The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum and forms a deep cup that surrounds the ball of the upper thigh bone (femur), or femoral head. Thick muscles of the buttock at the back and the thick muscles of the thigh in the front surround the hip. The greater trochanter is the large bump on the outside of the upper end of the femur. This bump is the point where the large buttock muscles that move the hip connect to the femur. Where friction occurs between muscles, tendons, and bones, there is usually a structure called a bursa. A bursa is a thin sac of tissue that contains fluid to lubricate the area and reduce friction. The bursa is a normal structure. The body will even produce a bursa in response to friction.
The exact causes of hip bursitis are not totally understood. Sometimes a bursa can become inflamed (swollen and irritated) because of too much friction or because of an injury to the bursa. An inflamed bursa can cause pain because movement makes the structures around the bursa rub against it. Most cases of trochanteric bursitis appear gradually with no obvious underlying injury or cause. Trochanteric bursitis can occur after artificial replacement of the hip joint, other types of hip surgery, or from an underlying tightness in the hip, pelvis, or even lower back. The cause may be a combination of changes in the way the hip works or the way it is aligned. A fall on the hip can be a direct cause due to the possibility of bleeding into the bursa, forming a hematoma. The bleeding is not serious, but the bursa may react to the blood by becoming inflamed. The inflammation causes the bursa to become thickened over time. This thickening, constant irritation, and inflammation may result in the condition becoming chronic, or long lasting.
The first symptom of trochanteric bursitis is usually pain. The pain can be felt on the outside of the hip right over the bump that forms the greater trochanter. Eventually, pain may radiate down the outside of the thigh. As the problem progresses, the symptoms produce a limp when walking and stiffness in the hip joint. Pain may develop to be present at rest and may even cause a problem with sleeping and lying on that side.
The initial part of physical therapy will be to attempt to determine the underlying cause of the bursitis and to develop a plan of care to address it. The initial goals of the physical therapy sessions may be to reduce the inflammation at the hip. This may be accomplished through various hands on techniques, exercises and modalities including heat, ice, or electrical stimulation. Additionally, your therapist will use hands-on techniques to improve the flexibility of the hip and pelvis as well as the muscles surrounding the hip. Exercises to improve the strength and control of the hip muscles will also be used to help decrease the pressure on the bursae.