Jill Murphy, DPT, LAT, CSCS
As I have always told my patients, trochanteric bursitis is one of the most over-used and rarely accurate diagnoses we see in the out-patient orthopedic therapy setting. Why? Patients rarely have the cardinal symptom of swelling, bursitis is rarely the cause of the patient’s pain, and MRI shows that only 8% of those diagnosed actually had bursitis while nearly 100% had abnormalities in their gluteus medius.
What else could be the source of pain at the front or outside of the hip? Degeneration to the hip abductor tendons, an avulsed tendon (tendon is literally pulled off its bony attachment), calcific tendonitis, myofascial dysfunction (excessive tightness), snapping hip,and iliotibial (IT) band syndrome are all possibilities. The greatest risk factor for pain in this area which is no surprise to myself, is having low back pain either currently or in the past. In fact the front and outside of the hip is a common area for referred pain from the low back and sacroiliac (SI) joint.
The treatments available for hip pain range from posture changes (avoiding crossing your legs, sleeping with a pillow between your knees), to icing, stretching tight structures, strengthening weak hip muscles, and correcting biomechanical flaws such as leg length discrepancies, abnormal walking patterns, and squatting mechanics where the knees come closer together. Soft tissue techniques to loosen the muscles such as soft tissue mobilization and myofascial release and hip joint mobilization are also commonly utilized treatments for the hip. If necessary, treatment will also be directed at any pain referred due to tightness in the joints or soft tissue of the lumbar spine, sacrum, and innominate/pelvis.