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Hip Disorders: Osteoarthritis & Bursitis

Our hip joints allow us to do an amazing number of things – walk on two
legs, pivot, squat, even kick a ball. It is an engineering marvel to
combine the stability required to balance the weight of the torso over a
structure the size of a golf ball, with the substantial degree of mobility
available. The high demands on the hip joints can, however, take their
toll over a lifetime.
Osteoarthritis is the most common hip disorder affecting adults. Primary
osteoarthritis (OA) has no recognizable cause, while secondary OA is
thought to occur due to altered joint mechanics or following joint trauma.
Obesity, excessive loading due to occupational or sport demands can
contribute to breakdown of articular cartilage. There is likely a genetic
component as well. Muscle imbalances around the hip are also predisposing
factors, as shearing forces or high compression load will cause abnormal
wear and tear. Alignment issues of the low back, pelvis and leg can also
contribute to abnormal forces around the joint.
Muscle imbalances occur as a result of weak, tight, or inappropriately
recruited muscles. Our neuro-muscular system can develop certain abnormal
pathways of firing, creating suboptimal movement, and potential damage to
joint structures. If these are retrained before the cartilage damage is
severe, it can halt the progression and reduce the symptoms of arthritis.
One of the most important groups of muscles for maintaining optimal
compression and centering the ball, (or head) of the femur in its socket
are the Gluteal muscles on the lateral side of the hip. Core strength and
balance are also very important components of optimal hip health.
A second common diagnosis of hip pain is trochanteric bursitis. The most
prominent lateral point on the hip bone is called the greater trochanter.
It was commonly thought that the bursa overlying this point was the most
common local cause of lateral hip pain. However, in a recent study, using
real-time ultrasound, 80% of patients with lateral hip pain did NOT have
bursitis. 50% of the 877 patients studied had tendinosus of their gluteal
muscles, ie. a degeneration of the deep hip rotators tendon’s collagen in
response to overuse, occuring when other stabilizer muscles weaken. It is
part of what has been labeled Greater Trochanteric Pain Syndrome (GTPS).
Symptoms of both OA and GTPS can be similar. Pain from OA is usually felt
in one or more of the following areas: the groin (most common), over the
greater trochanter, or down the front of the thigh and knee. Usually,
arthritis pain is reported with or after activity, progressing to pain at
night or at rest.
With GTPS, point tenderness is noted at or behind the greater trochanter,
typically worse at night, especially when lying on the affected side.
Lateral hip pain with repeated stair climbing and squatting is more likely
due to GTPS.
Maintaining adequate strength and flexibility of the hip muscles is an
important component of treatment and prevention of both hip osteoarthritis
and trochanteric pain syndrome. Physiotherapists are trained to assess
these disorders. They can prescribe individual exercise where deficits in
strength, mobility and balance are noted.
by Brenda Walsh, Physiotherapist
June 20, 2016 by Suncity Physiotherapist