Diagnosed with Trochanteric Bursitis and not getting better. Please help.
Pain started this past September while training for a marathon.
10/18/08 Ran marathon but barely finished due to pain in both hips.
Got a massage 6 days after marathon. no relief in hips.
Made multiple visits to a chiropractor/massage therapist searching for relief - no relief.
Tried to run 2 weeks after marathon. Had to stop run at mile 4 due to hips.
Visited a Physical Therapist who diagnosed me with Trochanteric Bursitis, gave me a series of stretches and told me to not run for 4 more weeks.
4 weeks post PT visit I ran but had to stop due to hip pain.
Visited an Ortho Doc and was again told that I had Trochanteric Bursitis and possibly had stress fractures in both hips. Doc could not see any fractures on X-ray but was confident that I had them due to the acute pain that I had while performing simple stretch with PT 4-6 weeks earlier. Doc tells me not to run (only swimming and bike) for another month, take some anti-inflamatories and gives me a few more stretches to do.
2009 arrives and still no running. I return to Ortho Doc still having pain. Feb. 2nd an MRI is performed showing nothing more than inflamation in the Greater Trocanteric Area. Doc gives me a cortisone shot in my left hip. I have some relief but can still feel it a little bit. Hopefully I will get a shot in the right hip when I go back to the Doc in two weeks.
Will this ever go away?? I have been swimming a couple of times a week and doing spin class one time a week over the past few months. I have even cut back on the swimming the past 2 weeks hoping that it would help.
I am sure the the culprit is my IT Band gliding over the trocanteric area and causing the inflamation. What can I do to get past this. Not running is driving me crazy!
Why would it take more than four months off to go away? Could it be something else that is not common? If it is Trochaneric Bursitis, how do get rid of it and how do i keep it from occurring again?
LINK containing some good basic information.
This is a frustrating problem. Obviously you need to see a physician with an interest in sports medicine. Usually there is an underlying problem, multiplied by repetition. The most common causes are weak hip abductors and a tight IT band. I like to start with a visit to a good physical therapist with the goals of strengthening the hip abductors, stretching the IT band and deep tissue massage. Which you’ve done. At this point I usually inject a corticosteroid into the bursa to calm it down. At this point the hope is that the cause is treated and the effect is relieved. If you begin running again and pain persists there is a problem. One proprioceptive cue is to called Axel Between the Knees. Imagine that there is an axel between you knees that pushes your knees about a half an inch farther apart than normal when you run. This cue will help relieve some of the stress on the bursa. Also try not to cross the midline of your body with your arms, legs or footstrike. Hope this helps. See what others have to say. You need an expert to help pinpoint the cause of your problem. Remember it could be something you do on the bike that manifests on the run.
That’s exactly what I had during and after my Ironman. You need an aggressive very sports-oriented chiropractor or physical or massage therapist. Stretching, pressure and release, ultrasound, pain relief creams, ice, motrin. The bursitis will only go down with anti-inflamatories, ice and rest. It’s amazing how my chiropractor can get right on the muscle and force it to release. If you’re not getting that, find somebody else.
I went through the same thing 3 years ago after a marathon. Ended up taking 5 months off, gained 25 lbs, improved but it wasn’t until I started a consistent stretch program and saw a quality massage therapist who took me through stretches for this region. Foam rollers help the issue if consistent in using them. My bursitis is caused by a tight IT and I literally stretch any free moment I have. I got tired of sleeping on my back. It took some time but I only occassionally have pain after a long run now but nothing debilitating. Good luck.
One comment. There is NO SUCH THING as a “tight IT band.” The IT Band is a tendon and is basically fixed in length. The issue with people who say they have a tight IT band is actually the muscle at the top of the IT band…the TFL (tensor fasciae latae or something like that). Loosening that muscle with various stretches (tennis ball or the foam roller) and sideways hip stretches in combination with strengthening of the TFL through hip hikes is pretty much the solution for ITBS.
Regarding your issue, I’d suspect that you could get fairly quick relief through what an above poster mentioned. Hip hikes, TFL stretches and the tennis ball (likely to be excruciatingly painful) and some R&R. YMMV
Let me begin by saying I am sorry that you are going through this and I know how frustrating this must be for you. You have done all of the things that most people would suggest and still no results… VERY FRUSTRATING! Anyway, no one has mentioned the CAUSE of this injury so here is my experience and opinion on this matter. I have seen this in practice but only once and the ‘typical’ modalities did seem to give relief but really did not get rid of the stresses on the bursa in question. So… what next?
Running Technique. Now, without watching you run I can probably imagine (please excuse me if i am incorrect) that your feet are landing out in front of your body with a heavy heal strike. The body then has to move up and over the foot during mid-stance. It is during the foot strike and subsequent midstance phases where the hip is under excessive load and the Hip Abductors are under excessive strain. You mentioned this first began during a marathon build up which is a common presentation for this injury in runners. With the strain/stress on the abductors they weaken and a Trendelenburg gate (not a the true neurologic deficit causing gate however) is seen which places even more stress on the greater trochanter region which includes the bursa. Bursa are sacs filled with fluid that are there to create a cushion between tissue surfaces. When too much stress is placed on the tissues, in this case due to improper running mechanics, the bursa becomes inflammed. So… to make a very long story short, you will do yourself a dis-service if you do not atleast look into changing how you run. This in and of itself can be a frustrating prospect but I have seen this, in my own practice I might add, work wonders and eliminate not only the bursitis but also a myriad of other running related injuries. So… To simplify things for you (some may disagree with me on this) I would try Chi Running and Pose Method reading each, researching everything you cand find, make the changes and do the work required. it may take weeks, months or even up a a year but I can say that you will not regret it.
I know you want a quick fix. I am sorry I cannot give it to you. I am giving you something you can do to fix the cause of this condition rather than putting a temporary band-aid on it. Good luck and PM me if you need further information or if you have questions. ERIK
If you have been correctly diagnosed with trochanteric bursitis then you need to have someone identify the cause.
In my experience there is always an asymmetry which is the root cause of the injury. I have never seen it be just from muscle tightness. It is caused my muscle weakness and or limitations in a joint somewhere along the chain.
A good examination should include a detailed assessment of each joint and muscle from head to toe, including running, walking, biking mechanics, footwear. Once the asymmetry is identified, strengthening (painfree) in weightbearing the weak muscles and joint mobilizations of the limited joint/joints is the bread and butter. The practicioner should include as needed, stretching, trigger point release/massage of the limited muscles and joint (guaranteed you will have these limitations in flexibility and ROM), ultrasound (for people who are limited in their ability to do WB’ing strengthening), ice/ice massage. A plan should be set forth for home strengthening, and stretching, address long term footwear, running mechanics, and set up a return to running program (gradual increase from walking painfree, to jogging, and finally return to running).