# Hip Bursitis - anyone deal with this crap?



## Green Giant (Dec 19, 2003)

So finally got my back under control but the hip bursitis that I developed early season decided to come back with avengence. Long story short, had a bit of bursitis early season, took 2 months off with my back, started riding again. Bursitis came back late July after 2 weeks back on the bike.

Late July - Cortizone shot.

August - pretty good riding.

Sept - bursitis back, and now really off the bike and doing PT to try and get this under control.

I'm suprised 2 months off the bike didn't solve it, and I'm slightly worried it could be something else. But, that said has anyone dealt with this and how long did it really take to clear up? I've been off the bike for 3 weeks again now, and improvement is coming real slow.

Thanks.


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## BoiseBoy (Mar 1, 2006)

*"Hip Bursitis"*

The problem with "hip bursitis" is that it often isn't really a true bursitis.
If the bursa over your Greater Trochanter (the prominent bump on your lateral hip) is palpable, it may be a true bursitis. Usually it is not.

What tends to happen is that the Lumbar spine (L5) will often become dysfunctional. THis dysfuntion often causes the irritated nerve root that exits at that level of the spine to become hyperexcited causing some of the muscles that are innervated by that nerve root to become hypertonus. Essentially, the nerve tells the hip abductor muscles that connect to your painful hip bump to continually contract. This constant tension pulls on the muscle's connection and causes your "hip bursitis".
Injections typically only help for a short period because the true cause isn't addressed.

So, what you need to do, if you haven't already, is find a good manually trained Physical Therapist (PT).
If you don't fix what is going on at the L5 segment then you likely will only have temporary relief of your hip bursitis.

Good luck


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## Green Giant (Dec 19, 2003)

*Sounds about right*

As this point the hip feels pretty good (it was however really irratible to the touch 3 weeks ago).

I"m still having pains on the outside of my hip, along the illiac crest, and at times in my left Glut (this is all on the left side).

Sitting makes it worse, as does driving in my car, or standing in one spot.

I did have an L4/L5 problem, but the back feels great.

My IT band is doing better, but this other stuff comes and goes. What should I be doing? Stretching? Resting? Icing?

Any thing would help.


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## BoiseBoy (Mar 1, 2006)

*Back and Hip*

One challenging thing to realize is that tight muscles do not typically cause back issues. On the contrary, people typically have tight ITbands, Hamstrings, and Hip Abductors BECAUSE of the spine. It is also quite common to have leg sx's without having any back pain.
Stretching is good, and important, however, if one does not attend to the cause of the tight muscles (the spine) then they are putting a band-aid on a broken leg.

What I would do is assess your spine to see what is going on. It sounds as if you have some radicular issues that may be discal in nature given your explanation of your sx's.
It is quite possible that you also have some instabilty about the spine as well.

At the very least what you should do is specifically stabilize those segments that are involved (likely L4-S1). Now when I say stabilize, I mean specifically the muscles at that/those segments. Wihout getting into great detail, neuromuscularly speaking you will not improve with typical sit ups, crunches, and "core exercises" that you do in the gym. The problem is that these muscles are already weak and have compensatory patterns of other muscles taking over. When you do a challenging "core exercise" all you are doing is supporting the compensatory musles while the real muscles that need strength continue to get weaker.
Look at it this way, if having a sx free back were all about your outer core then football players and body builder would never have back pain because they typically have well developed abdominal core muscles. The funny thing is, these groups have more problems with the back pain.
Go see a PT and make sure they are a good manual therapist and you will be set.

Good luck again


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## mlepito (May 1, 2007)

boiseboy, don't you think that pain is a little high for referral? What about TFL and glute medius. Many linear sport athletes have problems with weakness in these muscles and get pain in the outside of the hip. In these cases there is almost always a sacroiliac problem as well as the pelvic incoorination. 

What are your thoughts boiseboy. You seem to know a lot about the human body.


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## BoiseBoy (Mar 1, 2006)

*Valid*



mlepito said:


> boiseboy, don't you think that pain is a little high for referral? What about TFL and glute medius. Many linear sport athletes have problems with weakness in these muscles and get pain in the outside of the hip. In these cases there is almost always a sacroiliac problem as well as the pelvic incoorination.
> 
> What are your thoughts boiseboy. You seem to know a lot about the human body.


