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Knee & Hip Problems Message Board

Knee & Hip Problems Board Index

This is a reply to plreynolds who contacted me about more info on chronic hip bursitis and what to do when it won't go away. Rather than email him directly, I figured it would be more of a help to post it here for anyone suffering with this pain.

When trochanteric(hip) bursitis hits, it's usually because of overuse of the leg. There are tons of muscles and the "iliotibial band" that runs down the outside of the thigh from above the hip joint to the tibia. That band of tissue is like a giant tendon made up of fascia. The bursa's job is to lubricate all of this. So overuse is the most common problem. Rest, and for a considerable amount of time is one way to treat it.

But underlying problems can also cause this problem. Bursitis usually follows tendinitis, meaning that the tendon gets inflamed first, swells and puts pressure on the bursa and then the bursa swells along with it. Chronic hip bursitis can be from overuse or from an inflammatory process such as Raactive Arthritis(formerly known as Reiter's Disease) which causes tendinitis all over the body and can affect both ends of the tendons. The tendinitis then causes the chronic bursitis. Even plain old osteoarthritis of the hip can trigger an overlying tendinitis and bursitis(my problem). That's why it won't go away with me. And for those wondering, replacing an arthritic hip won't stop the bursitis...didn't in my knees. If anything it made it worse. Now I overuse my knees(since they don't hurt anymore).

So those are some of the possible to treatment. Plreynolds asked about home remedies as he has no insurance and that what lots of people are facing(or huge deductibles). If we assume that overuse is not a factor then we have to look for the underlying problem and for this post, I'll assume it's some early arthritis of some kind that is aggravating the entire joint capsule and the tendons and bursas around the joint(yes, there are other bursas around the hip).

The standard treatment for OA(osteoarthritis) is NSAIDs(non-steroidal anti-inflammatory drugs). The trick with these is not to take them just for the pain but to take a lower dose consistently to knock down the inflammation. So if you use ibuprofen, try taking up to 800mgs(4 of the OTC pills) 3-4 times a day for the first couple of weeks then reduce it to 600mgs 3-4 times a day. If you can reduce it even further until the pain returns then up it slightly to keep the pain and inflammation at bay. You can get these higher dose pills cheaply from a variety of places that offer $4 for a month's supply with a doc's script. But I just buy the biggest bottle of ibuprofen I can get so I can take what I need, be it 2, 3 or 4 pills.

You can do the same with Aleve and other OTC's. Aleve is naproxen and you can take a theraputic dose of 2, 3 times a day and slowly reduce as your pain resolves. Orudis is ketoprofen and it comes in regular and time released forms so if you want the max. dos on that I can give it to you for either form. I've been on all of them and still use ibuprofen regularly.

When the pain first starts, use ice to reduce swelling. But no more than 20 minutes per hour and never directly on the skin...frostbite! Try going to heat after a few days to increase blood flow to the tendon and bursa to help them heal. If this doesn't help of makes it worse, go back to ice. You're still swollen.

Learn to stretch your hip muscles. There are a ton of exercises and if you do a search, you'll find sites that offer the exercises endorsed by physical therapists, including pictures of how to stretch the muscles.

If you find yourself in pain so bad that you limp, consider using a cane(tough for young folks but it does help). You use it in the opposite hand as the bad leg. Or, if you don't want to look like an old lady, get a pair of crutches at your local drug store and use them for the first couple of weeks while on the max. dose of meds. Keep the hip as straight as possible. If you sit at work and it hurts, take a cooler to work with ice packs in it and use them(or hopefully you'll have a fridge w/ freezer at work you can keep them in).

If the pain gets really bad you can take a combination of ibuprofen at 800mgs along with acetaminophen 1000mgs. They enhance each other and I have found them to be as good as low dose morphine. But avoid OTC drugs that combine acetaminophen with aspirin...that's asking for an ulcer. For you Canadians out there, you can add the ones with codeine. But that only treats the pain, not the underlying inflammation. So only use the combination meds for pain. It's the daily doses for the inflammation that will cure it. Generally, the maximum prescribed dose for OTC(over the counter) anti-inflammatories is 4 times what is on the bottle but you should check this first(ask here if necessary).

The key to battling bursitis is not to treat the pain but the underlying problem. So learn to stretch and when the pain is gone, strengthen the hip muscles so they will do the work instead of your tendons taking the brunt of the work. Weak muscles lead to over worked tendons and tendinitis and bursitis. Strong muscles not only prevents them but helps to take the pressure off joints and helps arthritis pain.

And please, if you do any of this, watch your general health. NSAID's can raise your blood pressure and hurt your liver. So can acetaminophen. That's why I recommend reducing the doses every 2 weeks if possible. If you find you are staying on these drugs for longer periods of time, see your doc and have you liver function tested. Stay away from alcohol too while on these drugs. No need to push your liver that hard! And if this doesn't work, see a doc for a cortisone shot. A GP or Primary can do need to see an orthopedist.

I've battled chronic bursitis all over my body from an unknown cause for over 30 years(started after an infection). I've found that the best treatment is immediate aggressive treatment...don't wait to see if it will go away. I have all sorts of splints to use and the faster I splint, the faster it goes away. But there aren't any splints for hips. YOU have to "splint" it in your mind by not moving it if possible(or as little as possible). I have actually become allergic to cortisone due to all the shots I've had so I now have to rely on this type of treatment and I do exactly what I have described above. I hope it works for others.

gentle hugs to all..............Jenny

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