Hip Bursitis and Patella Femoral Pain Syndrome physiotherapy

What is Hip Bursitis?

Bursitis is a painful condition that affects the fluid filled sacs that cushion the bones, tendons and muscles near a joint connection.  Bursitis is the inflammation of those fluid filled sacs causing them to swell and become tender or painful to touch or proceed through joint range of motion (ROM).  Common locations physiotherapists treat bursitis is in the shoulder, elbow, hip and knee.

What Causes Bursitis?

This often occurs near the joints where the individual produces repetitive and frequent motion.  Hip bursitis is also called trochanteric bursitis and its is normally as result of injury, spinal abnormalities, arthritis and surgery.  It is most common in woman, middle age and elderly individuals.

• Aseptic Bursitis
  • This is the inflammation resulting from local soft tissue trauma (direct impact) or a strain injury. The bursa is not infected.
• Septic Bursitis
  • This is when the bursa becomes infected with bacteria which casues pain and swelling

Common Symptoms of Hip Bursitis

• Pain
• Localized tenderness
• Limited motion
• Swelling and redness if the bursa sac is close to the surface of the skin

Chronic Hip Bursitis

It is possible for bursitis to become chronic and it may involve repeated attacks of pain, swelling and tenderness around the joints.  This can lead to the deterioration of the muscles and can severely limit the range of motion in the affected joint.

How to Treat Bursitis?

More simple methods include rest, ice, compress and elevate (RICE method), anti inflammatory and pain medications, steroid injections or splints and braces to limit movement of the affected joint.  Others may include antibiotics, surgical drainage and aspiration to remove the fluid.

How to Prevent Hip Bursitis?

• It is important if you are participating in any bout of physical activity that warm up exercises prior to the physical activity bout are completed. The same can also be said for repetitive work movements taking a quick 10–15-minute warmup prior, during and after as a cool down following a day of work can greatly improve muscular fitness and reduce any long-term negative health implications such as bursitis.

• When starting these newer exercises, it is important to gradually put the demands on the body rather than vigorously starting which causes increase risk to injury.

• When completing long repetitive tasks it is important to take breaks where individuals can stretch and allow the body to rest.

• Cushioning the at-risk joints can work as well having lumbar roll support so pressure is released off the lumbar spine and so that the pelvis does not rotate which also helps practicing good posture and knowing when you are in bad posture.

How Can Physiotherapists Help?

Physiotherapists can help with bursitis because they can help reduce pain and manage your recovery process by means of massage, rehabilitation exercises, muscle stimulation and laser therapies.  Physiotherapists promote the recovery by assisting the individual to change the routine in which you are working so that it reduces the amount of strain on a joint.  Physiotherapists can also help by assessing how your body moves, posture, tissue and joint strength as well as your biomechanics.  If bursitis is left untreated it can lead to the calcification in the fluid sac and cause even more pain and disability.  This can also be associated with other conditions such as RA and OA or that torn ligaments or tendons can cause the bursa to swell.  Nonetheless, physiotherapists can help manage, prescribe stretching and strengthening exercises and provide friction massages as well as manipulate the muscles to aid you in the path to recovery.

Patella Femoral Pain Syndrome (PFPS)

What is PFPS?

This pain syndrome is pain at the very front of your knee around the knee cap (patella) which is also called runners knee and is most common in those who participate in sports or activities that require you to run and jump repetitively.  This type of knee pain increases as you walk, run, walk up and down stairs, squat or sit for long periods of time.

Common Symptoms of PFPS

• This is normally a dull aching pain in the front of the knee and is aggravated by walking up and down stairs, kneeling and squatting and sitting or bending the knees for a long period of time

What Causes PFPS?

• Overuse: running or jumping sports puts a repetitive stress on the knee joint which causes irritation under the knee cap
• Muscles Imbalances or Weakness: PFPS can occur when the muscles around the hip and knee do not keep the patella aligned correctly. Inward movements of the knee during a squat (valgus knee) have been associated to the type of pain.
• Injury: Direct trauma to the knee cap like dislocations or fractures are linked to this pain
• Surgery: Repair of the anterior cruciate ligament (ACL) using a graft from the patellar tendon can also increase the risk of PFPS.

Risk Factors

• Age: Normally affects adolescents and young adults. Knee problems in older populations is more commonly due to arthritis
• Gender: Women are more likely to develop this type of pain due to the woman’s increase in hip angle which the bones in the knee joint meet (Q angle).
• Certain Sports: running and jumping sports where extra force is placed on your knees and even when you increase your training level

How to Prevent PFPS?

Physiotherapists can help prevent PFPS through numerous ways which include:

• Maintaining Strength: Strong quads and hip abductor muscles will help keep the knee inline and balanced during activity.  They can help by prescribing you isometric exercises first then strengthening exercises so that muscular imbalances do not occur.

• Alignment and Technique: Physiotherapists will help increase your flexibility and range of motion to optimize your technique for jumping, running and pivoting to help properly track the patella. They will also focus on strengthening exercises on the outer hip muscles to prevent your knee from going inward when squatting or landing from a jump and stepping down from a step.  Physiotherapists will teach you the proper jumping, landing and squatting mechanics before progressing forward into the normal activities the individuals participate in.

• Warm up and Stretch: Very important for every individual whether participating in activities or not that warming up and stretching helps with proper blood flow to the muscles and allows muscles to contract and lengthen under lighter intensities so that they become warm raise the heart rate so you can proceed to more vigorous training. Physiotherapists will give at home exercise program in the form of warm ups or stretches for the muscles in the area that must be completed daily even when noticeably better so that this type of pain does not occur again.

• Proper Training Shoes: This is commonly overlooked with athletes as they may have a brand loyalty or want the better-looking shoe however having shoe orthotics or orthopedic shoes for training can greatly decrease the pain in the knee. Physiotherapists can assist you in looking for orthotics or orthopedic shoes by doing a biomechanical assessment and foam impressions to send to a lab to get a mould of the foot to insert into your training shoes so during exercise there is a great reduction in pain.

Make sure you book your appointment today and get assessed by our physiotherapist now.