First, I think one has acknowledge the shortfalls of telemed. It certainly is not perfect.
I think you bring up valid points. I often see knee/hip/ITband issues as a result of a pelvic asymmetries. Many Lumbar dysfunctions will also be accompanied by pelvic dysfunctions as well. I think that GG's presentation and history lead me to think that it may be more of a spinally related problem. I wouldn't call this "bursitis" a referral necessarily. I think that it is certainly sounding like an L5 facilitated segment which is different than a referred pain. 
Glut Med is notorius for having issues when the Lumbar spine is involved.

I get the impression that you are a clinician as well. If so, you likely know that rarely is there just a single thing going on with any injury or ailment. He could have a host of other compensatory/secondary issues, but I think that the lower Lumbar spine is where I would begin.


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## Green Giant (Dec 19, 2003)

*Thanks - interestingly enough...*

I asked my PT to evaluate me a bit for more Lumbar Spine issues. A lot of pushing on the L5/S1 area for tenderness - none. Bent my left leg a number of ways to see if I had any pain in my lower back - none.

Now, back in May I would have jumped off the table my back was so screwed up.

The area of "bursitis" has gotten much better this week (3rd week of PT). I was even able to drive several hours without pain (I drive a lot, and it usually always flares up).

I also really started working my core exercises again (which at this point is the bladder control flex) even while in the car.

I am definitely having some glut problems still, and problems along the illiac crest.

So, I"m stretching those, along with IT band, lots of anti-inflamitory stuff, and he wants me off the bike for at least 2.5 more weeks.

I should note that I broke my pelvis when I was 17, but that was 19 years ago now... I've never had any problems like this until this year, when the back flared up, then the hip etc which is why I'm so confused on this thing. I've NEVER been able to do much running since then. Every time I decide to train with some running the hip ached like heck, and I had all sorts of knee and calf pain. I essentially broke the "wing" of my pelvis on the left side and it now flares out.

Bursitis does seem to be improving, though slowly. Still some other left side pains which points toward the back being involved.

He also told me to stop doing my back extentions every day (I was still doing them 1-2x per day) to see if that helped calm things down. Said to do them, but in moderation.

I guess I'll keep this combo going. My BIGGEST fear is losing all this time off the bike, then when getting back on the bike having it start up again.


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## stoked (Mar 23, 2004)

I have a chronic case of trochanteric bursitis on left hip for over past 2 years now. I was struck by a car on left hip and shoulder. Shoulder took almost 2 years to heal, and 95% normal now. Left hip on the other hand has been a nightmare. After 5 months of continuous PT it was OK until 1st winter. Cold weather woke up pain demons. I had more PT and started to ride in spring. As I started to put in over 100 miles a week(mostly road) and then pain came back ... Back to PT for few months and off the bike again. I had MRI done and nothing showed up but I did have pain. After 1st cortisone shot and 4 weeks of PT it felt little better. I started to ride 6 weeks later carefully until bursitis pain got bad again. 

For me personally, PT, stretching only helps temporarily and pain comes back 2 weeks into riding. I had another MRI recently using 1.5 Tesla(high resolution) which showed bursitis on left hip. 2nd Dr gave me another shot but this time he spread the medication in all direction from center of the pain spot. From what I read you might need more than 1 cortisone shot. I saw 3 Dr.s whom all ruled out surgery in my case due to results they have seen. I also read that if you have a very serious case with lots of liquid build up you could get a shot with the help of ultrasound so that they inject it directly into it. I also like to add that 1st shot I got I didn't feel a thing but 2nd one I felt very sharp pain when needle was injected suggesting that it hit the pain spot. I've also had acupuncture for 6 weeks which helped. 

For now I decided to stay off the bike until next spring and hit the gym. I am going to work mostly on upper body and do light weight strength exercises on lower body. I want to make muscles around the hip stronger by using light weights and stop at first sign of pain. 

I know it is hard to stay off the bike for a long time but I think jumping on it too early causes delays for it to heap permanently.


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## Green Giant (Dec 19, 2003)

*stoked.. I'm with you*

Yeah, weather changes are bugging it a bit again this week, but my trajectory seems to be up, but a bit plateaued.

It kills me not to ride as you know, but at this point I may completely shut down any cycling until January, including spin etc.

I just sold off my useless road bike as it caused more problems than anything.

Good thing for me was after the first cortizone shot in August, I rode pain free for a month, but then it came back like hell. Thus the PT.

So, I may just start lifting upper body, doing some walking, and start swimming like crazy to try to loose some weight and do something cardiovascularly.

I'm wondering if dropping 20 lbs will help, figure it can't hurt.

Most frustrating injury ever for me. The back got better, I never expected the hip to crush me.


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