I’ve got this pain in the side of my hip… is it bursitis?
If you’ve been having pain in the side of your hip, you may have been told by your GP or someone else (or Google!) that you have hip bursitis. Hip bursitis is commonly thought to be the reason for pain in the side of the hip.
A bursa is a small, slippery sac of fluid that functions as a cushion and reduces friction in the body. Tendons, ligaments, and muscles all glide over bones and other structures when we move, so bursa are strategically located in areas where there is a lot of movement or pressure. Sometimes, the bursa can become inflamed due to excessive friction or pressure from surrounding structures, and the inflammation can contribute to pain in the side of the hip.
Although bursitis is commonly blamed for this pain, research has found that many patients with hip pain actually show little or no signs of inflammation (Strauss et al., 2010), which means that inflammation is not always the problem. Sometimes, the pain may be due to sensitivity of other structures nearby such as tendons. As such, we use the term greater trochanteric pain syndrome (GTPS) to describe the pain that people have in this region.
How do I know if I have GTPS?
If you are unsure if you have GTPS, check out the following list of symptoms that people who have the condition usually report:
- Pain when lying on the affected side
- Pain with prolonged standing or walking
- Pain when going up or down stairs
- Pain when sitting cross legged
- Tenderness when pressing against the hip bone
If you find yourself nodding along, it is possible that you may have GTPS. Activities like standing, walking and going up stairs require contraction of the muscles on the side of the hip, which places tension on the tendons and can also increase pressure on the bursa. Both of these can lead to pain that is felt in the side of the hip. Lying on your side or sitting cross legged will directly compress the structures on the side of the hip, which can lead to pain and discomfort when in those positions.
Sometimes, patients may consult their GP about their condition and may be referred for a scan (usually an ultrasound or MRI). Whilst a scan can be helpful for seeing the inflammation or any other structural changes, this is usually not necessary for successful treatment of the condition! That’s because a scan can only show the structures of the hip – it doesn’t really tell us much about what you’re experiencing.
I think I might have GTPS… what do I do?
If you think you might have GTPS, seeing a physiotherapist is a great first step to figuring out how to deal with the issue. In a typical consultation, your physiotherapist will ask you questions about activities that bring on your hip pain, how long you’ve been having the issue for, and questions to rule out other conditions. In addition, your physiotherapist will have a look at your movements and may also measure your hip strength to see if this is something that needs to be worked on. After all the testing, your physiotherapist will have a much better idea of how to help you fix your hip pain. Depending on your specific case, your physiotherapist can also discuss if having a scan is necessary.
The first step to addressing your hip pain will usually involve some simple adjustments to your daily activities. For example, sleeping on the unaffected side with a pillow between your, sitting with the feet flat on the ground instead of crossed, and standing with your feet slightly further apart can all relieve tension through the side of the hip.
Whilst these strategies can be helpful for short-term pain relief, we also recommend exercise to improve the strength and function of the hip muscles as this has been shown to improve longer-term outcomes (Ganderton et al., 2018). Although it may seem counterintuitive to do exercise as this places tension around the sensitive hip structures, choosing the correct exercise can make a big difference and actually help to reduce pain and discomfort too.
How long will it take to get better?
The short answer is: it depends. The long answer is: it also depends! How long you have had your pain for, whether it affects one or both sides, what activities you would like to be able to do, and many other factors can affect how quickly you respond to treatment. As a general guide, it takes some time for muscles to adapt and become stronger –usually around four to six weeks– but there are other treatments physiotherapists can use to help improve your symptoms quicker.
Well, my hips don’t lie!
Ganderton, C., Semciw, A., Cook, J., Moreira, E., & Pizzari, T. (2018). Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. Journal of women’s health (2002), 27(6), 815–829. https://doi.org/10.1089/jwh.2017.6729
Segal, N. A., Felson, D. T., Torner, J. C., Zhu, Y., Curtis, J. R., Niu, J., … & Group, M. O. M. S. (2007). Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of physical medicine and rehabilitation, 88(8), 988-992.
Strauss, E. J., Nho, S. J., & Kelly, B. T. (2010). Greater trochanteric pain syndrome. Sports medicine and arthroscopy review, 18(2), 113-119.