Macomb County Physical Therapist Discusses Bursitis of the Hip

Mechanism of injury:

Bursitis of the hip can result from one or more of the following events:

• Direct injury to the hip. This can include a fall, bumping the hip into an object, or lying on one side of the body for an extended period of time.
• Usually an overuse injury resulting from playing sports or working activities such as running up stairs, climbing, or standing for long periods of time.
• Incorrect posture. This condition can be caused by scoliosis, arthritis of the lumbar spine, and other spine problems. Also pelvic malalignment could be a factor; this may be from the result of a leg length discrepancy or    from  lack of internal rotation of hip.
• Previous surgery around the hip or prosthetic implants in the hip. Other diseases such as rheumatoid arthritis, gout, psoriasis, or thyroid disease may also be a contributor.

Predisposing factors:
Supination Causes:
• May result from tight IT Band or gluteus medius, usually common in runners
• Lack of subtalar joint eversion
• Functionally shorter leg, may be caused by posteriorly rotation ilium (person may have a trigger point in iliopsoas or quadratus lumborum)
• Lack of thoracic rotation

Pronation Causes: (Most common)
• Weak abductors or gluteus maximus, and tight adductors or lateral hamstrings
• Lack of ankle dorsiflexion
• Leg feels too long, may be caused by anteriorly rotated ilium (person may have trigger points in iliopsoas or piriformis)

Treatment Plan
Treating bursitis of the hip takes more than just pain control. Most patients benefit well from physical therapy treatment and do not need surgery. It requires training the stabilizers of the gluteal muscles, hips, and thighs to assist with posture and to guide the joint in the right placement to allow you to perform functional activities of daily living without risk of getting reinjured.

There are 3 phases of an exercise program:

The first phase is the acute phase and this phase focuses on stability and endurance exercises. The emphasis of plane of motion is in the sagittal plane. We may also focus on stability of other joints above and below the hip joint as well. The goal is to increase range of motion and get the joints stable and ready for movement. When movement of a joint is limited, the pain and symptoms of a bursitis of the hip may worsen. Improving hip movement can help keep the joint surfaces aligned, while helping to control friction against the bursa. Getting more motion can give you the relief you need for daily activities.

The 2nd phase is the sub-acute phase and this phase promotes strengthening exercises. When muscles get weak, other muscles may overpower them. This leads to an imbalance where the lengthened muscle becomes weaker and the shorter muscles become stronger. These imbalances change the way the joints usually work, leading to problems like a hip bursitis. Problems with alignment of the pelvis, hips, or knees can affect the balance of muscles and tendons. The exercises you do to help strengthen the weak muscles of the hip and buttocks areas can often make the difference in getting your hip back in balance.

The last phase is the advanced phase and this helps the patient to be able to return to normal function. Its emphasis of plane of motion is the same plane it was injured, so we will work in the frontal and transverse planes.

Here are some manual techniques that may also be performed during physical therapy sessions.
Correct pelvic malalignment of anterior pelvic tilt with muscle energy technique
• Stretch or counterstrain tight muscles
Soft tissue mobilization to IT Band or adductor muscles
• Normalize hip internal rotation (to prevent frontal plane compensation) with hip mobilizations and or counterstrain to piriformis or iliopsoas.

References:
Mulford, Kathy. “Greater Trochanteric Bursitis.” Journal for Nurse Practitioners 3.5 (2007): 328+. Academic OneFile. Web. 24 Nov. 2009. <http://find.galegroup.com.libproxy.macomb.edu/gtx/start.do?prodId=AONE&userGroupName=lom_macombcc>.
MUIRHEAD, GREG. “Diagnosing bursitis of the hip.” Patient Care 34.5 (2000): 196. Academic OneFile. Web. 24 Nov. 2009. <http://find.galegroup.com.libproxy.macomb.edu/gtx/start.do?prodId=AONE&userGroupName=lom_macombcc>.
Mandell, Brian F. “Avascular necrosis of the femoral head presenting as trochanteric bursitis.” Annals of the Rheumatic Diseases 49.9 (1990): 730+. Academic OneFile. Web. 24 Nov. 2009. <http://find.galegroup.com.libproxy.macomb.edu/gtx/start.do?prodId=AONE&userGroupName=lom_macombcc>.
Overuse injuries of the musculoskeletal system / Marko Pecina; Ivan Bojanic 1993
English Book 369 p. : ill. ; 25 cm. Boca Raton, FL : CRC Press, ; ISBN: 0849344921; 9780849344923
The Missing Link: Manual Therapy Guide Book
Sherry L. McLaughlin, MSPT, OCS, CSCS 2006
ML Publishing, Birmingham, MI, p 24; 37; 41; 105
Greater Trochanteric Pain Syndrome: A Review of Anatomy, Diagnosis and Treatment
Bryan S. Williams, MD, MPH*, and Steven P. Cohen, MD
Anesth Analg 2009; 108:1662-1670 © 2009 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31819d6562
Trochanteric bursitis–a frequent cause of ‘hip’ pain in rheumatoid arthritis.
Annals of the Rheumatic Diseases 1982;41:602-603; doi:10.1136/ard.41.6.602
http://emedicine.medscape.com/article/87788-overview
http://my.clevelandclinic.org/disorders/Bursitis/hic_Trochanteric_Bursitis.aspx
Dwight Orthopedic Outpatient Rehab Center, Madison Heights MI

Macomb County Physical Therapist Discusses Bursitis of the Hip

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Macomb County Physical Therapist Discusses Bursitis of the Hip