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.
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.