Hip bursitis

Irritated bursae can become swollen and very painful, a condition known as bursitis. Because bursitis is most often a result of excessive loading on the hip by surrounding muscle, it often coexists with tendinopathy. Over time, excessive loading of the hip may lead to osteo-arthritis.

Although the hip has around 20 bursae, only two are commonly a source of pain:

• Trochanteric bursitis is the most common hip bursitis and often produces pain at the outer aspect of the hip that is deep, intense and “bone-like”, which may radiate down the outside of the thigh all the way to the knee. Pain may be associated with swelling over the side of the hip.

This bursa is located between the upper outer thigh bone and the tendons of some of the buttock (gluteal) muscles. Excessive pull on the tendon by these muscles is the most common cause of trochanteric bursitis.

The gluteal muscles are very important and strong hip stabilising muscles, so placing excess pressure on the bursa via these muscles is associated with pain when, for example, getting out of a chair or car, prolonged standing, climbing up or down stairs, walking (especially up-hill or on uneven surfaces), squatting and lunging. Side-lying on the affected side (especially on hard surfaces) can also further irritate the bursa.

• Less common, iliopsoas bursitis produces pain in the groin area (on the front inside of the hip), which may radiate all the way down the front of the thigh to the knee. This bursa is located between the upper front thigh bone and the tendon of groin muscle (iliopsoas) which lifts the thigh upwards (flexion).

  Pain is often experienced during hip flexion such as pulling your knee up to your chest or even pulling your socks or stocking on. Pain may be felt during or after activities that involve repetitive hip flexion such as walking up-hill, walking up stairs, jogging, running and kicking.

  A snapping or clicking sound in the hip or groin area, called snapping hip syndrome, is often associated with this condition. As are knee conditions such as patella tendinopathy and patella tracking dysfunction.