Introduction

Trochanteric bursitis is a common condition that affects athletes across various sports, particularly those involving repetitive lower-body movements. Trochanteric bursitis causes an inflammation of the bursa, a small fluid-filled sac that cushions and reduces friction around the greater trochanter, the prominent bony structure on the side of the hip. Overuse injuries, characterised by repetitive stress without sufficient recovery, are a leading cause of trochanteric bursitis. Understanding this condition and its underlying causes is vital for athletes and healthcare professionals aiming to prevent long-term complications and maintain optimal performance.

Anatomy and function of the greater trochanter

The greater trochanter is part of the femur, located on its lateral side. Surrounding this bony prominence are several bursae, with the trochanteric bursa being the most relevant in trochanteric bursitis.² These bursae act as cushions to reduce friction between the femur and the overlying tendons, such as the gluteus medius and gluteus minimus.

Additionally, the iliotibial band (IT band), a thick band of fascia, a stringy tissue surrounding every body part, runs from the hip to the knee and passes near the greater trochanter.² Together, these structures facilitate smooth movement during activities such as walking, running, and cycling.

Causes of trochanteric bursitis

Trochanteric bursitis often develops due to repetitive stress, muscle imbalances, and biomechanical issues. Understanding these contributing factors is crucial for effective prevention and management.

Overuse and repetitive motion

Athletes involved in sports that require repetitive lower-body movement, such as running, cycling, or soccer, are at a higher risk of overuse injuries. Activities that place continuous pressure on the hip joint can irritate the trochanteric bursa, leading to inflammation.³ Sudden increases in training intensity or volume exacerbate this risk, as the body lacks sufficient time to adapt to the heightened stress.

Muscle imbalances

Weakness in the gluteal muscles or overdominance of other muscle groups, such as the hip flexors or quadriceps, can disrupt normal hip mechanics; this imbalance places additional strain on the IT band and the trochanteric bursa, contributing to irritation. Strengthening and activating the gluteus medius and minimus can alleviate these issues by enhancing hip stability and reducing compensatory movements.³

Biomechanical issues

Poor biomechanics, such as improper running form or pelvic misalignment, can contribute significantly to trochanteric bursitis. Athletes with leg length discrepancies or flat feet could experience altered load distribution across their hips and increase the risk of bursa irritation.³ Gait (walking style) analysis and biomechanical assessments are valuable tools for identifying and addressing these underlying issues.

Other contributing factors

Inadequate footwear or lack of proper support during physical activity can increase stress on the hip joints. Additionally, pre-existing conditions such as osteoarthritis or hip injuries predispose athletes to trochanteric bursitis.³

Moreover, factors such as age and gender contribute significantly. For instance, women are more prone to trochanteric bursitis due to wider pelvic anatomy and hormonal influences on connective tissue.

Symptoms of trochanteric bursitis

Trochanteric bursitis presents with a characteristic set of symptoms that are often aggravated by activity:⁴

• Localised pain is typically felt on the outer side of the hip and could radiate down the thigh; this pain often worsens with movement, especially during activities such as walking, running, or climbing stairs
• Tenderness The greater trochanter area feels soft to touch, and athletes experience discomfort when lying on the affected side
• Stiffness in the hip joint is common, particularly after prolonged periods of rest or inactivity. This reduces the range of motion of the joint
• Pain at night is reported by many athletes, making it difficult to find a comfortable sleeping position

Diagnosis

A thorough evaluation is essential to diagnose trochanteric bursitis accurately and rule out other conditions, including hip labral tears or lumbar radiculopathy.

• Clinical examination: Healthcare providers assess the patient’s medical history, palpate (examine) the hip area for tenderness, and perform specific tests to reproduce pain during movement²
• Imaging techniques: Ultrasound or MRI can confirm inflammation of the bursa and identify any associated soft tissue abnormalities. X-rays could be used to exclude bony abnormalities or degenerative changes²

Prevention strategies

Preventing trochanteric bursitis involves a combination of proper training practices, targeted exercises, and biomechanical corrections.

Gradual training progression

Avoiding sudden increases in training intensity or volume is a critical prevention strategy. Athletes should adopt a gradual approach to building endurance and strength, allowing the body adequate time to adapt to new demands.

Strengthening and flexibility

Strengthening the gluteal muscles and other hip stabilisers reduces the strain on the trochanteric bursa. Exercises including clamshells, side-lying leg lifts, and bridges are effective for targeting these muscles. Stretching tight structures, including the IT band and hip flexors, alleviates tension and improves flexibility.⁵

Biomechanical assessments

Gait analysis can identify abnormal movement patterns that contribute to trochanteric bursitis. Corrective measures, such as orthotics for flat feet or adjustments to running form, can redistribute loads more evenly across the hip joints.⁶

Proper footwear

Choosing supportive footwear that aligns with the athlete’s biomechanics is crucial. Shoes should provide adequate cushioning and stability to minimise stress on the hips and lower extremities.

Treatment options

Treatment for trochanteric bursitis varies depending on the severity of symptoms. Most cases respond well to conservative management.

Rest and activity modification

Rest is often the first line of treatment, allowing the inflamed bursa to heal. Athletes should avoid activities that exacerbate symptoms and gradually reintroduce low-impact exercises, such as swimming or cycling.

Ice and anti-inflammatory medications

Applying ice to the affected area can reduce inflammation and alleviate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, are effective in managing symptoms during the acute phase.²

Physical therapy

Physical therapy plays a crucial role in rehabilitation. Therapists design individualised programs to strengthen weak muscles, improve flexibility, and correct movement patterns. Manual therapy techniques, such as soft tissue mobilisation, can further reduce muscle tightness and inflammation.⁶

Corticosteroid injections

For persistent cases, corticosteroid injections into the bursa can provide significant pain relief. However, these should be used cautiously, as repeated injections could weaken surrounding tissues over time.⁷

Surgical intervention

Surgery is rarely required for trochanteric bursitis. In severe cases where conservative treatments fail, surgical removal of the inflamed bursa could be considered.⁵

Implications for athletes

Trochanteric bursitis can significantly impact an athlete’s performance and training schedule. Early diagnosis and intervention are crucial to prevent chronic issues and prolonged downtime. Addressing the underlying causes, such as muscle imbalances or biomechanical faults, aids recovery and reduces the risk of recurrence. Athletes should prioritise consistent maintenance practices, including strength training, flexibility exercises, and periodic assessments, to stay injury-free.

Summary

Trochanteric bursitis is a medical condition that affects athletes, particularly those involved in repetitive lower-body movements. It causes an inflammation of the bursa, a small fluid-filled sac that cushions and reduces friction around the greater trochanter, the prominent bony structure on the side of the hip. Trochanteric bursitis is a preventable and manageable condition that commonly affects athletes due to overuse and repetitive stress. By understanding its causes, symptoms, and prevention strategies, athletes could take proactive measures to safeguard their hip health. The importance of early diagnosis, personalised treatment, and a gradual return to activity cannot be overstated. With proper care, athletes can overcome trochanteric bursitis and continue to excel in their respective sports.