Your race is only two weeks away, but your feelings of excitement are overshadowed by frustration due to a sharp pain on the right side of your hip. Do you get it looked at or rest a few days before the race, hoping it’ll heal itself? The signs and symptoms of trochanteric bursitis are important to identify to avoid a nagging injury. But here’s the problem: it is often misdiagnosed and not clearly defined.

This type of chronic hip pain is common in runners, but there is an elusive cause of the pain that is often overlooked. In this article, we’ll discuss how to differentiate between trochanteric bursitis and somatic referred pain from the lower back.

What is Trochanteric Bursitis?

Trochanteric bursitis was traditionally defined as any pain on the side of the hip. More specifically, bursitis refers to inflammation of the bursa sac; however, inflammation of the bursa sac at the greater trochanter is rare.

Greater Trochanteric Pain Syndrome (GTPS) is the updated medical term used to describe general pain on the side of the hip. The definition is still broad, and it does not identify the cause of hip pain. The pain may originate from a torn gluteus medius, inflammation of the bursa sac, friction of the IT band, the lower back or other sources.

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What is Somatic Referred Pain?

Somatic referred pain is pain perceived in an area distant from the site of origin. Have you considered the lower back as the cause of your hip pain? In my experience, the lower back is a common cause of lateral hip pain in a majority of non-runners; however, runners should still be aware of the lower back contributing to hip pain.

I remember helping a runner who had pain on the side of her hip while training for a race. Her pain would increase while running and the side of her hip was painful to the touch. One may conclude she had trochanteric bursitis, but we investigated further to rule out the lower back as the source of her pain.

During the assessment, we discovered she had limited range of motion and minor pain in her lower back, which meant there was a direct correlation between her low back and the pain in her hip. She was given exercises specifically for her lower back and the pain in the hip disappeared. These stories occur more often than you would think.

A study showed that 76 of the 87 individuals with pain in the buttocks, thigh or calf had pain that centralized in the lower back. In other words, the pain moved from the legs towards the lower back, indicating that the source of their pain originated from there. The physiological reason for somatic referred pain is linked to complex pain pathways occurring at the spinal cord and brain. Current pain science research is helping us construct a new understanding of pain.

Regardless of the complexities, we must do our best to recognize the differences between somatic referred pain and trochanteric bursitis. We’ll keep it simple by discussing two signs for each.

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  1. Presence of Lower Back Pain – Pain in the center of the lower back usually accompanies pain on the side of the hip. Nerves fibers in the lower back may be triggering a pain response in the hip. If you experience lower back pain along with hip pain, you may want to consult with a physical therapist to rule out somatic referred pain.
  2. Loss of Motion– Movements in the lower back will be limited. The loss of motion indicates the lower back may be the source of the problem. An approach called the McKenzie Method is very reliable at detecting any loss of motion in the lower back. By addressing the lower back, you may experience a reduction in hip pain.

 What are Signs of Trochanteric Bursitis

  1. No Lower Back Symptoms – One of the best ways to rule in trochanteric bursitis is to rule out the lower back as the source of the pain. Clinical tests to rule in trochanteric bursitis are often inadequate to make a definitive diagnosis.
  2. Pain to Touch – It may be painful to press the area by the greater trochanter. Despite limitation with the validity of this clinical test, pain to touch is one of the most common ways to rule in trochanteric bursitis.

Be a Detective

Impairments in the lower back often cause secondary effects such as weakness in the lower extremities or compensatory movements contributing to additional injuries such as trochanteric bursitis. As a result, one may experience a combination of somatic referred pain and trochanteric bursitis.

The elusive nature of trochanteric bursitis—better known as Greater Trochanteric Pain Syndrome—can be more clearly detected by improving your knowledge and awareness of your body. You can learn how to identify the aggravating or alleviating factors of your symptoms with on-going education. As you discover these factors, you will create a pathway to pain-free running.  Nagging injuries can fade into a distant memory rather than trigger frustration as you prepare for your next race.

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Dr. Marc Robinson is a Physical Therapist in San Diego, CA who provides online physical therapy and virtual consultations for those who need on-demand help with injuries. His company, Evercore offers online injury prevention courses and fitness products to promote a pain-free, active life. They specialize in low back pain and helping their clients achieve health goals beyond what the traditional medical system can offer.