Hip_BursitisBursitis of the hips is usually caused by inflammation of the bursa. Bursae, are small, jelly-like sacs that are located throughout the body, including around the knee, heel, shoulder, elbow and hip. They contain a small amount of fluid, and are centered between the bone and a muscle/tendon, acting as a cushion to help reduce friction and irritation to the underlying soft tissue. The bursa can become inflamed causing pain in the surrounding areas. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone; called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis. Another bursa, the iliopsoas bursa, is located on the inside of the hip. When this bursa becomes inflamed, pain is often located in the groin area. By far, the most common type of hip bursitis is from the trochanteric bursa. This injury is caused in one of two ways; 1) through direct impact to the bursa, such as a fall onto the outer hip, which is known as traumatic bursitis, or 2) through repetitive friction to the bursa from the overlying muscles and tendons; usually during running. This repeated friction results in the bursa becoming inflamed and swollen. Every time the tendons rub over the bursa, pain is elicited.

Hip bursitis presents clinically with pain on the outer side of the hip, where the outer hip attaches to the upper thigh bone. Typically, patients with hip bursitis have some combination of these symptoms; Pain that is worse after prolonged inactivity, such as after sleeping or prolonged sitting. Pain that is worse with repetitive activity. The pain may intensify after prolonged repetitive hip movements, such as with walking, jogging, or stair climbing. Hip tenderness. Patients with hip bursitis often have tenderness and pain over the outside of the hip. Lying down on the affected side of the hip may cause a sudden and sharp increase in pain.  Radiating pain. Initially, the pain may be located primarily at the outside of the lower hip. Over time, the pain may radiate down the outside of the thigh or to other points in the body, such as the lower back, buttock or groin. Hip pain. Pain on the outside of the lower part of the hip is the most common symptom of hip bursitis. Patients often initially describe the pain as sharp or burning. After several days or weeks, the pain may change to a dull ache. With iliopsoas bursitis, the pain will be felt mostly in the groin area. Pain at extreme range of motion. Some patients may experience pain during extreme rotation, hip adduction (using the hip to move the leg past the center/ midline of the body), or hip abduction (using the hip to move the leg away from the body).

Hip bursitis is sometimes caused by a fall onto the side of the hip, but most cases of bursitis are overuse injuries, due to biomechanical issues. If you overpronate your feet, you are more susceptible to bursitis as the knee falls inwards, increasing the angle at the hip. Weakness in the hip abductors, especially the gluteus medius, has a similar effect. Bursitis can also result from tight structures surrounding the hip, such as the iliotibial band, hip flexors and hamstrings. A bone spur, which is a small excess growth of bone, can also aggravate the bursa.

Diagnosis of bursitis is often made by a comprehensive study of medical history and a physical exam. If diagnosis can not be made through an exam, additional tests may be performed to rule out other possible injuries or conditions. These may include x-rays and magentic resonance imaging.

Treatment for hip bursitis includes resting until the pain has subsided. Continued physical activity will increase the inflammation and prevent hip bursitis from healing. Chiropractic adjustments are beneficial to restore full range of motion and biomechanics to the hip, foot and low back. Ice can be applied for 20 minutes every hour, 3 or 4 times a day, to reduce inflammation and facilitate healing. Strengthening muscle imbalances, which may have contributed to the condition, is necessary to properly fix biomechanical faults. Orthotic insoles, for the feet, may be utilized to correct poor foot biomechanics. Surgery and steroid injections may be prescribed if conservative treatment fails.

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