Hip Bursitis / Trohanteric Bursitis / IT Band Syndrome / Tensor Fasciae Latae Tendonitis / Hip Impingement / Femoral Acetabular Impingement (FAI) / Sciatica / Gluteus Medius or Minimus deconditioning

One of the most common visits to the office is for hip pain. Sometimes this pain is localized to the buttock, sometimes to the lateral side of the hip over the trochanter down the side of the thigh and past the knee. Sometimes there is pain in the groin. Sometimes it extends down the back of the leg in a sciatica distribution.

Folks describe this as a burning type pain. Sometimes they have difficulty lying on their side at night due to compression of the hip bursa.

There are 2 populations of patients that present this way – those that have a sedentary lifestyle – professionals who work at a desk fit into this category or those that have an active lifestyle and the hip aBdutors/gluteus medius and minimus are underconditioned.

This occurs because the pelvis begins to rock upward and forward with walking. The hip aBductor muscles usually stabilize the pelvis during walking and prevent the pelvis from rocking. If they are weak or overtasked, they fail to prevent the pelvis from rocking and this causes other muscles around the pelvis to be stretched. Other muscles try to compensate to try to hold the pelvis stable.

Pelvis tilts with every step upward and forward. The forward tilt can cause “Femoral Acetabular Impingement” and groin pain.

So this is a 2 part problem:

1. Pelvis unstable due to muscle weakness.
2. Muscles/Tendons/Bursa inflamed due to above.

To fix the problem:

Perform exercises as below. Note that until the muscles are strong this will continue to be a problem. The exercises may be painful or cause pain but they will continue to contribute to the problem until they are strong so its important to use NSAIDs or Tylenol to address pain and inflammation as a tool to get the muscles strong.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Aleve (generic name: naproxen)

Advil/Motrin (generic name: ibuprofen)

**Please check with your primary care doctor to see if its safe to take these medications as they can make blood pressure mediations less effective and are contraindicated with prior history of ulcers.

GLUTEUS MEDIUS STRENGTHENING – 45 degree HIP ABDUCTION STRENGTHENING STANDING or SIDE LYING

FORM IS IMPORTANT when standing – must keep torso and pelvis level

PHONE ALARM recommended 4x per day sets of 10-15 reps.

Diagnosing Hip Bursitis and Related Conditions

Most cases of lateral hip pain can be diagnosed based on a careful history and physical examination. Classic features of trochanteric bursitis / greater trochanteric pain syndrome include pain directly over the greater trochanter (the bony prominence on the outer side of the hip), pain that worsens when lying on the affected side, pain with prolonged standing or walking, and tenderness to palpation over the trochanter. Imaging is not always required for diagnosis, but X-rays can help rule out hip arthritis or other bony abnormalities, and an MRI may be ordered if the diagnosis is uncertain or if a gluteus medius or minimus tendon tear is suspected. Ultrasound can also be used to assess the bursa and tendons in the office.

Non-Surgical Treatment Options

The initial treatment for hip bursitis and greater trochanteric pain syndrome is almost always non-surgical. A structured physical therapy program focused on hip abductor strengthening — particularly targeting the gluteus medius — is the most evidence-based long-term treatment and addresses the underlying biomechanical contributors to the condition. Activity modification, avoiding prolonged side-lying on the affected hip, and anti-inflammatory medications (such as ibuprofen or naproxen) can help reduce pain during the rehabilitation period. Corticosteroid injection into the trochanteric bursa under ultrasound guidance is a highly effective short-term treatment that can provide significant pain relief and allow patients to participate more effectively in physical therapy. Most patients improve substantially with this combination of approaches.

When Is Surgery Considered?

Surgery for trochanteric bursitis is uncommonly required. It is typically reserved for patients who have failed multiple corticosteroid injections, completed a thorough course of physical therapy, and have persistent, functionally limiting pain. In cases where an MRI demonstrates a significant gluteus medius or minimus tendon tear, surgical repair of the tendon may be appropriate. Endoscopic (minimally invasive) bursectomy — removal of the inflamed bursa through small incisions using a camera — is an option for refractory bursitis without tendon involvement. Dr. Gallagher will discuss all relevant surgical and non-surgical options with you based on your examination findings and imaging results.

Schedule an Evaluation in Austin, TX

If you are experiencing lateral hip pain, groin pain, or buttock pain that has not improved with rest and over-the-counter medications, a consultation with an orthopedic specialist can help clarify the diagnosis and guide appropriate treatment. At ATX Orthopedics in Austin, TX, Dr. Sean Gallagher provides comprehensive evaluation and treatment for hip pain of all types. Call 512-960-4590 to schedule an appointment.

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