduce friction between the glutes and the greater trochanter. (Moore et al, 2011)
What Does the Science Say?
The prevalence of bursitis must be high in lateral hip pain, that’s why it gets diagnosed so often, right?
Nope. An ultrasound study of 124 hips on 96 subjects with lateral hip pain diagnoses was done and it found that only 6% of people had bursitis as being the only US finding. This jumps to 12% when you take into account the bursitis that concurrently occurred with gluteal tendon dysfunction. The majority of the cases were gluteus tendon dysfunction and 29% OF PEOPLE HAD NORMAL ULTRASOUND READINGS.
Since it is called burs-ITIS, there must be an inflammatory component, right?
Nope. Check out the results of SCIENTIFIC STUDIES:- 24 women with greater trochanteric pain syndrome underwent an MRI and only 2/24 had signs of inflammation. The most common finding was that the women had gluteus medius tendon dysfunction- In 2014, another study looked at 25 hips that fit the classification of bursitis and took sample of the bursa.Not a single case of inflammation was found!
Well when there is inflammation is must be causing some sort of pain, right?
Wrong again. In 2008, an MRI study was done on 80 patients hips (40 symptomatic, 40 asymptomatic) and the findings were as shown below. (Woodley et al, 2008)
There was actually MORE bursitis found in ASYMPTOMATIC hips than symptomatic hips! As previously discussed, the condition present in most symptomatic hips was gluteal tendon dysfunction, and even that was found in asymptomatic hips.
So what do we take away from this?
If you have lateral hip pain, it can be of multiple origins but most likely it is NOT because of inflammation in your bursa. Just like in low back pain, hip MRI/x-ray/ultrasound findings are very weakly correlated to pain. Since inflammation is not cause of the pain, rest and ice is not the answer! Find a good physical therapist that understands the body and YOUR goals and get to work!
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Bird, P. A., Oakley, S. P., Shnier, R., & Kirkham, B. W. (2001). Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis & Rheumatism,44(9), 2138-2145. doi:10.1002/1529-0131(200109)44:93.0.co;2-m
Board, T. N., Hughes, S. J., & Freemont, A. J. (2014). Trochanteric bursitis: The last great misnomer. HIP Hip International,24(6), 610-615. doi:10.5301/hipint.5000154
Lee, A. J., Armour, P., Thind, D., Coates, M. H., & Kang, A. C. (2015). The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population. The Bone & Joint Journal,97-B(5), 623-627. doi:10.1302/0301-620x.97b5.35166
Lustenberger, D. P., Ng, V. Y., Best, T. M., & Ellis, T. J. (2011). Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review. Clinical Journal of Sport Medicine,21(5), 447-453. doi:10.1097/jsm.0b013e318221299c
Moore, K. L., Agur, A. M., & Dalley, A. F. (2011). Essential clinical anatomy. Baltimore, MD: Lippincott Williams & Wilkins.
Register, B., Pennock, A. T., Ho, C. P., Strickland, C. D., Lawand, A., & Philippon, M. J. (2012). Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study. The American Journal of Sports Medicine,40(12), 2720-2724. doi:10.1177/0363546512462124
Ruta, S., Quiroz, C., Marin, J., Catay, E., Rosa, J., García-Monaco, R., & Soriano, E. R. (2015). Ultrasound Evaluation of the Greater Trochanter Pain Syndrome. JCR Journal of Clinical Rheumatology,21(2), 99-101. doi:10.1097/rhu.0000000000000214
Schlesinger, N., Dundeva-Baleva, P., Abdel-Megid, A., & Borham, A. (2012). Trochanteric bursitis: Is there ultrasonographic evidence to suggest inflammation? Annals of the Rheumatic Diseases,71(Suppl 3), 275-275. doi:10.1136/annrheumdis-2012-eular.2317
Woodley, S. J., Nicholson, H. D., Livingstone, V., Doyle, T. C., Meikle, G. R., Macintosh, J. E., & Mercer, S. R. (2008). Lateral Hip Pain: Findings From Magnetic Resonance Imaging and Clinical Examination. J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy,38(6), 313-328. doi:10.2519/jospt.2008.2685