Do you experience stabbing, constant pain on the outside of your hip that makes it hard to sleep on your side? This painful discomfort is usually due to greater trochanteric bursitis, which is inflammation of the fluid-filled bursa that cushions your outer thigh bone. The sensitive structure can become irritated, making it difficult to walk, climb, stand from a chair, and perform other daily activities. Fortunately, you don't have to endure the pain and limited mobility that comes with this condition.

Suarez Physical Therapy in Las Vegas, Nevada, provides full physical therapy services that are non-invasive and will help you find long-term relief. Our skilled physical therapists create a personalized treatment program that addresses the underlying cause of your hip pain and restores joint mechanics and muscle balance.

Overview of Greater Trochanteric Bursitis

The greater trochanter is a prominent bony projection on the lateral hip. Several muscles that control hip motion are connected directly to this bony landmark via a network of thick tendons. Your body has small, fluid-filled sacs called bursae that act as protective cushions to prevent friction and facilitate smooth motion. The greater trochanteric bursa is located between the bony trochanteric prominence and the fibrous tract that runs over it, called the iliotibial tract or iliotibial band. Greater trochanteric bursitis is the result of irritation or swelling of this bursa.

Traditionally, bursal inflammation was thought to be the only cause of lateral hip pain. However, contemporary orthopedic studies suggest that the bursa is not typically inflamed alone. Instead, the condition is usually grouped under the diagnostic term "Greater Trochanteric Pain Syndrome."

This syndrome is a progression of microtrauma, tissue overload, and mechanical friction that irritates the bursa as well as the underlying gluteus medius and gluteus minimus tendons. These structures are subjected to high mechanical stresses during walking or running. When the load is too high, micro-tearing and irritation will take place, and this will hinder your physical function for a long time.

Symptoms of Greater Trochanteric Bursitis

Physical limitations are seen when the greater trochanteric bursa and the abductor tendons are irritated. Symptoms can be acute or chronic, but often you will have localized pain that directly interferes with your functional patterns, sleep, and the mechanics of your lower extremities.

Pinpoint Tenderness Over the Greater Trochanter

The main physical symptom of this condition is a sudden, localized pain in the outer surface of your hip when you touch it. The pain is easily felt by locating the hard, bony bulge on the side of the upper thigh. A simple touch or bump, like leaning against a kitchen counter or placing a hand on your thigh, can trigger a sudden, intense reaction. The bursa beneath is sensitive, and in severe cases, the pressure of tight waistbands, seatbelts, or narrow chairs is sufficient to cause irritation and make localized compression intolerable.

Night Pain And Sleep Disturbances

It can be difficult to sleep on the affected side as your body weight is directly compressing the swollen bursa. This mechanical compression is caused by the sensitive tissues being compressed against the greater trochanter, and causes a deep, throbbing pain that keeps you awake all night. Just lying on your uninjured side can be painful because the top leg can cross over your body and pull your hip into the midline of your body, stretching and compressing the outer hip tissues. This means you are left feeling tired from poor quality and fragmented sleep.

Radiating Discomfort and Gait Stiffness

This pain is not usually localized, but tends to spread down the lateral side of your thigh. This spreading pain may extend to the outside of your knee and may feel like neurological symptoms, but it is usually limited to the knee area and does not go beyond your calf or foot.

Also, you develop a lot of stiffness when getting from a seated to a standing position, particularly after sitting for a long time. The deep ache may be worsened by walking up or down stairs, walking on uneven surfaces, or inclines.

The following movements are specific to the day and tend to exacerbate or cause this radiating lateral hip pain:

  • Sitting with legs crossed on a chair.
  • Standing and resting your weight heavily on one hip
  • When getting in or out of a car, lift your legs to step in or out
  • Removing socks/shoes while flexing the hip
  • Walking up hills or ramps that are steep

Different Types of Greater Trochanteric Pain Syndrome (GTPS)

Greater Trochanteric Pain Syndrome is a classification of the specific clinical presentation that is necessary to understand the cause of outer hip pain. The bursa sac itself can become damaged, or the ligaments that hold it in place, or the dense bands of connective tissue that attach it directly to the outside of your upper thigh bone can become damaged.

True Trochanteric Bursitis

This is a localized inflammatory swelling of the bursal sac, typically the subgluteus maximus bursa. Excess fluid is produced in the bursa as a protective mechanism against repetitive friction, especially when engaging in unaccustomed movements. Isolated bursitis is relatively rare and is usually caused by a direct traumatic injury, for example, a fall on the side or a sports injury resulting from contact. The bursa becomes very vascular and very sensitive, and sends a lot of pain signals with every step of the leg.

Gluteal Tendinopathy and Abductor Tears

Gluteal tendinopathy is the most frequent cause of lateral hip pain, which is caused by degeneration or micro-tearing of the gluteus medius and gluteus minimus tendons. These tendons go straight to the greater trochanter to help stabilize your pelvis. With time, mechanical overload causes the tendon matrix to break down, replacing the strong type 1 collagen with weaker type 3 collagen. This chronic wear and tear can continue to develop from mild tendinosis to partial-thickness tears or full-thickness tears, causing significant instability of the pelvis and a very noticeable, persistent limp that makes it difficult to move around.

