Physiotherapy – Hip

Trochanteric bursitis is associated with inflammation of the trochanteric bursa.

A bursa is a fluid filled sack which sits in between muscle attachments around a joint. There are lots of different bursa around joints in the body, with often more than one bursa being present in any one joint. Their role is to act as a shock absorber and lubricant, helping spread force or load through the joint and its supporting muscles as they work. The trochanteric bursa takes its name from the area in which is sits close to, the trochanter. This is the bony part on the outside of your hip.

Signs and symptoms

• Tenderness on the outside of the hip
• Pain when lying on the affected side
• Sleep disturbance due to pain at night (usually inflammatory pain)
• Aggravated by climbing stairs
• Prolonged periods of standing or walking
• Getting in and out of a car
• Runners experiencing this condition usually have pain radiating down the thigh as well as localised hip pain.

How physiotherapy can help

The primary treatment is rest. This does not mean bed rest or immobilising the area but avoiding the actions which bring on, or reproduce, the pain. Icing the joint may help. A non-steroidal anti-inflammatory drug may relieve pain and reduce the inflammation. Should your condition not be improving, a steroid injection maybe recommended but this is usually after trying Physiotherapy and more conservative treatments.

Physiotherapy can help with both pain management and can aid recovery. Following identification of the cause of the problem your Physiotherapist will work with you to strengthen the hip muscles, core stabilisers and may stretch the iliotibial band, which if tight, will relieve tension around the hip and reduce the friction caused by the band ‘rubbing’ over the bursa.

The use of ultrasound has also been found to be helpful in treating the bursal pain, reducing inflammation and aiding tissue healing. Acupuncture around the hip joint is also effective in resolving many of the symptoms caused by this painful condition. Your Physiotherapist will be able to advise you on exercise strength, progression and your return to activity or sport should you require.

If the Physiotherapist feels a biomechanical problem maybe a contributing factor, we have an on-site Orthotists Clinic which will be able to undertake a more detailed biomechanical assessment and make custom made orthotics to improve your foot mechanics and gait.

Ilotibial Band Syndrome (ITBS) is one of the leading causes of knee pain in runners, typically experienced on the outside or ‘lateral’ aspect of the knee. However ITBS is not exclusive to runners and can be experienced by many people of a variety of ages, causing significant discomfort during walking or standing.

The iliotibial band (ITB) is a superficial thickening of tissue on the outside of the thigh extending from the outside of the pelvis, over the hip down to the outside of the knee, and ending just below the knee joint. The band plays a crucial role in stabilising the knee during movement of the hip and knee, which takes place as the band roles over the top of the thigh bone (femur) during movement, and as muscles surrounding it contract.

In cases where the band has shortened becoming tight, or the muscles around have weakened, this continual rolling of the band over the outside bone of your hip (lateral femoral condyle) combined with the repeated knee motion, during activities such as walking or running, may cause the ITB, or parts of the band to become inflamed and painful.

Signs and symptoms

ITBS symptoms range from a stinging sensation just above the knee joint to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present above and below the knee, where the ITB actually attaches to the tibia.

ITBS can result from one or more of the following biomechanical problems, muscular imbalances, or exercise training habits.

Biomechanical problems

• High or low arches 
• Supination of the foot (rolling in of the forefoot and arch causing a tightening the ITB)
• Excessive lower leg rotation 
• The force at the knee when the foot strikes 
• Uneven leg length
• Bowlegs or tightness about the iliotibial band
• Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator.

Muscle imbalances 

• Weak hip abductor muscles (particularly Gluteus Medius)
• Poor core stability
• Poor muscle control around the knee cap (VMO) causing problems with the tracking of the knee cap over the knee when walking or running, relative to the ITB.

Training habits 

• Always running on a banked surface (such as the shoulder of a road or an indoor track) 
• Excessive up-hill and down-hill running
• When cycling having the feet "toed-in" to an excessive angle 
• Running up and down stairs
• Hiking long distances 
• Poor rowing technique
• Poor breaststroke technique.

How physiotherapy can help

While ITBS pain can be acute, the iliotibial band can be Rested, Iced, Compressed and Elevated (RICE) to reduce pain and inflammation, followed by stretching, which your therapist can show you the correct techniques for. Using a foam roller to loosen the iliotibial band through deep tissue massage, can help prevent and treat ITBS (your therapist can discuss this with you).

Other treatment options include acupuncture of the ITB to help relax the tissue and improve blood supply; this is also beneficial if your problem is long standing (chronic) and you have developed ‘trigger points’, or painful knots in the ITB.

Taping has also been shown to help with ITBS through restoring control around the knee. Physiotherapists use a taping technique for the knee cap (patella taping) to improve the mechanics or use Kinesio taping of the ITB.

Other treatments available for this injury include a compression wrap to mobilise the ITB where the tendon meets the knee. This is called an 'IT band compression wrap.' These are all treatment options that your therapist may discuss with you to tailor the treatment to suit your needs.