Is your hip pain from bursitis? Have you been treating your hip pain with bursitis treatments like steroids and non-steroidal anti-inflammatories? There are times these treatments help to give some relief, but many people continue to experience a substantial amount of discomfort even after trying them. Plus, continued use of steroids injected into a degenerated joint can unfortunately increase the rate of degeneration.
Why not treat the pain with treatments that regenerate rather than degenerate the joint structures? In this article, we will discuss hip bursitis, various treatment options, and other reasons for hip pain that cause bursitis like symptoms.
We see quite a few patients who come to our office for treatment of bursitis who do not actually have bursitis. Bursitis is so painful that even touching the skin over the painful area is difficult to tolerate. If the area can be palpated with a lot of pressure by the doctor, the patient may not have bursitis. What could the problem be then?
Hip Bursitis, or trochanteric bursitis, is actually rare! Multiple studies have shown that patients presenting with bursitis type symptoms actually have tendinopathy (tendon degeneration) of their gluteal tendons. These tendons attach near the bursa and often fool providers into thinking the patients have bursitis. Badly degenerated tendons are what they really have. And they need regeneration!
On top of that, as we mentioned, steroid injections are often used as the treatment for true bursitis. So when steroids are injected into the degenerated tendons, they actually can cause them to degenerate faster! Tendinopathy of the gluteus minimus or gluteus medius is often at the root of greater trochanteric pain syndrome.
Regenerative Orthopedics including Stem Cell Therapy, PRP, and Prolotherapy is a safe and effective treatment option for bursitis, tendinopathy, and other underlying soft tissue injuries of the hip.
True bursitis is an inflammation of the bursae, which are small, fluid-filled sacs that lubricate and cushion pressure points between the bones, tendons, and muscles of joints. And the bursae help the joints to move with ease. So when the bursae become inflamed due to bursitis, movement or pressure can be painful. Bursitis often affects areas around the joints in the elbows or hips.
Hip bursitis involves a bursal sac that is inflamed between the hip bone and glutei muscle attachments. The bursal sac inflames because of injury to the soft tissue structures. The bursal sacs decrease the friction of the soft tissue structure and the underlying bone. This allows the tendon or muscle to glide across the bone more easily. Bursitis pain usually goes away within a week or so with proper treatment, but recurrent flare-ups are common as well as frustrating.
Common causes of bursitis are overuse, stress, or direct trauma to a joint, such as repeated bumping or prolonged pressure. Bursitis may result from an infection, arthritis, or gout. Bursitis may also be due to the repetitive motion related to certain activities. Tendonitis, which involves the irritation or inflammation of tendons, or tendinopathy (degenerated tendon) are again oftentimes misdiagnosed as bursitis.
Symptoms of hip bursitis include a dull ache or stiffness in the affected hip. Bursitis pain often worsens with movement or pressure. And the area may be swollen and feel warm to the touch. Intermittent redness of the skin in the area of the inflamed bursae may be another symptom.
Visible swelling or skin redness is usually absent from bursitis of the hip because the bursae are located beneath some of the body’s bulkiest muscles. Pain is primarily centered over the greater trochanter, a portion of the femur that juts out just below where the bone joins the hip.
Since bursitis is an inflammation of the fluid-filled sac, or bursa that lies between a tendon and skin, or between a tendon and bone, bursitis treatment often involves the use of non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and steroids such as cortisone.
If the problem is not true bursitis, the steroid injections to decrease the inflammation will usually not work to eliminate the pain, since inflammation is not the real problem. The steroid will, however, inhibit fibroblastic proliferation or the process by which soft tissue structures such as ligaments, tendons, and muscles grow and repair, and result in a weakening of the joint.
