Have you been experiencing lateral hip pain—pain on the side of your hip—perhaps when you are lying on your sides, sleeping, after you’ve gone for a walk, or even after you’ve got up from sitting? Today, we’ll discuss greater trochanteric bursitis—what it is and also, more importantly, the causes and what you can do about it.
Rather watch or listen?
What is hip bursitis?
We have a bone that’s right on the side of our femur, our leg bone, called the greater trochanter, where we have muscle attachments. On that bone, there is something called a bursa, which is essentially a fluid-filled sac. When we have friction over time or poor tensioning on the bone, this can ultimately contribute to inflammation in the bursa, i.e., bursitis.
The specific muscle that attaches to the greater trochanter on the side of the hip called the TFL, tensor fascia lataee. This muscle tends to get very tight. Why does it tend to get very tight on many people? Often it is due to the significant amount of sitting we do.
Now, that’s not the only reason. However, when we are in a seated position, that muscle is in a shortened position. Most people sit seven to eight or more hours a day, between driving to work, sitting at work, and even watching TV at night. Therefore, that muscle is not able to get that proper length-tension throughout the day, the elasticity, and the tissue.
Now, when this muscle starts to get tight, it can contribute to a lot of things. Often what will happen is it will pull the hip forward in the joint because of its attachment, so it’s essentially pulling the femur forward in the socket. It can create a global tightness, or facilitation. This creates a perpetual cycle of instability around the area.
This means that there is poor sequencing or coordination at the timing of how things are actually firing. Our core functions as an integrated unit —we have our diaphragm, pelvic floor, deep hip stabilizers, transversus abdominus, psoas, and our multifidus. When we start to have movement compensations, pain, and tension, in one area, it can really throw off the whole system.
What are some of the other things that can contribute to this?
Besides sitting too much, is, of course, mechanics. As I mentioned with everything relating to the core, we also want to think about your feet.
Many times, not always, greater trochanteric bursitis will present in someone who has more of an unstable foot. This is called an everted foot type, otherwise known as a flat foot type. If we are collapsing inward at our feet, the hips are internally rotating, which is the action of the TFL muscle. One of its roles is to internally rotate. So, therefore, it can again exacerbate the condition.
It can also be somebody that has a neutral foot type but has lost stability and strength in their foot because they’re wearing socks and shoes all the time.
Lastly, we want to think about how these things work together. So one of the things that I see often is that the deep front fascial line that starts from the bottom of the feet that comes all the way up to the pelvic floor, diaphragm, hip stabilizers, and up to the neck, is normally impacted. In summary, it’s important to look at building your foundation and not just treat the symptoms.
We want to remember that if you’re having pain with sleeping, it isn’t being caused by the sleeping or the mattress. It’s really caused by something happening in your body, but sleeping is the aggravating factor.
With that said, you can modify your sleeping position so that it’s not just causing additional pain. If you normally sleep on your side, try putting a pillow between your knees to keep your hips level.
Check out the video for how to perform these.
Use a ball on the TFL to to create and inhibition of the muscle. Hold this position for approximately two minutes and breathe into it to really allow yourself to relax. You want to have the leg naturally rotated in, so you’re emphasizing that muscle.
When we start to have this faulty pattern, the hip shifts forward and up. After relaxing the tissues, now mobilize the joint, bringing it to an optimally centrated position. Rock forward away from the band for 15 reps and to the side for 15 reps, while trying to keep the back nice and relaxed, breathing throughout the process.
Now most importantly after that, you want to stabilize. Diaphragmatic breathing is one of the best ways to do this.
This is where we want to integrate the foot with the core, i.e. short foot.
To perform this, you want to think about using your breath to allow yourself to really engage your foot with your core. Inhale, relax your foot completely, and then exhale and gently rooting the tips of the toes into the ground. You’d repeat this anywhere from five to eight times, ensuring you feel that connection and have the appropriate hip, knee, and ankle alignment.
If this is not appropriate for you based on your foot type or pathology, you can also do a heel rise with the ball squeeze.
This is also a version of a short foot, but to perform this, you are trying to focus on locking your foot in a nice rigid position. This is exactly what is supposed to happen when you are walking, running, or doing dynamic movements. But if it’s weak or unstable, this will contribute to bursitis.
So how often would you do this?
Initially, every day. This is an easy little sequence, doesn’t take a lot of time, and you’re beginning to work on fixing the root of it, while also treating the symptoms.
That’s always a win-win, and that’s really what physical therapy should be.
If you found this blog helpful, make sure to show your support by giving it a like, sharing it with others, and leaving a comment to let us know. Don’t forget to also subscribe to our YouTube channel for more valuable content.
Reach out if you need help, please text us at 302-635-9220 or reach out over our website themovementparadigm.com.
Other things that might interest you: