Trochanteric bursitis is a common diagnosis for patients presenting with lateral hip pain. In theory, this makes complete sense when considering the anatomy and proximity of the trochanteric bursa to the commonly reported of point tenderness in this region. However, is this really the underlying pathology in those individuals presenting with lateral hip pain?
Greater Trochanteric Pain Syndrome
When performing a retrospective review of musculoskeletal sonographic examinations performed over a 6-year period for pain in the greater trochanteric region, Long and colleagues found some surprising results.1 After evaluating the findings of 877 individual patient cases, they found only 20.2% or 177 patients to have true trochanteric bursitis. The more common underlying pathology was gluteal tendinosis – found in 438 (49.9%), followed by thickening of the proximal iliotibial band (28.5%). Based on these results, close to 80% of patients referred with greater trochanteric pain did not actually have trochanteric bursitis.
In lieu of classifying this patient group as trochanteric bursitis, the evidence-based clinician should instead classify this patient group as greater trochanteric pain syndrome. This catch-all term includes patients with pain and tenderness in the region of the greater trochanter and the surrounding soft tissues of the buttock and lateral proximal thigh. This cluster of symptoms includes individuals with gluteal tendinopathy, iliotibial band friction, and/or Inflammation and effusion of the trochanteric bursae.
Underlying Pathological Features
Clarifying the underlying pathological features of greater trochanteric pain syndrome allows the treating clinician to better understand the mechanisms and appropriate interventions to best treat the patient. This allows the clinician to take into consideration and apply the best research available with regards to management of tendinopathies. This includes reducing compression and utilizing long duration, low load isometrics initially and progressively load the tendon within patient tolerance.
Here is an example HEP for introductory management of greater trochanteric pain syndrome focusing on low load, long duration isometrics in non-compressive positions for the lateral hip (i.e. avoiding femoral adduction):
The author recommends the following exercises for introductory management of greater trochanteric pain syndrome:
Note: It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient.
Instead of worrying about how to decrease the inflammation of one specific structure (trochanteric bursa), the clinician can focus on the underlying tendinous pathological process at hand.