NSAIDs are associated with a higher risk of cardiovascular- and gastrointestinal-related adverse events. The FDA issued a medication guide for NSAIDs recommending physicians prescribe the lowest dose for the shortest time possible.”[i]
As physicians become educated on the side effects of these medications, they hopefully decrease their use of them. “As years of experience increased, practitioners were more likely to prescribe lower doses of corticosteroid in musculoskeletal injections.”[ii]
Newer therapies are sought to replace NSAIDs due to their significant side-effect profile. Regenerative Orthopedics is both a safe and effective treatment option for bursitis pain from various causes.
For the person diagnosed with bursitis, first, consider whether the diagnosis is correct or not. There have been several studies on hip bursitis symptoms, demonstrating, as we noted earlier, that the pain is coming from tendinopathy rather than from bursitis.
“Some studies have questioned the real involvement of the trochanteric bursa in greater trochanteric pain syndrome, and tendinopathy of the gluteus medius and/or minimus has been proposed as an important cause of this syndrome.”[iii] One study of 75 patients with pain and point tenderness over the greater trochanter, revealed that only 8 had fluid pooling in the trochanteric bursae per sonography.[iv]
Another study showed that only a minority of patients had bursitis, because in 700 out of 877 patients the pain was not from bursitis, but rather, it related to “some combination of pathology involving the gluteus medius and gluteus minimus tendons as well as the iliotibial band.”[v]
And one more found that only 5 of 124 patients with trochanteric pain had bursitis, plus most of those with bursitis also had associated tendinopathy.iv
Regenerative Orthopedics stimulate the body to repair painful areas. And that includes those with both true bursitis and tendinopathies. An experienced Regenerative Orthopedics doctor will be able to ascertain what structure is causing the pain.
In the hip, the soft tissue structures that attach to the greater trochanter are often involved, including the glutei muscles. Regenerative Orthopedic treatments to these soft tissue structures stimulate them to repair. Once they are fully repaired, the ‘bursitis’ pain resolves.
Platelet Rich Plasma (PRP) is one of the Regenerative Orthopedic treatment options that may be recommended for bursitis pain.
A study presented at the 2014 meeting of the American Academy of Surgeons showed PRP to be very effective in the treatment of severe bursitis of the hip. The study compared one injection of PRP to one injection of cortisone. The cortisone demonstrated only short-term effectiveness. PRP provided both short and long-term pain relief from a condition that is difficult to treat successfully.”[vi]
Regenerative Orthopedic options like Stem Cell Therapy, Platelet Rich Plasma, and Prolotherapy all accomplish repair of the affected soft tissue. And your clinician will recommend which treatment will most effectively repair and regenerate your hip, bringing relief from bursitis pain.
[i] Sofat N. Kuttapitiya A. Future directions for the management of pain in osteoarthritis.Int J Rheumatol. Apr 2014; 9(2): 197–276.
[ii] Lazaro D, Alon L, Ramessar N, Cabas-Vargas J, Shwin K, Stefanov D. Intra-articular, bursa, and tendon sheath injections: A survey of practice patterns among members of the American College of Rheumatology. Journal of Rheumatology.2014; 20(2): 91-93. doi: 10.1097/RHU.0000000000000080
[iii] Quiroz C, Ruta S, Rosa J, Navarta DA, Garcia-Monaco R, Soriano ER. Ultrasound evaluation of the Greater Trochanter Pain Syndrome: Bursitis or tendinopathy?
[iv] Connell DA, Bass C, Sykes CJ, Young D, Edwards E. Sonographic evaluation of gluteus medius and minimus tendinopathy. European Radiology. 2003; 13(6): 1339-1347.6.
[v] Long SS1, Surrey DE, Nazarian LN.Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis.AJR Am J Roentgenol. 2013 Nov;201(5):1083-6. doi: 10.2214/AJR.12.10038.
[vi] Goel K,Riley LP. Platelet Rich Plasma (PRP)treatment more effective than cortisone for severe hip bursitis. http://www.aaosannualmeetingpresskit.org/2014/news_briefs/downloads/PRP-HipBursitis.pdf.
