A common disorder of the hip is called greater trochanteric bursitis. This presents as pain on the side of the hip. Intensity of pain ranges from an annoying ache to an excruciating pain. You can touch the painful area to duplicate the pain. Usual complaints involve pain with weight bearing with that leg while walking, going down stairs (more than going up stairs), and lying on that side—which results in waking up from sleep because of the pain. This pain usually results in a limp with less time spent on that leg while walking. If this condition is allowed to go untreated, not only will it significantly worsen in intensity, but it could cause back or knee pain from the abnormal gait it causes and significant muscular imbalance.

The most common causes of greater trochanteric bursitis can range from an injury to the opposite extremity such as a sprain, fracture or surgery within a 1-2 year period resulting in overcompensation, load, and demand on the current painful hip. Other causes can be from a recent increase in exercising, especially running or walking on a cantered road, and are usually associated with weakness of the gluteus medius and tightness of the iliotibial band (ITB) and piriformis resulting in tendonitis of those tendons and greater trochanteric bursitis. 

Treatment: Physical Therapy has a very high success rate treating this diagnosis and deals with resolving the cause of this condition and instructs the patient on how to handle this diagnosis so it doesn’t come back.

Initial physical therapy treatments would focus on decreasing inflammation at the hip. Ice would be the first choice with 5 minute ice massages or 15-20 minute ice packs. High frequency of icing is recommended. Iontophoresis, a non-invasive delivery system for a steroid (no needles) in the clinic would be used for more serious conditions or conditions that are not responding quickly to ice. For severely painful conditions, the patient also has the option to see their physician to receive a cortisone injection which should give them immediate relief / decreased pain. Physical therapy should continue after the injection to treat and resolve the cause of this condition which will help to prevent another episode.

Once the inflammation is decreased, physical therapy treatment will include aggressive soft tissue mobilization/ massage / manual techniques which would be used on the ITB, hip flexors, and piriformis with both the practitioner’s hands and a foam roller which the patient can do on their own as part of their home exercise program.

Kinesio Tape by a certified Kinesio Tape Practitioner works very well with this condition to help facilitate weak/hypotonic muscles and to inhibit tight/hypertonic muscles. Fascial and mechanical Kinesio Tape corrections are sometimes required as well.

Stretches would be initiated immediately and gentle exercise progression initiated as well. Appropriate strengthening of the gluteus medius, quads, VMO, and abdominals would be stressed.

Physical therapy is extremely effective in resolving this condition. The key is decreasing inflammation, increase flexibility of tight muscles especially the ITB/ hip flexors followed by the piriformis, with manual techniques and the use of a foam roller, restoring muscular symmetry, increasing strength of primarily the gluteus medius as well as the VMO, quads, abdominals, as well as addressing the underlying cause—for instance, making sure there are no arch problems in the foot.

Kristin Tognetti is a Physical Therapist at Spectrum Rehabilitation. Kristin is also manual therapy certified through the University of St. Augustine for Health Sciences. Kristin received her Bachelors of Science degree from the University of Michigan in 2005 and her Doctorate in Physical Therapy from the University of St. Augustine in 2008.