“My bursitis is acting up again!”
This is one of the most common complaints heard by physical therapists, usually from the over-60 population, about a sudden onset of shoulder pain. Runners often have a similar complaint, although the area most often affected is the outside region of the hip.
What exactly is bursitis? If you’ve followed this column over the years, you know by now that the “-itis” refers to inflammation. The “burs-” refers to a bursal sac; a small fluid-filled pouch designed to act as a cushion between a bony prominence and the tendon that may rub against it during movement. There are approximately 150 such structures in the body, the most-often-affected ones at the shoulder, elbow, hip, knee, and heel. Patients suffering from bursitis complain of a deep, aching, often throbbing pain that they liken to a terrible toothache. The pain can radiate a short distance away from the actual site of inflammation. Direct pressure to the bursa is exquisitely painful
Bursitis can have several causes. Direct trauma, such as from a kick or fall, can result in an acute swelling of the bursal sac. Prolonged kneeling on a hard surface can irritate the bursa in front of the kneecap, earning this the somewhat sexist appellation “Housemaid’s Knee.” While an inflamed bursa can sometimes become infected, “germs” are not thought to be the usual mechanism for onset initially, despite one of my colleague’s assertions to the contrary. (He was convinced by the “streaky” nature of cases presenting in the clinic – none for months; several of the same type within a few days – that a “bursitis virus” must somehow be responsible.)
The most common cause for bursitis is overuse and/or improper biomechanics during repetitive activities such as distance running. The most frequent injury of this type in runners affects the trochanteric (tro-KAN’-ter-ik) bursa found on the outer hip area. The two tendons (gluteus maximus and tensor fascia lata) that join to form the iliotibial band [ITB] traverse the bony protrusion of the upper femur (the Greater Trochanter). The trochanteric bursa lies between these structures to protect the tendons. Too much rubbing, however, can irritate and injure the bursa, leading to that deep, aching pain on the outer upper thigh that can radiate downward along the upper ITB. The pain is usually made worse with running, stair climbing, and turning over or lying in bed on the affected side.
The biomechanical faults that can lead to this malady include the usual suspects: functional leg length discrepancy; hip muscle strength imbalances; excessive foot pronation. External influences, such as running on one side of an extremely cambered road, can account for the biomechanical flaw that causes the problem. Another leading culprit often turns out to be improper footwear, with “improper” referring simply to shoes that are just not right for an individual as they cause some detrimental change in that person’s gait pattern.
Accordingly, the first step in determining a possible cause for an episode of bursitis should be a careful analysis of the runner’s shoes. If the footwear is old and obviously broken down, or more commonly, if the runner just prior to the onset of injury (within the past 2-4 weeks) purchased new shoes that are a different style and model from those used in the past, the initial form of treatment is fairly obvious. If improper footwear does not appear to be implicated, a thorough evaluation of the runner’s biomechanical status may be advised.
“First-aid” treatment for the injury consists of rest (light or no running), ice and/or heat, anti-inflammation medications is tolerated well. Sometimes in very extreme, acute cases, patients are advised to walk with a cane (held in the hand opposite the injured hip) to reduce weight-bearing pressure on the hip. If the problem fails to resolve within six weeks, your physician may elect to inject the bursa with a corticosteroid medication to reduce the inflammation. This is very often an almost instantaneously effective measure.
Trochanteric bursitis can be a debilitating running injury, but one that if properly evaluated and treated need not become a chronic, recurrent problem.
