Runners Should Know Hip Bursitis Basics

If you have chronic hip pain but an examination has not turned up evidence of OA (see “Get Active In Dealing With Your OA Pain,” in this issue), there are other causes that runners can be susceptible to. If you happen to be a side sleeper and your hip sometimes wakes you in the middle of the night, the cushioning in your hip might be to blame. The problem is known as bursitis, and though it is sometimes associated with sedentarism, it also affects healthy runners who may not be strengthening and stretching properly in addition to their regular training. Bursitis can also be caused by repetitive motion like throwing a baseball. But here we look at otherwise healthy runners who develop hip bursitis from improper stretching and strengthening.

Symptoms

  • You will feel pain on the outside of your hip, particularly at the point where the bony area at the top of your thigh bone—called the greater trochanter—protrudes. It may feel sharp at first and then give way to achiness you feel during and after running.
  • The pain may intensify when you get up out of a chair or climb stairs.
  • You'll also experience discomfort when you're lying on your injured side.

What's happening
Lying next to the greater trochanter is a fluid filled sac called a bursa. You have several bursae in your body, and their job is to create cushioning between bones and soft tissue to reduce friction. The bursa at the greater trochanter comes between the bone and a small muscle known as the tensor fascia latae (TFL). This muscle joins the ITB further down your leg. We all know what a tight ITB can do to runners, including debilitating knee pain. But a tight TFL is equally troubling, because it squeezes the bursa against the hip bone, resulting in inflammation and pain.

Causes
In addition to simple tightness along the TFL (and ITB), if you have weak muscles in in you hips, you will have less stability there—meaning, more wobbly, non-sport-specific motion as you run. This creates greater tension in the ITB and TFL, squeezing the bursa.

Overpronation is another cause of hip bursitis. This is a classic running behavior that causes tension on the outside of the leg, because the foot is rolling excessively inward upon landing.

What to do
With only mild pain that doesn't affect running form, bursitis is easily managed without compromising training load. As soon as you find that you are favoring that hip, however, or that you are altering your biomechanics in any way, avoid running and perform cross-training and strengthening activities as tolerated.

You should also:

  • Ice the sore area 15 minutes four to six times a day

  • Consider ibuprofen or naproxen, anti-inflammatories that can help with pain and swelling

  • Wear shoes with good medial support and/or try an o-t-c orthotic

  • Strengthen your core and the muscles around your hips (once the pain eases up)

  • Stretch both your ITB and your TFL:

Lie on the floor and raise the leg on the side where you have hip pain, keeping it straight. Slowly stretch and lower the leg across your body toward the far hip and hold as far down as you can for 15 seconds. Return your leg to its straight-in-the-air position. Repeat 3 to 5 times.

Bursitis should clear up within 3 weeks; if not, see your sports physician, who may recommend a cortisone injection into the bursa to shrink it.


Running Strong
by Jordan D. Metzl, MD, 2015, Rodale, New York, NY, pp. 114-115, 13
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