Rest, pain medication, stretching help relieve hip bursitis
DEAR DOCTOR K:
I was just diagnosed with hip bursitis. What will my treatment entail?
Your hip has several fluid-filled sacs, called bursae. They cushion the hip joint. When one of these sacs becomes irritated or inflamed, the condition is known as bursitis.
My patients use different words to describe the pain they have from bursitis: aching, burning, dull, sharp and radiating. The type and location of your pain depend on which bursa is affected.
Inflammation of the trochanteric bursa is the most common. The greater trochanter is the name of a bony bump on the side of your hip. Where is it, exactly? Put your fingers on the most outside part of your waist. Then run your fingers down the most outside part of your hip. About 3 to 5 inches below the waist you'll feel the bump. If you have inflammation of the trochanteric bursa, pushing on that bump will hurt.
The iliopsoas bursa lies between the front of the hip joint and one of the hip flexor muscles, near the groin. The pain it causes goes from the groin down the inner part of the thigh, toward the knee.
Ischial bursitis is, literally, a pain in the butt. It occurs when the bursa under one of the bones you sit on becomes inflamed. A hundred years ago it was called "tailor's bottom" because people who sit all day are more prone to getting it. (I guess that includes doctors who write newspaper columns every day.)
Treatment for any type of hip bursitis includes rest and ice. Pain relievers such as ibuprofen or naproxen also help. You'll need to reduce your activity until the symptoms subside; this usually takes a few weeks.
Specific stretching and strengthening exercises, under direction from a physical therapist, will also help.
For trochanteric bursitis, therapy may involve iliotibial band stretches. The iliotibial (IT) band is a thick cord of tissue extending from the hip bone to the shin bone.
For iliopsoas bursitis, you may stretch and strengthen the hip flexors and rotators.
For ischial bursitis, you may temporarily use a cane to take pressure off the affected hip. If needed, a single corticosteroid injection with a local anesthetic should provide permanent pain relief.
We have more information on hip bursitis in our Special Health Report, "Knee and Hip Pain." (Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.)
In rare cases, your bursa may remain inflamed and painful even after these treatments. If this is the case, your doctor may surgically remove the bursa. (The hip can function normally without it.) This is a very effective, minimally invasive procedure and can be done on an outpatient basis.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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