Bursae are small sacs between structures within the body where friction is consistently created. These sacs fill with fluid and can become inflamed, causing pain to an individual. When the inflamed bursa is located in the leg between the femur’s greater trochanter and the tendons that surround the musculature, it is clinically diagnosed as tronchanteric bursitis.
The bursa becomes irritated from frequently moving structures due to repetitive movements, often climbing stairs or uphill surfaces. The pain caused by the bursa feels like a tightness or burning pain in the area. It can result from heavy training in sports, or simply from a middle aged individual increasing activity.
Occasionally, the pain will move down the thigh but rarely is complained about in the knee. The sooner the problem is identified, the easier it will be to treat.
Greater Trochanteric Pain Syndrome (GTPS)
In recent literature, this disorder is referred to as GTPS. The reason it is called this, is due to some of the signs that appear, such as swelling and redness, are not normally present with trochanteric bursitis. When bursae (pleural for bursa) were studied and dissected, no inflammation was detected. It has also been observed that the pain has been found to originate from the bursa’s surrounding structures.
- Corticosteroid injections
- Anti-inflammatory medications
- Physical therapy
- PRP Therapy and Stem Cell Injections
No matter which treatment is chosen, it is important that the patient understands what caused the injury and the phases required for it to heal. The tissue must be given precise conditions in order for it to heal quickly and properly. The four stages of healing are as follows:
- Hemostasis – This begins right after the injury and can continue for a couple of hours. The proteins, platelets, and blood-borne cells travel outside of the tissues. In addition, this phase involves the forming of clots of fibrin and vascular constriction. Once the tissues begin releasing growth factors, the next phase begins.
- Inflammation – This second phase lasts from the couple of hours following hemostasis, and last for up to three days afterwards. In order to clear the cellular debris, neutrophils migrate to the injured area. The macrophages then clean the apoptotic cells from the tissues and prepare for proliferation.
- Proliferation – The proliferation of the cells follows the inflammation phase and lasts for a couple of weeks, during which epithelial cells begin to reproduce and promote granular tissue and collagen formation on the damaged tissue. In the latter part of this phase, the extracellular matrix forms.
- Remodeling – In this last stage, the remodeling of the tissue will begin. This stage begins after proliferation and can continue for several years. The collagen and scar tissue creates cross links.
Physical Therapy Management
Often times, the inflammation can cause a lot of pain for the patient. Physical therapy can be used in order to reduce inflammation and irritation. This is done so that the patient can improve their quality of life without surgery.
Recommended therapy includes rest, modifications of activities, cryotherapy, ultrasounds, soft tissue mobilization, iontophoresis, transcutaneous electrical nerve stimulation, and phonophoresis.
After the inflammation has seized, physical therapy will continue with a focus on increasing flexibility and strength. By and large, over 95% of trochanteric bursitis will successfully be treated nonoperatively.