Hips are sore

[kathy]

Over the past 6 months, I have experienced a lot of hip soreness on my left side. I did see an orthopedic in January and stopped running for 3 months, (as of Dec.) instead opted to walk and do yoga. That seemed to decrease the pain, along with a cortisone shot.
He diagnosed my pain as slight bursitis and gave me the green light to run. I do still feel pain, however, it is after I run. I was not as sore as I thought I would be after the training last night. Are there any suggestions you have, in terms of exercising, or physical therapy to help my hip?

[Gene Zeitler]

Greater Trochanteric Bursitis is inflammation of the bursa that sits on the lateral aspect of the hip. A bursa is a fluid filled sac which secretes synovial fluid in regions of the body where there is a significant amount of friction. This oil like fluid decreases the friction between two or more structures of the body, therefore, decreasing the chance of injury. When there is too much friction occuring too frequently the bursa becomes inflammed and painful. Cortisone injections, anti-inflammatory and or analgesic medications are provided by the orthopedist to reduce the pain and inflammation. These can be quite effective at reducing or eliminating the pain. They work well in cases of acute trauma or infection, however, if the pain is caused by activities that put repetitive stress on the tissues because of factors such as tight muscles, weak muscles or poor running biomechanics then the problem usually returns, as in your case.

I find that bursitis of the hip is more common in females because of the shape of the female hip and its relationship to the femur (upper leg bone). In general, female hips are wider then males and this causes the femur to slope inward putting the muscles on the outside of the hip or lateral aspect of the buttocks at a disadvantage. The TFL, which is the muscular portion of the iliotibial band (ITB), goes from the lateral aspect of the hip over the greater trochanter and attaches to the lateral aspect of the knee. If the muscles of the hip are weak then when you run or walk you can get a hip drop (I call it the runway walk b/c the hips sway from side to side-this can be subtle) causing the ITB to rub, irritate and inflame the bursa. This is fairly common in runners and speed walkers (speed walker purposely swing their hips from side to side in order to walk faster). A cortisone in this case will only work temporarily until you go back to your activity and irritate the bursa again. Usually the orthopedist will have you go to a chiropractor or physical therapist to help improve your biomechanics, muscle length and muscle strength.

In many cases the ITB can be tight causing the increased friction over the bursa. If you overpronate (flat feet) this can cause increased friction as well. A short leg can also causes bursitis.

Home treatment should consist of ice over the bursa several times after running and at the end of the day for 20 minutes at a time (20 min on 20 min off for at least 3 cycles). This helps decrease the inflammation. Stretch the ITB 3-5 times per day for 30 seconds. This helps reduce the friction over the bursa. Strengthen the hip muscles particularly the gluteus medius, gluteus minimus and TFL. Clam shells are a good exercise-lie on your side with your hips and knees at a 90 degree angle. Keep the feet together and lift the top knee towards the ceiling and lower slowly-10 reps 3x per day. Only go as high as your hip allows-don't move your back. Lunges going from side to side are another good exercise. There are several exercises that work, but not all exercises work for everyone so if an exercise starts increasing your symptoms don't continue it. Cross friction massage over the bursa can be beneficial-i.e. rub over the bursa with your fingers for a couple of minutes-this pushes the inflammation out of the bursa.

Make sure you don't increase your miles too quickly as this will irritate the bursa. Make sure that you have good running shoes fit by a knowledgeable sales person. The shoes may cost you a bit more if you go to a good store, but you will more than make up for it in copays. Also replace your shoes as recommended-I believe it is every 300 miles. After this time period the absorption of the shoe starts to really breakdown even if the shoe looks ok.

If all this fails I typically manually work to lengthen the muscles, work the bursa and provide exercises that may be more effective. In addition, evaluation of the running stride may be very informative at helping direct treatment.

Hope this helps! Gene