Our hip joints are one the largest and strongest in our body. They provide strength and flexibility during walking, running, and jumping. However, the hip joints can take a beating leading to pain. One of the most common causes of hip pain is tendon swelling on the outside of the hip. We often call this problem greater trochanteric pain syndrome. Also referred to as trochanteric bursitis or hip tendonitis, it is common and readily treatable.
What causes greater trochanteric pain syndrome?
This condition occurs primarily from an overuse injury to the tendons on the outside of the hip. Adults who walk, run or play sport are more likely to get this injury. Moreover, women are more likely to suffer from this injury than men, perhaps related to the shape of a women’s pelvis. Other causes include a muscle or tendon tear, a fall onto the outside of your hip, or acute inflammation such as rheumatoid arthritis. Finally, weakness of the hip muscles is an important factor.
A recent study found that those people who developed greater trochanteric pain syndrome were more likely to develop hip arthritis. Why people with tendon pain are more likely to develop arthritis is not known. However, we suspect that weakness of the buttock muscles can lead to both tendon swelling and joint arthritis.
Symptoms of greater trochanteric pain syndrome
Usually, you’ll first notice pain on the outside of the hip. Pain is worse with lying directly on your hip, walking up and downstairs, and prolonged walking and running. Also, you may get pain when crossing your legs. The hip joint can feel stiff. Moreover, the outside of your hip is tender to touch and pain occurs with moving the leg outwards. Sometimes, we need further investigations such as ultrasound or MRI to confirm the cause and rule out other causes.
Trochanteric bursitis ultrasound
Generally, investigations are needed if you’re not responding to therapy or you present with unusual symptoms. Usually, ultrasound shows trochanteric bursitis or thickening of the gluteal tendons. Sometimes, calcification or tears can be seen. X-ray or MRI is useful if we think hip pain is due to another cause such as hip arthritis.
Hip tendonitis treatment
Most cases of greater trochanteric pain syndrome or hip tendonitis respond to simple treatments.
Firstly, if the hip is irritable, reducing pressure on the hip tendons by not lying on the hip is useful. Using a pillow between the knees to help keep the hips apart while sleeping helps. Also, avoid crossing your legs if you can. Secondly, reduce activities that make your hip abductor tendonitis irritable such as prolonged walking. As discussed previously in hamstring tendonitis, keeping pain levels at a low level (<3/10) is a key principle. Thirdly, using a short course of tablets such as ibuprofen for 1-2 weeks with other treatments is effective.
Greater trochanteric pain syndrome exercises
It is important to see an expert in therapy to guide you through hip tendonitis exercises. Recent evidence suggests that exercises are better than no treatment or injections. Hip tendonitis exercises such as hip bridges build muscle around the hip joint including glutes, hip flexors, and hip adductors. Sometimes soft tissue massage and acupuncture can help greater trochanteric tendonitis.
What happens if you get stuck?
Generally, in cases that don’t improve with physiotherapy, other options are available.
Shockwave therapy uses sound waves directed to the painful tendons. We think shockwave reduces pain by healing the tendon or stunning the small nerves sending pain messages to the brain. Often 3-5 sessions will help with pain.
Greater trochanteric bursitis injections
Alternatively, injections can be suitable for some patients. Injections are useful if your pain keeps you up at night or stops you from doing your rehab. There are two different types of injections.
Cortisone is a powerful anti-inflammatory that reduces pain by lowering inflammation. Research suggests that cortisone injections for greater trochanteric pain syndrome are effective (but less so than exercise). However, we need to be careful with cortisone injections due to potential side effects.
Recently a new type of injection called PRP or platelet-rich plasma has been used for difficult cases. About 15-30 mls of whole blood is taken from a vein in the elbow. We spin the blood down so the heavier red cells move to the bottom. The plasma on the top, which contains a high concentration of platelets and growth factors, is then injected into and around the swollen tendons in your hip. Studies suggest that improvements in greater trochanteric pain syndrome occur with PRP injections even after 2 years.
Generally, we suggest injections are done under ultrasound to improve accuracy. You should only see a doctor who has experience in ultrasound-guided injections. you should be wary of other practitioners such as physiotherapists who are injecting but have much less experience.
Dr Masci has written a review on injection in tendonitis including hip tendonitis.
Final word from Sportdoctorlondon about greater trochanteric pain syndrome
Greater trochanteric pain syndrome or trochanteric bursitis is a common cause of hip pain. We suggest rehab first. If ineffective, then we suggest shockwave therapy or injections. If you’re thinking about an injection, then choose a doctor who has experience in injecting with ultrasound.
Other hip and groin conditions: