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Hip bursitis

What is it?

  • Hip bursitis (ber-SEYE-tis) is swelling and pain of a bursa in your hip. A bursa is a fluid-filled sac that acts as a cushion or shock absorber between a tendon and a bone. A tendon is a cord of tough tissue that connects muscles to bones. Normally a bursa has a small amount of fluid in it. When injured, the bursa becomes inflamed (painful and filled with too much fluid).
  • There are different types of hip bursitis. These types include trochanteric (tro-kan-TER-ik) bursitis (pain on the side of your hip) and ischial (IS-kee-al) bursitis. Ischial bursitis causes pain at the base of the hips where you sit down. The amount of time that you have bursitis depends on the cause of the bursitis. With treatment, many people feel better in about six weeks, but it may take longer for bursitis to heal.

Causes:

  • Constant pressure on your hips. This is often caused by standing or sitting on hard surfaces for long periods of time.
  • Direct, hard hit to your hip. This may happen if you fall on your hip.
  • Health problems such as scoliosis (skoh-lee-OH-sis), arthritis (ahr-THREYE-tis) or gout.
  • Infection (in-FEK-shun).
  • One of your legs is shorter than the other. This may cause you to limp or walk a certain way.
  • Overusing your hips. This is caused by doing activities or sports that use the same motions (movements) over and over again. Examples of repeating motions are running, climbing stairs or hills, and pedaling a bicycle.
  • Past surgeries such as hip arthroplasty (AHR-throh-plas-tee), or hip joint replacement.
  • Sometimes people do not know how they developed hip bursitis.

Signs and Symptoms:

Hip bursitis usually causes pain, aching, and stiffness. Pain is different depending on the type of hip bursitis you have.

  • The pain may be over the outside of your hip and thigh. The pain may be in your buttock and later move into the hip. The pain may also be in one side of the groin with some milder pain in the opposite hip.
  • Pressing on your hip or turning your hip and leg inward as you flex your hip may make the pain worse. The pain may be worse when getting up from a deep chair or getting out of a car. You may have trouble sleeping because the pain may be worse at night. Pressing on your groin may make the pain worse.
  • Your hip may feel stiff and not be able to move as well as before. You may hear a "pop" or "snap" as you flex or pull your leg up. Walking up stairs may be harder to do.

Wellness Recommendations:

  • The most important part of treating bursitis is resting your hip while the bursa heals. Rest your hip as much as possible to decrease pain and swelling. Resting may also prevent the bursitis from getting worse. Avoid activities that make the pain worse, such as walking up stairs. Sitting on a cushioned chair or foam donut may help decrease the pain. When the pain decreases, begin normal, slow movements.
  • Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this on your hip for 15 to 20 minutes, three to four times each day. Apply ice for two to three days or as long as you have pain. Do not sleep on the ice pack because you can get frostbite.

Medical Care:

  • You may be given antibiotics (an-ti-bi-OT-iks) to fight infection if needed. Take them as ordered until they are all gone, even if your hip begins to feel better.
  • You may use nonsteroidal (non-ster-OID-al) anti-inflammatory (an-tee-in-FLAM-ah-tohr-ee) medicine to help decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body temperature (fever). This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  • You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your hip is healed and that you can return to heavy exercise. It is important not to exercise your hip until your caregiver says it is OK. You could make the bursitis worse if you exercise your hip too soon.
  • Physical (FIZ-i-kal) therapists (THER-ah-pists) can do treatments to help your bursitis heal faster. These treatments include ultrasound to increase blood flow to the injured area. These include massage to stretch the tissue and bring heat to the injury which increases blood flow. You may slowly increase the amount of weight you put on your hip when caregivers say it is OK. You will be told to stop doing an activity if you feel any hip pain. Exercises to stretch your hip muscles and tendons to make them stronger will be started after the bursitis has healed.
  • Caregivers may use a needle to drain fluid from your hip. Removing the extra fluid may help the bursitis heal faster. The fluid may be sent to a lab and checked for infection.
  • You may be told to avoid sleeping on the side with bursitis. Sleep on your back or on the side without bursitis. You may want to place pillows between your knees when you lie on your side.
  • You may need surgery to remove the bursa or parts of bone from the hip. Surgery is usually not needed unless the bursitis is very bad, and does not heal with other treatments.
  • If you are overweight, your caregiver may ask you to lose weight to help decrease pressure on your hips.

