Have you been treating your hip pain with bursitis treatments like steroids and non-steroidal anti-inflammatories? There are times these treatments help to give some relief, but many people continue to experience a substantial amount of discomfort even after trying them. Continued use of steroids injected into a degenerated joint can unfortunately increase the rate of degeneration. Why not treat the pain with treatments that regenerate rather than degenerate the joint structures?
We see quite a few patients who come to our office for treatment of bursitis who do not actually have bursitis. Bursitis is so painful that even touching the skin over the painful area is difficult to tolerate. If the area can be palpated with a lot of pressure by the doctor, the patient may not have bursitis. What could the problem be then?
Hip Bursitis, or trochanteric bursitis, is actually rare! Multiple studies have shown that patients presenting with bursitis type symptoms actually have tendinopathy (tendon degeneration) of their gluteal tendons, which attach near the bursa and often fool providers into thinking the patients have bursitis. What they really have are badly degenerated tendons that need regeneration! On top of that, as we mentioned, steroid injections are often used as the treatment for true bursitis, so when steroids are injected into the degenerated tendons, they actually can cause them to degenerate faster! Tendinopathy of the gluteus minimus or gluteus medius are often the tendons involved in greater trochanteric pain syndrome.
Regenerative Orthopedics including Stem Cell Therapy, PRP, and Prolotherapy are safe and effective treatment options for bursitis, tendinopathy and other underlying soft tissue injuries of the hip.
True bursitis is an inflammation of the bursae, which are small, fluid-filled sacs that lubricate and cushion pressure points between the bones, tendons and muscles of joints. Bursae help the joints to move with ease. When they become inflamed due to bursitis, movement or pressure can be painful. Bursitis often affects areas around the joints in the elbows or hips. Hip bursitis entails a bursal sac inflamed between the hip bone and glutei muscle attachments. The bursal sac becomes inflamed because of injury to the soft tissue structures. The bursal sacs are there to decrease the friction of the soft tissue structure and the underlying bone. They let the tendon or muscle glide across the bone more easily. Bursitis pain usually goes away within a week or so with proper treatment, but recurrent flare-ups are common as well as frustrating.
Common causes of bursitis include overuse, stress or direct trauma to a joint, such as repeated bumping or prolonged pressure. Bursitis may result from an infection, arthritis or gout. Bursitis may also be due to the repetitive motion related to certain activities. Tendonitis, which involves the irritation or inflammation of tendons, or tendinopathy (degenerated tendon) are again oftentimes misdiagnosed as bursitis.
Symptoms of hip bursitis include a dull ache or stiffness in the affected hip. The pain often worsens with movement or pressure, and the area may be swollen and feel warm to the touch. Intermittent redness of the skin in the area of the inflamed bursae may be another symptom. Visible swelling or skin redness is usually absent from bursitis of the hip because the bursae are located beneath some of the body’s bulkiest muscles. Pain is primarily centered over the greater trochanter, a portion of the femur that juts out just below where the bone joins the hip.
Since bursitis is an inflammation of the fluid-filled sac, or bursa that lies between a tendon and skin, or between a tendon and bone, bursitis treatment has involved the use of non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, and steroids such as cortisone. If the problem is not true bursitis, the steroid injections by the orthopedist to decrease the inflammation of the bursitis will commonly not work to eliminate the pain, since inflammation is not the real problem. The steroid will, however, inhibit fibroblastic proliferation or the process by which soft tissue structures such as ligaments, tendons and muscles grow and repair, and result in a weakening of the joint.
NSAIDS are associated with a higher risk of cardiovascular- and gastrointestinal-related adverse events. The FDA issued a medication guide for NSAIDs recommending physicians prescribe the lowest dose for the shortest time possible.”[i]
As physicians become educated on side effects of these medications, they hopefully decrease their use of them. “As years of experience increased, practitioners were more likely to prescribe lower doses of corticosteroid in musculoskeletal injections.”[ii]
Due to their significant side-effect profile, newer therapies are sought to replace them. Regenerative Orthopedics is both safe and effective to treat bursitis pain from various causes.
For the person diagnosed with bursitis, first consider whether the diagnosis is correct or not. There have been several studies on hip bursitis symptoms, demonstrating, as we noted earlier, that the pain is coming from tendinopathy rather than from bursitis. “Some studies have questioned the real involvement of the trochanteric bursa in greater trochanteric pain syndrome, and tendinopathy of the gluteus medius and/or minimus has been proposed as an important cause of this syndrome.”[iii] One study of 75 patients with pain and point tenderness over the greater trochanter, revealed that only 8 had fluid pooling in the trochanteric bursae per sonography.[iv] Another study showed that only a minority of patients had bursitis, because in 700 out of 877 patients the pain was not from bursitis, but rather, it related to “some combination of pathology involving the gluteus medius and gluteus minimus tendons as well as the iliotibial band.”[v] And one more found that only 5 of 124 patients with trochanteric pain had bursitis, plus most of those with bursitis also had associated tendinopathy.iv
Regenerative Orthopedics stimulate the body to repair painful areas and those with both true bursitis and tendinopathies. An experienced Regenerative Orthopedics doctor will be able to ascertain what structure is causing the pain. In the hip, the soft tissue structures that attach to the greater trochanter are often involved, including the glutei muscles. Regenerative Orthopedic treatments to these soft tissue structures stimulate them to repair. Once they are fully repaired the ‘bursitis’ pain resolves.
Platelet Rich Plasma (PRP) is one of the Regenerative Orthopedic treatment options that may be recommended for bursitis pain. A study presented at the 2014 meeting of the American Academy of Surgeons showed PRP to be very effective in the treatment of severe bursitis of the hip. The study compared one injection of PRP to one injection of cortisone. The cortisone only demonstrated short-term effectiveness. PRP provided both short and long-term pain relief from a condition that is difficult to treat successfully.”[vi]
Regenerative Orthopedic options like Stem Cell Therapy, Platelet Rich Plasma, and Prolotherapy all accomplish repair of the affected soft tissue, and your clinician will recommend which treatment will most effectively repair and regenerate your hip, bringing relief from bursitis pain.
[ii] Lazaro D, Alon L, Ramessar N, Cabas-Vargas J, Shwin K, Stefanov D. Intra-articular, bursa, and tendon sheath injections: A survey of practice patterns among members of the American College of Rheumatology. Journal of Rheumatology.2014; 20(2): 91-93. doi: 10.1097/RHU.0000000000000080
[iii] Quiroz C, Ruta S, Rosa J, Navarta DA, Garcia-Monaco R, Soriano ER. Ultrasound evaluation of the Greater Trochanter Pain Syndrome: Bursitis or tendinopathy?
[vi] Goel K,Riley LP. Platelet Rich Plasma (PRP)treatment more effective than cortisone for severe hip bursitis. http://www.aaosannualmeetingpresskit.org/2014/news_briefs/downloads/PRP-HipBursitis.pdf.