External Snapping Hip Syndrome

This condition is caused by the third band of the iliotibial tract rubbing against the prominent greater trochanter bone. You will feel and/or hear a clear snap when you flex and extend your hip. This snapping may occur painlessly in an athletic population, but it is often associated with progressive irritation of the underlying bursa. The rubbing continuously thickens the connective tissue, leading to a vicious cycle of:

  • Rubbing
  • Localized heat
  • Inflammation
  • Chronic, throbbing lateral hip pain over a long clinical history

Causes of Greater Trochanteric Bursitis

Greater trochanteric bursitis is not a one-off occurrence but is generally caused by a progressive overload of the tissue. The outer hip irritation occurs when compressive and tensile forces are applied to the bursa and underlying gluteal tendons that are greater than their structural ability at this time.

Repetitive Mechanical Overuse

Constant hip flexion and extension movements are the main factors involved in bursal irritation. The hip structures can become overloaded with repetitive physical activity, walking longer distances, or high-intensity cycling. The constant rubbing of the iliotibial band over the greater trochanter causes friction to occur that is greater than the cushioning ability of the bursa. Because of this repetitive microtrauma, the tissues do not have time to heal and, directly, cause persistent, highly localized aching in your outer joint, along with chronic swelling.

Direct Trauma and High-Impact Injuries

Acute bursal inflammation can occur from direct trauma to the lateral aspect of your hip. Bruising of the bursa can occur when the bursa comes into contact with a hard surface, is bumped during recreational activities, or is placed on a hard floor for a prolonged period. The sudden impact crushes the fluid-filled sac against the hard greater trochanter, resulting in immediate bleeding, swelling, and localized pain. This traumatic injury can change joint mechanics as your body tries to protect the painful, injured area.

Biomechanical Imbalances and Altered Gait

Imbalances in your lower legs and back can significantly affect the compression on your outside hip. If the pelvis is unstable, the hip has to adduct too much during weight-bearing, which puts the greater trochanter bone into the iliotibial band.

The most frequent biomechanical imbalances that cause this increased compression are:

  • Leg length difference that changes the alignment of your pelvis and the function of your joints.
  • Poor deep core and gluteal stabilizer strength
  • Low back problems like degenerative disc disease or lumbar scoliosis
  • Hip or knee osteoarthritis causes a walking pattern that is limping
  • Severe foot pronation, so your knee collapses inwards during your normal walking or running around the house or office today.

Risk Factors for Greater Trochanteric Bursitis

Several factors can make you more vulnerable to developing this painful hip condition. They include the following:

  • The peak incidence is from the ages of 40 to 60
  • Women are 4 times more likely to develop the condition than men because they have a wider pelvis
  • Increased weight also puts constant pressure on the joints of your lower limbs and increases the compressive forces on the lateral hip during simple gait.
  • Systemic diseases like thyroid problems, diabetes, or inflammatory arthritis can affect your body's ability to heal on its own, making your tendons more susceptible to the effects of minor activities on them.
  • Manual work involving prolonged standing increases your overall clinical risk of localized lower limb tissue overload.
  • Sports activities that are of high intensity without adequate physical conditioning

Complications of Untreated Greater Trochanteric Bursitis

If the lateral hip pain is ignored and work is continued through the pain, it can cause significant structural and functional problems, which are much harder to correct. A mild, temporary irritation of the tissue can develop into chronic, degenerative changes in the gluteal tendons, which can permanently affect your mobility.

The most common problems that arise from not seeking professional physical therapy treatment are:

  • Gluteal tendinosis and full-thickness tendon tears.
  • The gluteus medius and minimus (muscles) are severely atrophied
  • Compensatory lower back, knee, or opposite hip pain
  • Persistent Trendelenburg gait and permanent instability of the hip
  • Systemic fatigue and “cognitive fog” from sleep deprivation
  • Loss of athletic endurance and decline in overall quality of life in the long term

Greater Trochanteric Bursitis Treatment Through Physical Therapy

A multi-phase treatment protocol, aimed at load management and tissue capacity, is required to treat lateral hip pain successfully. If you can get the initial symptom relief you need and then move on to progressive, targeted active rehabilitation, you can have your lower extremity function back and be completely free of discomfort.

Phase 1: Acute Load Management and Decompression

During the acute phase of recovery, the aim is to remove the compressive forces that irritate the swollen bursa and sensitive gluteal tendons. You will need to change your daily routine for a while, for example:

  • Avoiding high-impact activities
  • Avoiding long periods of walking up and down stairs
  • Avoid walking on steep hills

At this stage, physical therapy is focused on lateral hip precautions and teaching you about movement patterns that aggravate symptoms. Avoid end-range stretching of the iliotibial band and piriformis, which will tighten the irritated, tight connective tissues across the painful greater trochanter.

