Sunday, September 24, 2017

I took my father in for an injection for hip bursitis. I was amazed by how much better he was after just one treatment. He's still complaining about a little bit of pain. Should we have him get another injection?

Injecting a numbing agent and an antiinflammatory drug into the bursa can have significant results in just one or two treatments. Most physicians will try as many as three injections but only if the patient is continuing to get pain relief.

Correct placement of the injection is the key to success with this treatment. If the needle misses the bursa and injects the drug into the tendon, it can cause tendon rupture. Successful steroid injection may end the problem. If it does not, then other options exist.

Patients with hip bursitis can get relief with physical therapy treatment. Besides treating the local area of inflammation, the therapist can address the underlying cause(s) of the problem. Often, this is an issue of postural or body alignment.

Friction can build in the bursa during walking if the long tendon on the side of the thigh is tight. It is unclear what causes this tightening of the tendon. The gluteus maximus attaches to this long tendon. As you walk, the gluteus maximus pulls this tendon over the greater trochanter with each step. When the tendon is tight, it rubs against the bursa.

Stretching the overlying soft tissue structures makes sense. Relieving tension in the structures around the greater trochanter reduces friction leading to the pain syndrome. The therapist has several other tools to help realign structures for pain relief.

A proper relationship between the joint surfaces and muscle to joint interface is important. Good alignment means good joint integrity and normal range-of-motion. Leg alignment and symmetry is a big part of posture and alignment needed for normal biomechanics.

The foot is a good place to start when lining up the legs, hips, pelvis, and spine. Proper shoes that distribute the weight evenly over the foot and up into the legs is important. Athletes in training (and even older adults who walk or run long distances over time) should especially pay attention to how many miles they put on a shoe and replace them often. New shoes should be purchased when the person has met the shoe manufacturer's limits on the lifespan of each pair of shoes.

Once the foot is in a stable, supported position of alignment, the entire kinetic chain (connection and force spread from foot to ankle to knee to thigh to hip) is supported. This is a large part of the prevention program. Core training is the next step. Strengthening the muscles of the spine, abdomen, and hips can also help prevent hip pain.


Chris Dougherty, DO, and John J. Dougherty, DO. Managing and Preventing Hip Pathology in Trochanteric Pain Syndrome. In The Journal of Musculoskeletal Medicine. November 2008. Vol. 25. No. 11. Pp. 521-523.'

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