Welcome to the realm of Trochanteric Pain Syndrome, a discomfort often synonymous with lateral hip pain or, more commonly, hip bursitis. As an experienced musculoskeletal physiotherapist, my aim is to unravel this condition, exploring the “why did this occur” and “how to fix this injury” and by importantly equipping you with effective strategies for managing the symptoms and facilitating recovery.
Unveiling trochanteric pain syndrome :
Trochanteric pain syndrome, commonly referred to as hip bursitis, results in pain over the greater trochanter, which is the the bony prominence on the outer side of the hip. This condition can involve inflammation of the bursa — a small, fluid-filled sac that cushions the interaction between tendons and bones. The term “bursitis” encapsulates this inflammation, often resulting in localised tenderness and pain during movement.
Trochanteric pain syndrome doesn’t adhere to a one-size-fits-all model. Patients often describe a spectrum of sensations, from a dull ache to sharp, stabbing pain, however will always comment that it is located at the side of the hip. At times this pain can refer down the side of the leg but it will never go further than the knee. The discomfort may intensify during activities such as walking, climbing stairs, or prolonged periods of standing. Understanding the style of pain you’re experiencing is fundamental to tailoring an effective management plan.
Factors that cause trochanteric pain syndrome
Several factors contribute to the development of trochanteric pain syndrome. These include biomechanical abnormalities, overuse or sudden increase in physical activity, and muscle imbalances. The latter, in particular, plays a pivotal role in the perpetuation of symptoms. There is a strong imbalance between the genders when it comes to this condition as women are most likely to experience this type of pain. This is even more so when it comes to age, as middle aged women, ages 45-60 years old, are most likely to get this condition.
Managing the Symptoms: Multiple approaches
1. Hip Muscle Mobility: The Foundation of Recovery
Ensuring optimal hip muscle mobility is the bedrock of managing trochanteric pain syndrome. A simple yet effective method involves using a tennis ball for self-massage. Either sitting on the ground or leaning with your back against a wall place the ball behind the affected hip and gently roll over the muscles that are located at the back of the hip bone. You can apply as firm a pressure as you feel comfortable. Using the ball to roll directly over the bone can be uncomfortable and typically not recommended. This aids in releasing tension and promoting blood flow to the area.
2. Targeted Strength Work: Building Resilience
a. Hip Abduction Exercises:
i. Side-Lying Leg Raises:
- Starting Position: Lie on your side with your affected hip on top. Ensure your body forms a straight line.
- Execution: Lift the top leg upward while keeping it straight. Lift and lower the leg slowly but smoothly.
- Repetitions: Perform 3 sets of 15 repetitions.
- Adjustment: If this exercise is already to challenging, in the same start position, lift the leg up and hold it up for up to 10secs. Lower and relax the leg and complete this 5 times.
ii. Clamshell Exercises:
- Starting Position: Lie on your side with your sore hip on the top side. have your knees bent at a 90-degree angle and your feet together.
- Execution: Keeping your feet together, lift the top knee toward the ceiling while keeping the feet in contact with each other.
- Repetitions: Perform 3 sets of 15-20 repetitions on each side.
b. Quadriceps Strength Exercises:
i. Straight Leg Raises:
- Starting Position: Lie on your back with the affected leg straight and the other bent. Tighten your thigh muscles of the straight leg.
- Execution: Lift the straight leg off the ground, keeping the knee straight. Hold for a moment before lowering it back down.
- Repetitions: Perform 3 sets of 15 repetitions on each leg.
ii. Terminal Knee Extensions:
- Starting Position: Sit or stand with a resistance band looped around a fixed point and the back of your knee.
- Execution: Straighten your knee against the resistance of the band, emphasizing the quadriceps contraction.
- Repetitions: Perform 3 sets of 15 repetitions on each leg.
c. Gluteal Strength Exercises:
i. Bridge Exercises:
- Starting Position: Lie on your back with your knees bent and feet flat on the ground. Place your arms at your sides. Your feet at best to be just slightly wider than your hips.
- Execution: Lift your hips toward the ceiling, forming a straight line from your shoulders to your knees. Squeeze your glutes at the top.
- Repetitions: Perform 3 sets of 15 repetitions.
ii. Donkey Kicks:
- Starting Position: Begin on your hands and knees.
- Execution: Lift one leg toward the ceiling, keeping the knee bent at 90 degrees. Squeeze the glutes at the top.
- Repetitions: Perform 3 sets of 15 repetitions on each leg.
These exercises, when performed with proper form and consistency, contribute significantly to strengthening the muscles around the hip, promoting stability, and aiding in the recovery from trochanteric pain syndrome. Adjust the intensity and repetitions based on your individual comfort and progress.
Recovery Aids: Products to Facilitate Healing
To complement your rehabilitation efforts, consider the following products:
1. Foam Roller:
- Ideal for enhancing muscle flexibility and alleviating muscle tightness. This can be used over your glut muscles and thigh muscles.
2. Resistance Bands:
- Essential for progressive resistance training, aiding in the strengthening of hip muscles.
3. Ice Pack:
- An effective tool for reducing inflammation and providing relief after exercises. This can be placed over the site of pain to help reduce the intensity of symptoms.
What to do next:
Trochanteric pain syndrome, with its intricate interplay of inflammation and muscle imbalances, demands a multifaceted approach to rehabilitation. Start by reducing your pain intensity and this is where the ice pack comes in handy. Secondly, attempt 1 or 2 of the exercises described above. Every couple of days if you feel fine after doing the exercises either add a different exercise or increase how many reps you do of your initial exercises.
Keep in mind: Before embarking on any exercise program or using recovery aids, it is advisable to consult with a healthcare professional to ensure they are appropriate for your specific condition.