What is the Pain in Your hip from??

Have you been told that you have “Bursitis” but it is not going away?

As Physiotherapists, we get many referrals from G.P’s with the diagnosis “hip bursitis”.  Often the patient does in fact have “bursitis”, but if we don’t treat the underlying cause, it will never go away!

What is Bursitis?

The bursa is a thin pouch filled with fluid that serves to lessen friction between bones and muscles. Bursae become inflamed when infected, and this can be very painful. Doctors call this illness bursitis. It may strike any of the joints, but it most commonly affects the joints at the hip, elbow, knee, and heel. Bursitis of the hip may affect the bursa on the outer part of the hipbone (known as the greater trochanter), or the bursa close to the groin (this is called the iliopsoas bursa). Since the condition is more likely to occur on the hipbone bursa, you sometimes find that it is labelled trochanter bursitis.

Common treatments for Hip Bursitis, such as aspiration and cortisone injections, only address the symptoms, not the root cause. While aspiration may bring down the inflammation of your bursa, it won’t fix the underlying problem. Cortisone shots mask the pain and also do nothing to address the condition itself. Without addressing the root cause, aspiration and cortisone become an endless cycle without proper healing, and can lead to eventual negative side effects such as osteopenia or osteoporosis.

So how do we address the underlying problem? 

During your physiotherapy assessment, we will assess the muscles that move the hip, or the gluteal muscles.

Gluteal tendinopathy is an injury to the gluteal tendon complex and is often associated with trochanteric bursitis.

Your gluteal tendons are the tough fibres that connect your gluteal muscle to your hip bone. A tendon injury may seem to happen suddenly, but usually, it is the result of many tiny tears to the tendon that have happened over time.

Typically, tendon injuries occur in three areas:

• musculotendinous junction (where the tendon joins the muscle)
• mid-tendon (non-insertional tendinopathy)
• tendon insertion (eg into bone)

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually, it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means “inflammation of the tendon,” but inflammation is actually only a very rare cause of tendon pain. But many doctors may still use the term tendinitis out of habit.

The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. Therefore tendinopathies do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

What Causes a Tendon Injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Your tendons are designed to withstand high, repetitive loading, however, on occasions, when the load being applied to the tendon is too great for the tendon to withstand, the tendon begins to become stressed.

When tendons become stressed, they sustain small micro tears, which encourage inflammatory chemicals and swelling, which can quickly heal if managed appropriately.

However, if the load is continually applied to the tendon, these lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a tendinopathy or tendinosis.

Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces generated during sport or an activity causes a tendinopathy.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

• The pain may get worse when you use the tendon.
• You may have more pain and stiffness during the night or when you get up in the morning.
• The area may be tender, red, warm, or swollen if there is inflammation.
• You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy
2. Tendon Dysrepair
3. Degenerative Tendinopathy
4. Tendon Tear or Rupture

It is very important to have your tendinopathy professionally assessed to identify what injury phase it is in. Identifying your tendinopathy phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist will ask questions about your past health, your symptoms and exercise regime. They’ll then do a physical examination to confirm the diagnosis. If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

How is Tendinopathy Treated?

In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:

• Rest the painful area, and avoid any activity that makes the pain worse.
• Apply ice or cold packs
• Do gentle range-of-motion exercises and stretching to prevent stiffness.
• Have your biomechanics assessed by your physiotherapist.
• Undertake an Eccentric Strengthen Program. This is vital!

More Specifically…..

What Causes a Gluteal Tendinopathy?

The most common onset of gluteal tendinopathy is due to poor hip and gluteal muscle control that leads to overstressing of the gluteal tendons, causing pain and hip-pelvis instability.

Continued hip instability can cause you to walk or run with poor control, which causes your hip bursa to become under friction load, leading to trochanteric bursitis.

What are the Symptoms of Gluteal Tendinopathy?

Gluteal tendinopathy usually causes lateral hip pain, muscular stiffness, and loss of strength in the hip muscles.

• The pain may get worse when you use the tendon eg running or hopping.
• You may have more hip pain and stiffness during the night or when you get up in the morning.
• Pain is often worse when you lie on your affected hip.
• The lateral hip may be tender, red, warm, or even swollen if there is inflammation of the hip bursa.

How is a Gluteal Tendinopathy Diagnosed?

In most cases, your doctor or physiotherapist will accurately suspect your gluteal tendinopathy diagnosis in their clinic.

If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

Gluteal Tendinopathy Treatment

• In most cases, you can start treating your hip tendon injury at home using a RICE regime.
• Rest the painful area, and avoid any activity that makes the pain worse.
• Apply ice or cold packs
• Do gentle hip range-of-motion exercises and stretching to prevent stiffness.
• Have your hip joint and muscle function professionally assessed by your physiotherapist.
• Undertake a “Hip Core Stabilisation Program”. This is vital to prevent a recurrence.
• Modify your return to sport under the advice of your physiotherapist.
• Despite the common use of painkillers and anti-inflammatory medications the cause is related to hip control, so it is your control that should be retrained as a priority. Persisting tendon injuries are best managed by exercise under the guidance of your physiotherapist.
• Should your tendinopathy be slow to improve you have the option of a steroid injection under ultrasound guidance. For the best long-term results, you should continue to strengthen your hip rather than rely solely on the steroid effects.
• In severe cases, hip surgery may be required.

Get on your road to recovery, and book an assessment with a Physiotherapist at Active Care Physiotherapy!

Call 519-601-6099 to book an appointment in London

Call 519-485-4444 to book an appointment in Ingersoll