Using an ice pack on the lateral hip for 15 minutes several times throughout the day will help to reduce acute irritation, and a thick contour pillow between the knees will prevent the hip from adducting and pinching the bursa as you sleep quietly in bed each evening, supporting your structural tissue recovery and cellular healing.

Phase 2: Isometric strengthening and gentle muscle activation

Once your acute pain is under control, your physical therapist will begin to add low-load isometric strengthening exercises. These contractions are made with the gluteal tendons in a shortened and non-compressed state in order not to squeeze the bursa.

Isometric exercises are useful as they recruit muscle fibers, decrease cortical inhibition, and are a natural pain reliever to help dull your hip pain. You will be practicing gentle contractions with the stable resistance loop lying on your back with your thighs pushed outwards, or standing with your leg pushed outwards against a wall.

These exercises need to be done with the hip angle slightly abducted so that the tendons do not slide over the bony trochanter or cause sharp pain at any point in your clinical rehabilitation program at the clinic.

Phase 3: Progressive Isotonic Loading

After isometric contractions without reactive pain, your physical therapist will move on to heavy, slow resistance isotonic training. This is an important phase to restore the integrity of your gluteal tendons, to encourage the production of normal type 1 collagen, and to strengthen the stabilizers of the pelvis. You will be doing controlled concentric and eccentric movements, slowly lifting and lowering your leg to develop tissue capacity.

During this stage of physical therapy, the following are some of the key therapeutic exercises:

  • Supine glute bridges to build up strength in the posterior chain and stabilize the pelvis
  • Controlled clamshells with a resistance band, targeting deep external rotators
  • Upright side-stepping with a resistance band placed around your ankles
  • Wall squats utilizing a soccer-sized ball to build lower limb endurance and strength
  • Standing hip abduction, holding a stable surface to improve your single-leg balance and core pelvic stability during functional daily standing tasks today

Phase 4: Functional Plyometric Loading and Graded Return to Activity

The last step of active rehabilitation is to make your hip ready for the high velocity and dynamic stresses of athletics, running, or physically demanding jobs. Your physical therapist will add exercises that involve the storage and release of energy by your tendons. This is a slow progression of dynamic loading with emphasis on keeping the pelvis level and not collapsing inwards at the knees during movement.

You will be doing controlled step-ups, single-leg balancing exercises, and progressive lateral lunges. Unfortunately, to avoid a regression, continue a dedicated loading and strengthening program after your pain has resolved, since tendons need to be loaded regularly over time to maintain their cellular health and structural stiffness without any sudden regression of the lower limb joint structures.

Medical and Invasive Interventions

When conservative physical therapy fails to resolve your symptoms, several medical and interventional treatments can be incorporated into your treatment plan. Acute flare-ups can be managed with over-the-counter (OTC) nonsteroidal anti-inflammatory drugs or topical pain-relief gels. However, these are not a solution to the underlying biomechanical issues.

If pain is chronic and severe, an ultrasound-guided injection of the bursa with corticosteroid can be performed to give you immediate and significant relief so that you can begin your active physical therapy. However, these injections should be limited because, over time, repeated cortisone injections can weaken the tendon.

Extracorporeal shockwave therapy is an amazing non-invasive alternative that stimulates tissue healing with acoustic waves.

Surgical treatments such as an endoscopic trochanteric bursectomy or abductor tendon repair are considered a last resort in chronic, refractory cases that do not improve with high-quality, evidence-based active physical therapy after 6-12 months.

The Prevention of Greater Trochanteric Bursitis

The ideal way to avoid the development or return of lateral hip pain is to take a proactive approach to load management and develop healthy movement patterns. You can prevent excessive compression on the greater trochanter and maintain the integrity of your hip bursa and gluteal tendons by avoiding positions that compress the greater trochanter.

Lifestyle changes and prevention measures are as follows:

  • Using a supportive pillow between the knees to maintain the hips fully aligned throughout the night
  • Not sitting with crossed legs or leaning on one hip when standing
  • Slowly increase the amount and length of any new exercise routine
  • Supportive and shock-absorbing shoes that do not allow the knee to collapse inwards when moving
  • Doing weekly gluteal and deep core muscle strengthening exercises
  • Take active breaks to stretch and move often during standing activities at the workstation

Consult a Las Vegas Physical Therapist Near Me

You can overcome greater trochanteric bursitis without making it a chronic, degenerative condition. However, you do need to get on top of it quickly. If you ignore the symptoms of lateral hip pain, you can develop chronic movement compensation, altered gait mechanics, and localized muscle atrophy, which can make the healing process take longer. Seek help from a physical therapist who focuses on providing evidence-based rehabilitation protocols tailored to each individual's clinical needs.

At Suarez Physical Therapy, our highly experienced physical therapists have a wealth of knowledge in dealing with hip problems, correcting muscle imbalances, and restoring functional mobility. We treat patients throughout Las Vegas, NV, and offer personalized, caring treatment to help you get back to your favorite activities safely. Make an appointment with our clinical experts today at 702-368-6778 and begin your physiotherapy session for a stronger, pain-free, much more mobile physical future.