Member Case Study: Return from Pregnancy, Hip Pain

author : AMSSM

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Could this be related to IT band problems or someone thought it might be bursitis and what should I do to treat it? Also, should I see a sports med doc or orthopedic specialist?

Question from bmax

Since my return from pregnancy I have had pain in my left hip generally behind and slightly below the bone on the hip (sorry, don't know the correct term). I was fitted with good running shoes and don't pronate, if anything I supinate (under pronate) with the outside of my feet hitting the ground.

The pain always flares up when I run and will be sore for at least a day when walking or getting out of the car from a sitting position. Also, when I lay on my right side and really stretch that area, it is very tender.

My history with that side: I've had 2 knee surgeries (arthroscopic meniscus trim and ACL reconstruction-patellar tendon graft).  I guess my question is: Could this be related to IT band problems or someone thought it might be bursitis and what should I do to treat it? Also, should I see a sports med doc or orthopedic specialist? As of right now, it's been a week since my 5K race when I really aggravated it and it's still sore but not as bad as the first 2 days after the race.
 

Answer

John Martinez, M.D.
Member, AMSSM

The area that you are describing sounds like the greater trochanter, which is the large bony protrusion off the thigh bone (or femur) that you can feel on the side of your hip. The pain that you are experiencing is mostly likely from an inflamed or irritated bursa (or fluid-filled) sac. This is commonly called greater trochanteric bursitis.

These bursa sacs act as a cushion and reduce friction between bones and muscles. There are two bursas near the greater trochanter; the greater trochanter bursa which sits on the lateral (outside) part of the greater trochanter, and the ischial bursa which is located between the gluteal muscles and the ischial bones (the bones you feel when you sit on your bike seat).

Symptoms
Symptoms of trochanteric bursitis include:

• Pain on the outside of the hip either on, or behind the greater trochanter.

• Pain typically increases with activity such as running or prolonged walking.

• Sometimes, the pain can get worse with prolonged sitting, such as after long drives in the car.

Causes
Greater trochanteric bursitis can be the result of a traumatic injury, such as a fall onto the hip, or from repetitive stress on the iliotibial band and gluteal muscles. Typically there is an underlying cause, such as running on an uneven or canted surface (for example, from running on the side of the road) or weakness in the hip and buttock muscles that help stabilize the pelvis while running. Supination (or running on the outside of the foot) may place increased stress on the knee and hip. Lying or sleeping on the affected side may also cause irritation of the bursa.

Treatment
Treatment of greater trochanteric bursitis usually consists of attempting to decrease the inflammation or irritation of the bursa. Treatments that can be done at home include:

• Application of ice to the affected area for 10-15 minutes at a time several times a day for the first three to four days that you experience symptoms or have a flare-up.

• If you do not have any medical conditions that would prevent you from taking anti-inflammatory medications (such as a previous allergy, recent stomach ulcers or current use of aspirin or other anti-inflammatories), you can try a short (one week) course of an anti-inflammatory such as ibuprofen (Motrin or Advil) or naproxyn (Aleve).

• Stretching of the iliotibial band and the gluteal muscles.

When to see your doctor
You should seek medical care if the pain persists after trying the treatments above, or if you develop new symptoms such as pain or numbness down your leg.

If the pain does not improve, sometimes an injection into the inflamed bursa with a corticosteroid and a local anesthetic such as lidocaine can help with the pain and inflammation.

Physical therapy can also help the condition, and usually focuses on stretching and strengthening the muscles around the hip, as well as assessing any biomechanical problems that may lead to this injury.

Returning to training
The most important question injured athletes want answered when they visit our office is when return to training is safe. We typically recommend the following:

• Cut back on training volume and intensity by about 50%

• Use pain and discomfort as a guideline. If the pain starts after two miles of running, then try to reduce the run to one and one-half miles.

• Avoid sloped or canted running surfaces such as the side of the road. Substitute running on a track or a flat running trail.

• Cross train! If you are a triathlete, substitute a bike workout for your longer runs. You will continue to maintain your aerobic fitness while you heal.

John Martinez, M.D.
Member, AMSSM

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date: October 2, 2005