Following are things you can do to help prevent bursitis from returning:

  • Keep pressure off your hips. Wear flat shoes that are cushioned (padded) and comfortable. Ask your caregiver about the best shoes to buy. Avoid sitting or standing for long periods of time, especially on hard surfaces. Sit on padded surfaces such as cushioned chairs or a soft foam pad whenever possible. Do not lie on the hip with bursitis. Bend at the knees, not at the hips, when picking up objects from the ground.
  • Stay at a normal weight. Ask your caregiver what weight is right for you. Ask for information about eating a healthy diet to help stay at the best weight for you.
  • Start exercising when caregivers say that it is OK. Exercise is important for stretching your muscles and keeping them strong. Slowly start exercise such as bicycling when caregivers say that it is OK. Do not begin running or other heavy exercise until you have no more pain, and your caregiver says it is OK.
  • Stretch, warm up and cool down. Always warm up your muscles and stretch gently before exercising. Do cool-down and stretching exercises when you are finished. This will loosen your muscles and decrease stress on your hips. Rest between exercise sessions.
  • Wear well-fitting shoes. Buy running or exercise shoes that fit your feet well. Talk to your caregiver or go to a special exercise footwear store to get well-fitting athletic shoes. Run or exercise on flat, even surfaces. Use orthotics (or-THOT-iks) if needed. Orthotics are shoe inserts that help line up your feet, legs, and hips correctly.
  • Use a shoe lift if one of your legs is shorter than the other. Ask your caregiver to help you decide which shoes lifts are best for you. Wearing a shoe lift may help you walk with less stress on your hip joint. Your caregiver may also ask you to use a cane.
  • Start treatment right away if you feel hip pain, aching and stiffness. Rest your hip, use ice treatments and take NSAIDs as directed by your caregiver.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Boswellia (Boswellia s errata) has been used for many years, but has not been studied in people who have bursitis.
  • Capsaicin creams (Capsicum frutescens) , made from the cayenne pepper, can help pain when applied to the affected area. Wash your hands after using the cream so that none of it gets into your eyes.
  • Turmeric (Curcuma longa) has been used for many years, but has not been studied in people who have bursitis.
  • Willow (Salix alba) has been used for many years, but has not been studied in people who have bursitis.

Supplements:

  • Bromelain has been used, but has not been studied in people with bursitis.
  • DMSO (dimethyl sulfoxide) has been used, but has not been studied in people with bursitis. Do not use DMSO longer than 14 days as it may cause eye problems.
  • D-phenylalanine has been used, but has not been studied in people with bursitis.
  • Niacinamide has been used, but has not been studied in people with bursitis.

Complementary Therapies:

  • Acupuncture decreases bursitis inflammation.

Other ways of treating your symptoms :

Talk to your caregiver if:

  • You would like medicine to treat bursitis.
  • Your symptoms have not gone away or improved by these self-help measures.
  • Your pain and swelling increase or you develop new, unexplained symptoms.
  • You have questions about what you have read in this document.
  • You have a fever.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. American Academy of Orthopaedic Surgeons. Bursitis of the hip. October 2000. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=139&topcategory=Hip (cited 3/4/04).

2. American Academy of Orthopaedic Surgeons. What are NSAIDs? December 2002. Available at: http://orthoinfo.aaos.org (cited 3/1/04).

3. Arthritis Foundation. Bursitis, tendinitis and other soft tissue rheumatic syndromes (online brochure). September 26, 2003. Available at: http://www.arthritis.org/AFStore/singleproduct.asp?idproduct=3320&idcat=8 (cited 3/4/04).

4. Ceccherelli F, Gagliardi G, Matterazzo G et al: The role of manual acupuncture and morphine administration on the modulation of capsaicin-induced edema in rat paw: a blind controlled study. Acupunct Electrother Res 1996; 21(1):7-14.

5. Clymann BB. Selected periarticular soft tissue problems in the elderly. Journal of the American Medical Directors Association 2003; 4(3): 167-170.

6. Mayo Foundation for Medical Education and Research. Bursitis. December 18, 2003. Available at: http://images.mayoclinic.com/invoke.cfm?id=DS00032 (cited 3/2/04).

7. Mayo Foundation for Medical Education and Research. Injections. November 19, 2002. Available at: http://www.mayoclinic.com/invoke.cfm?id=PN00046 (cited 3/1/04).

8. Nettina SM. The Lippincott Manual of Nursing Practice. 7th ed. Philadelphia, PA: JB Lippincott; 2001.

9. Pinter E & Szolcsanyi J: Systemic anti-inflammatory effect induced by antidromic stimulation of the dorsal roots in the rat. Neurosci Lett 1996; 212(1):33-36.

10. Schoen AM. Acupuncture for musculoskeletal disorders. Probl Vet Med 1992; 4(1):88-97.

11. Schoen RT. Bursitis, tendonitis, myofascial pain, and fibromyalgia. In: Rakel RE, Bope ET (eds). Conn's Current Therapy 2004. Philadelphia, PA: Saunders; 2004:1040-1042.

12. The Cleveland Clinic. Trochanteric bursitis: what you need to know. December 4, 2001. Available at: http://www.clevelandclinic.org/health/health-info/docs/0700/0745.asp?index=4964 (cited 3/8/04).

13. University of Miami School of Medicine. Bursitis of the hip. 2002. Available at: http://www.med.miami.edu/patients/glossary/art.asp?articlekey=304 (cited 3/4/04).

14. Zhang WY & Li Wan Po A: The effectiveness of topically applied capsaicin: a meta-analysis. Eur J Clin Pharmacol 1994; 46(6):517-522.


Last Updated: 4/4/2014

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