Hip Pain

Acupuncture Treatment for Hip Bursitis

Tim H. Tanaka, Ph.D.

Director, The Pacific Wellness Institute Toronto, Ontario, Canada

March 28, 2007

Causes of hip pain

Woman having hip pain Pain or discomfort around the hip region is a common problem among both genders and all ages.  There are many conditions that cause hip pain such as osteoarthritis, rheumatoid arthritis, tendonitis of iliotibial (IT) band, hamstring/groin strains, dislocation, fracture, infection, osteonecrosis, or tumor.  It is important to see a qualified medical professional and obtain a diagnosis and treatment appropriate for your condition.  Here I mainly discuss trochanteric hip bursitis, one of the most common causes of hip pain.

What is Trochanter Bursitis in the Hip?

Bursitis means inflamed bursa.  A bursa is a small sac of fluid-filled cushion that prevents friction between bones and tendons.  Major bursae are located around the large joints such as the shoulders, elbows, knees and hips. There are two major bursae of the hip. The trochanteric bursa, which is located on the outer side of the hip and the ischial bursa, which is located in the lower buttock area (near the sitting bone).  The trochanteric bursa is designed to reduce friction between the greater trochanter and the iliotibial band. When the bursa becomes inflamed, it can cause swelling and pain.

Trochanteric bursitis is sometimes viewed as a condition among middle-aged or elderly persons. However, because bursitis can develop either by a direct trauma to the area, prolonged pressure, or by repetitive friction of the iliotibial band on the bursa from overuse through sports and other activities, the condition is common among young individuals and athletes.

Signs and Symptoms of Trochanteric Bursitis

Hip Muscles

  • Hip bursitis causes pain, aching, and stiffness. The pain may be dull, burning, or throbbing and it can be very severe.
  • The trochanteric bursitis typically causes pain over the outside of the hip and thigh.
  • The pain is often aggravated by excessive walking, running or stair climbing.
  • The pain is often intensified at night, especially when one lies on the painful side.
  • Practitioners can often detect a tender spot or an area that is painful to touch or pressure on the greater trochanter region (a bony lump at the top of the outside of the thigh bone).  A maneuver involving external rotation of the hip often elicits the pain.
  • Getting up from a chair or getting out of a car can be difficult due to the pain and stiffness in the hip.
  • Hip bursitis may cause radiating pain down the leg towards the knee. However, if pain radiates below the knee towards the foot, another cause or injury other than the hip needs to be investigated (such as lumbar herniation or sciatica).  Another type of hip bursitis called ischial bursitis can cause pain in your buttock around the sitting bone and upper part of the hamstring muscles.  In these cases pain is often aggravated after prolonged sitting on a hard surface.

How is trochanteric bursitis conventionally treated?

Your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, aspiration/drainage of the bursa and/or physiotherapy.  If all other approaches fail, surgery may be suggested.

Acupuncture treatment for hip bursitis

Acupuncture model hipThe greater trochanter is the point of attachment for several powerful muscles of the thigh and pelvis. Acupuncture treatment is targeted at reducing excessive tightness and spasm of the muscles attached to the greater trochanter (the palpable protrusion at the top of the femur).  This can help decrease excessive stress on the tendons attached to the hip.  In many cases we utilize a dynamic acupuncture procedure involving periodical self and assisted joint movement called dynapuncture.  This is particularly useful for patients who have trouble finding a comfortable position to lie down in long periods, which is very common among bursitis patients.

Applying ice is often recommended for bursitis.  Icing constricts local blood vessels and temporarily decreases the blood flow, thus can be useful for controlling acute local inflammation.  We also use a traditional heat therapy called moxibustion. In many cases, muscles around the inflamed hip joint and tendons are actually in an ischemic state (poor flow of blood and oxygen).  Application of localized heat on specific acupuncture points is used to enhance blood flow and reduce the muscle tension.  Therefore, with careful selection of acupuncture points, moxibustion heat therapy can be effectively used for bursitis during both acute and chronic stages.

Although orthopedic specialists may disagree, I believe an extremely important element for long-term success of bursitis treatment is stress management.  The possible mechanism is the same as in the relationship between low back pain and emotional stress which is described in more detail in the low back pain page. Acupuncture treatment at The Pacific Wellness Institute encompasses a stress management technique, which incorporates breathing and systemic acupuncture procedures.

Besides acupuncture, patients with hip bursitis are recommended to obtain proper rest and to modify any activities that aggravate the pain and inflammation.  One of the most important considerations is to avoid sleeping on the painful side, particularly for trochanteric bursitis patients.  If patients are overweight, losing weight is a very important element for short and long-term improvement.

Many patients with hip bursitis are prescribed non-steroidal anti-inflammatory drugs and/or corticosteroid local injection.  It is important to remember the different action and mechanisms between acupuncture and those medications.  Please refer to the information posted on this page before deciding to proceed with acupuncture treatment.

Cases when acupuncture alone may provide limited benefit:

How well and how quickly one responds to acupuncture treatment often depends on the underlying nature of the hip bursitis and severity of the condition.  While many bursitis patients respond very well with acupuncture treatment, some other patients require medical intervention or other therapies in addition to lifestyle modifications.  Some of the conditions with which patients may not respond optimally to acupuncture treatment alone are:

  • Underlying hip conditions involving joint deformity or severe degeneration due to dyspalsia, osteoarthritis or rheumatoid arthritis.
  • Bone spurs or calcium deposits in the tendons which attach to the hip trochanter.
  • Signs of infection such as feverish swelling around the hip joint.
  • If the person is overweight, it is recommended to combine the treatment with dietary and lifestyle modification.

 

Final note: Hip problems are a common underlying overlooked cause of recurrent low back pain

Pain or discomfort around the hip region is not always related to the hip itself. Because some nerves which originate from the low back spine pass through the buttocks and hips, hip pain can be a referral pain due to low back injury.  Although hip bursitis or tendonitis can produce radiating pain down your thigh, it does not typically cause any symptoms below the knee.  If you are experiencing pain, numbness, or tingling sensation below your knee, you may be suffering from sciatica associated with a lumbar related injury.

However, it should be noted that the opposite case occurs as well and based on my clinical experience it is often overlooked by health professionals. Many cases of chronic recurring low back pain and spasms are actually triggered by underlying hip problems (pain or instability in hip joint causing recurring spasms in muscles in the low back).  In such cases, patients receiving treatment and examination focusing only on their low back are unlikely to heal completely unless the underlying hip issue is properly addressed.