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Running Injuries 101: Hip Bursitis 07/08/2019 0 Comments

You’ve been training for a few months and now the miles are really starting to add up. You go out for another one of your weekly runs, but this time you begin to have some pain along the outside of your hip. You don’t remember doing anything that may have injured it, but notice it gets worse the longer you run, and may even persist for a while after your run. In more severe cases, pain can hurt with walking stairs, sitting or standing for a long duration, or even when attempting to sleep directly on that side of your body. One of the most common causes of lateral hip pain, or pain on the outside of your hip, is greater trochanteric bursitis, or commonly called hip bursitis. […]

What Is Hip Bursitis?

A bursa is a small fluid-filled sac that typically provides cushion between bones and tendon’s and helps reduce friction to allow for more free movement. The human body has bursae throughout the body, most commonly in the shoulder, elbow, hip, knee and heel. On the outside of the hip there is a larger bone (greater trochanter) that serves as the attachment site for several muscles and tendons. To protect the tendons that attach near or on that bone, there are 2 bursae: a superficial bursa located over the greater trochanter, which is the most commonly inflamed bursa, as well as a deep trochanteric bursa which lies a little deeper and can become inflamed in more severe cases. When this bursa is injured, either traumatically, or more commonly through repetition, it will become inflamed causing pain along the outside of your hip.

What Causes Hip Bursitis In Runners?

Hip bursitis in runners is almost always a repetitive motion injury, although it can also be caused by direct trauma to the outside of your hip. Runners subject their hips to frequent, repetitive motions as they take each stride. By performing these same repetitive motions 80-90+ times per minute, the bursa can experience constant friction and stress, leading to irritation and inflammation of the bursa.

Muscle weakness is one of the biggest contributors to increased stress along the outside of your hip. The glute’s help control hip abduction (bringing your leg out to the side) and external rotation, which helps decrease stress laterally, but this muscle group is too often too weak for the demands of running. When this muscle group is weak, the knee drops in towards the midline of your body, or the pelvis will drop, as well as your femur bone will rotate inwards, all causing increase stress on the outside of the hip, and therefore the bursa.

Other potential causes and risk factors:

  • Faulty running mechanics
  • Differences in leg length
  • Overpronation of the ankle
  • Running on cambered surfaces (i.e. tilted edge of the road)
  • Simply running too much, too soon
  • Gender – Females are at an increased risk because of the shape/size of the hips and pelvis
  • Age – Elderly more likely to develop condition
  • Previous injuries or surgeries to that area
  • Bone spur’s or calcium deposits

How Do I Treat It And Do I Need To Stop Running?!

The pain felt with hip bursitis is typically due to the inflammation and increased pressure of the bursa. The primarily goal therefore initially is to reduce the stress and inflammation along the outside of the hip. This can be done using ice, short-term use of anti-inflammatories, and modifying activities that are causing pain, which sometimes means decreasing mileage/intensity of your runs, or even stopping running all together. As a runner, I know that being told to stop running is something runners typically do not want to hear, so the general rule is if your running hip pain symptoms do not increase throughout your run, then proceed with caution making sure to monitor the symptoms following the run as well.

As symptoms begin to subside, you must then address what is actually causing the increased stress along the outside of your hip. For runners with considerable leg length discrepancies, this may mean getting a shoe insert to make the legs even. Most commonly though, runners will need to begin an exercise program that will address any flexibility and strength deficits and imbalances around the hip that can be contributing to increased stress along the outside of the hip. The most common weak muscles in runners dealing with hip bursitis are the muscles that perform hip abduction and external rotation as well as your core muscles which help stabilize your pelvis; some common tight muscles include stretching your hip muscles and calf muscles to allow for good alignment and proper movement patterns required for running.

If pain is primarily with running, and strength/flexibility seems to be adequate, it can go a long way to have your gait pattern analyzed and work on possible biomechanical errors. The most common findings seen in runners with hip bursitis include

  • Cross-over sign – this is when your foot lands on an imaginary line that goes through the midline of your body
  • Excessive hip adduction – when your thigh bone begins to drop in, such as a knock-kneed position
  • Excessive hip internal rotation – when your toes are pointing inwards rather than forward or slightly outwards, or you notice your knees are pointing inwards
  • Excessive pelvic drop – when the pelvis on the opposite side of the leg on the ground drops excessively lower than the stance leg.

In more severe cases, doctors may recommend an injection, which may temporarily reduce inflammation, although this does not get to the root CAUSE of the problem, only manage the symptoms. Although rarely done, and only in worst case scenario’s where all over conservative treatment options have failed, the doctor may recommend surgery, which requires the doctor to remove the bursa in a surgery called bursectomy.

Seeing a medical professional that specializes working with runners and dealing with running-related injuries can go a long way, especially when the pain is occurring during your run primarily.

​A specialist will help you identify the risk factors possibly contributing to lateral hip stress and therefore hip bursitis. Also, it was been shown in the research that gait retraining for as short as 2 weeks can decrease the risk for a running-related injury as much as 62% in runners. Don’t wait until pain is so severe you need to stop running; go see your local running specialist to get an accurate diagnosis and begin to help fix what is causing your pain, rather than just treating the pain itself!

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