How to fix hip bursitis and chronic hip pain

Hip bursitis and chronic hip pain are some of the most common complaints that we face in our clinic. Hip bursitis can be cataegorised as an overuse injury which can make it a tricky problem to resolve if you need to keep using your hip (walking, standing etc).

WHAT IS HIP BURSITIS?

The bursa is a fat pad that protects tendons from scraping against bone. In the hip there are two main bursa’s that can be affected – the subtrochanteric bursa and the ???. In the hip, the bursa’s job is to prevent the tendons of the gluteal muscles (glute medius and glute maximus) from scraping on the hip bone.

Hip bursitis occurs after excessive friction or excessive repetitions occur and the bursa becomes inflamed.

Bursitis refers to inflammation of the bursa (fat pad that protects the tendon from scraping against bone).

WHAT CAUSES HIP BURSITIS?

There are a few factors that can lead to hip bursitis:

1. Repetitive Stress

• Walking long distances – the body adapts well to regular walking, however an unusual uptick in walking long distances can lead to hip bursitis.
  For example: many cases of hip bursitis can be triggered after travelling oversees and undertaking a lot of walking as part of being a tourist.
• Standing in one spot for a prolonged time – when you stand on the same spot, the muscles at the hip work to keep you upright but can suffer as they are stuck at a fixed length for a long period of time. This can cause fatigue in the muscle as a result of a lack of endurance and subsequent hip bursitis.
  For example: we have seen hip bursitis in professions like hairdressers who are standing for long periods without covering much distance.
• Climbing stairs – Although it is generally deemed good for you to take the stairs over the escalator/lift, climbing stairs puts a lot of stress on the hip. For people who have to climb a lot of stairs as part of their daily routine or someone who has suddenly increased their stairs climbed per day, hip bursitis can be an unwelcome side effect.
• Doing too much – Many victims of hip bursitis have a “superhero” mindset where they tend to overexert their body. We have seen a trend of hip bursitis suffers who also instinctively do too much whether by choice or by life’s demand.

2. Lack of muscle strength

The two primary muscles that can result in hip bursitis are gluteus medius and gluteus maximus. Both these muscles affect the hip greately and are used in a variety of movements that are a routine part of daily living:

• Glute Medius – The primary hip stabilisation muscle. The glute medius helps anchor the pelvis especially when standing on one leg. Its is affected when you shift your weight onto one leg such as when you are walking or climbing stairs.
• Glute Maximus – This is one of the biggest muscles in the body. It is used to extend the hip and straighten the body at the hips. It is used very often throughout daily tasks and especially when standing up from a chair or bending at the hips.

Hip bursitis can occur when either of these muscles is weak. Weakness is a relative term and we specifically mean that hip bursitis can occur when your movements require more strength than your muscles have developed.

Hip bursitis can occur when your movements require more strength than your muscles have developed.

3. Lack of muscle endurance

As with the previous point, the primary hip muscles (glute medius & glute maxiumus) can be strong but lack endurance. In other words, your muscles may be sprinters and not marathon runners. Similarly, muscle endurance is also relative. That means that if you demand more endurance than your muscles have developed then hip bursitis can be a result.

4. Muscle tightness

The reason that a lack of muscle strength or a lack of muscle endurance can potentially lead to hip bursitis is that over-exerting a muscle leads to shortening (tightening) of the muscle.

Over-exerting a muscle leads to shortening (tightening) of the muscle.

As we have seen earlier in this article, hip bursitis is inflammation that occurs due to excessive friction. A tight muscle means there is greater force pulling on the tendon which leads to increased friction with the underlying bursa and hence hip bursitis.

5. Poor mechanics

The last common cause of hip bursitis is poor mechanics. Poor mechanics can occur following an injury or as we decline in our physical capacity due to ageing. It can also occur when sudden changes to body weight occur (sudden weight gain/pregnancy).
Poor mechanics can be:

• Poor walking mechanics
• Lack of muscle activation
• Overcompensation

How we solve hip bursitis

For our clients, we use *4 phases• to solve hip bursitis:

Phase 1 – Reduce Inflammation

• Ice – Apply an ice pack (or frozen vegies) on the affected hip for 15-20 minutes, 1-3 times per day. We especially recommend applying ice following rigoruous activity and/or at the end of the day before bed.
• Listen to your body/strategic rest – For most, complete rest is not feasible. We don’t like recommending rest because being active is good for other health reasons. However, it is also vital to get inflammation under control. So we suggest that you listen to your body and stop activities when pain is escalating.
• Use medicine – We understand that many people don’t want to use medicine and we are definitely pro-natural remedies. However, in some cases where the workloads cannot be modified or the problem has persisted for a long period of time, medicine can help get inflammation under control and set up a full recovery. The class of medicines that help fight inflammation are called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). There are also corticosteroid injections (cortisone) that can help bring inflammation down. These medicines have to be administered by a doctor and have side effects and care should be taken. They should be considered a last resort or for extreme cases.

Phase 2 – Reverse previous muscle tightness

As we discussed earlier, muscle tightness is a primary contributor to hip bursitis. Muscles gradually become shorter & tighter as a result of being over-exerted in terms of loads or endurance. This tightening process happens gradually day by day as the muscle gets used and often happens for many months before hip bursitis pain actually occurs or is noticed. So we have to consider and address the previous damage that has occurred at the hip joint in order to reduce pain and begin to solve the problem for good.

• Stretching
  • Glute Medius Stretch
  • Glute Maximus Stretch
  • Hamstring Stretch
  • Hip Flexor Stretch
  • Sciatic Nerve Floss
• Retraining movements
  It is also part of phase 2 to correct poor mechanics and poor movement patterns. Some examples of retraining movements are:
  • Walking gait
  • Lifting technique
  • Neural activation of key muscles

Phase 3 – Prevent future inflammation (muscle strengthening)

Improving the strength and endurance of the muscles that act on the hip means that the muscles will be able to take more repetitions before they tighten and the bursa becomes inflamed. Phase 2 and 3 can overlap and we generally find that the sooner we can commence phase 3 the quicker relief comes, especially for the majority of cases where the stress on the hip remains consistently high.
Strengthening of the muscle has two parts

• Improving max strength
• Improving muscle endurance

SUMMARY

• Hip bursitis is a very common problem that occurs as a result of increased friction of a tendon on the underlying bursa.
• Hip bursitis generally occurs as a result of:
  • repetitive stress
  • lack of muscle strength/endurance
  • muscle tightness
  • poor mechanics
• Hip bursitis can be solved in three phases
  1. Reducing inflammation
  2. Undoing muscle tightness
  3. Strengthening muscles to reduce future inflammation

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