home physical therapy TROCHANTERIC BURSITIS:

Hip - Spine Syndrome Rehabilitation Program

WHAT IS THE SOURCE OF MY HIP & LEG PAIN?

Inflammation around the hip is commonly associated with spinal conditions and develop postoperatively following lumbar spinal surgery. The conditon has been called "Hip-Spine" Syndrome. Also no causal connection has been found, they seem to associated with each other. The inflammatory process takes place in the hip "bursa" which may produce pain that can imitate radiating leg pain similar to lumbar radiculopathy due to nerve compression in the lower back. The two conditions can usually be distinguished by the extent of hip and leg pain. Bursitis related pain typically stops at or just below the knee. Radicular pain may radiate all the way down the leg including the foot.

WHAT IS A BURSA?

A "bursa" is a small jelly-like sac usually containing a small amount of iuid. Bursae are located throughout the body. The most important bursae are located around the shoulder, elbow, hip, knee and heel. A bursa functions as a cushion between bones and the overlying soft tissues. It helps reduce friction between the gliding muscles and the bone. The point of the hip is called the greater trochanter. It functions as an attachment point for several important muscles that move the hip joint.

The trochanter has a fairly iarge bursa overlying it. The bursa measures about 3 inches long, 2 inches wide, anc 1/4 inch thick. This bursa occasionally becomes irritated or inflamed. This is a common cause of hip pain. When this occurs, the condition is called "hip bursitis" or "trochanteric bursitis." Another bursa located on the inside (groin side) of the hip is called the iliopsoas bursa. When it becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. It is treated in a similar manner as trochanteric bursitis, but is less common.

TREATMENT OPTIONS

The initial treatment for hip bursitis does not involve surgery. Many cases of hip bursitis are treated effectively with simple lifestyle changes such as:

• Modifying activities (i.e., avoiding the activities that make it worse)
• Using non-steroidal anti-inflammatory medications (NSAIDs) to control inflammation and pain (i.e., ibuprofen. naproxen, piroxicam, celecoxib and othe's)
• Using a walking cane or crutches for a week or more when needed

The doctor may ask a physical therapist to teach you how to stretch the hip muscles.

Stretch groin supine static

• Lie on back with knees bent, soles of feet together.
• Slowly let your knees drop to floor.

Perform 2 sets of 4 repetitions twice a day.

Hold exercise for 30 seconds. Rest 30 seconds between sets.

Stretch hamstring supine wall

• Lie on back, leg elevated and positioned at doorway as shown.
• Buttocks should be about 5 inches from wall, low back flat on floor.
• Gently slide buttocks toward wall, keeping knee straight, until stretch is felt.
• Relax and repeat.

Perform 2 sets of 4 Repetitions, twice a day.

Hold exercise for 30 Seconds. Rest 30 Seconds between sets.

Stretch hip flexors supine 2

• Lie on table or firm bench with half of your thighs oft table.
• Position both knees on chest.
• Flatten back against table.
• Lower left leg while holding right leg to chest.
• Return to start position.
• Repeat with other leg.

Special Instructions: Do not allow leg on chest to fall outward.

Perform 2 sets of 4 Repetitions, twice a day.

Hold exercise for 30 Seconds.

Acknowledgement: Material courtesy of Robert Klingman, MPT, OCS, FAAOMPT, Athalon Physical Therapy Tucson AZ