By – Dan Pasiak

Hip bursitis (also known as Greater Trochanteric Bursitis) is by definition an inflammation of a bursa at the side of the hip.  A bursa is a small jelly-like sac that usually contains a small amount of fluid. The bursa acts as a cushion between bones and overlying soft tissues, helping to decrease friction between the bone and soft tissues gliding over top of it.

When irritated, the bursa swells and causes pain that may be sharp and intense at first and then gradually become achy and spread out. It may be worse lying on the side of the injury, or with running, walking, or stair climbing.  Pushing on the boney point of the hip will typically increase pain.

Hip bursitis is most often a symptom of another underlying problem in the muscles surrounding the hip or the joints near the symptoms including the hip joint itself as well as the sacroiliac joints or low back.  Consequently, people who are diagnosed with hip bursitis may have other symptoms not caused by the bursa itself including back pain or sciatic pain due to the body attempting to compensate for an imbalance.  One of the most frequent causes of hip bursitis is due to an imbalance between two hip muscles, the tensor fascia lata (TFL) and the gluteus medius.

People often have a weak or underused gluteus medius, causing an overuse of the TFL muscle which rides over the hip bursa.  The increased force over the bursa increases the friction on the bursa and causes swelling.  Other causes of increased force at the bursa may be a sacral iliac dysfunction, foot overpronation, a leg length difference, or tight muscles at the front, side or back of the hip.

At Probility Physical Therapy, we typically treat hip bursitis through a multi-faceted approach.  We start with trying to determine why the bursa is having increased stress placed on it in the first place and then treat that dysfunction.  This is often done through mobilizing (helping to move) any joints that are “stuck”, by decreasing muscles spasms / tightness, by using arch supports / orthotics in the feet and by using a heel lift if there is a true leg length difference.  Each of these treatments can help to decrease the pain and swelling in the hip.

Achilles Tendonitis

Author – Sarah Reese

Achilles tendonitis or tendinopathy is one of the most common overuse injuries among recreational athletes, accounting for up to 9% nine percent of injuries in elite and recreational runners, and more frequent in older runners.⁴

The Achilles Tendon attaches the calf muscles (the gastrocnemius and the soleus) to the heel bone and is what allows you to push off when walking or running.  Tendonitis is the inflammation, swelling, and irritation of a tendon.³

Symptoms:

• Sharp pain or mild ache in the back of your leg above the heel usually felt after running or other sports activity
• Decreased pain but stiffness at rest³
• Bump in Achilles tendon
• Cracking or creaking of Achilles tendon with palpation¹

Causes:

• Repetitive use or overuse of the tendon

• Low arches in feet without supportive shoes
• Tight calf muscles or decreased ankle mobility
• Change in training regime – new terrain, more pavement, increased hills, jumping activities
• Less recovery time after exercising
• Weakness in calf muscles
• Exercising without warming up¹

Treatments:

• Rest or less strenuous activities for a few days/weeks
• Increase length of calf

• • Stretch calf (both soleus and gastroc)  (see picture below)
  • Roll out calf with a foam roll  (see picture below)

• Buy shoes that properly fit your feet
• Properly warm up and cool down when exercising
• Calf strengthening – eccentric and concentric exercises
• Friction massage of the Achilles Tendon
• Icing

• • Ice cup

Get immediate care if the pain is severe – this is not a symptom of Achilles Tendonitis¹

**If it does not improve after using these suggestions, considering talking to your family physician or a physical therapist. **

What to expect when you are treated for Achilles Tendonitis at Probility:

On the first day at your initial evaluation, we will spend the majority of the session determining the cause of your Achilles Tendonitis.  It is our goal to go beyond giving you temporary relief so that we can prevent future injuries and allow you to go back to your favorite daily activities.  We will assess how your legs, pelvis and back are functioning because they all can alter how your feet hit the ground when you are walking or running, which can cause overuse and pain.

We use a manual therapy, or hands-on, method to improve foot, ankle and calf mobility.  We may also do myofascial release, or a type of massage if it is necessary to help restore normal movement of your muscles.

Following the hands-on portion of your treatment session, we move into exercises which are mostly focused on stretching and eccentric strengthening.  Other treatment modalities may be used to help control pain, swelling and muscle spasms.

If our suggestions for self-treatment don’t fix your pain, consider physical therapy so we can help you get back to your normal activities as soon as possible!!

1. http://www.mayoclinic.com/health/achilles-tendinitis/DS00737/DSECTION=symptoms

2. http://www.sportsinjuryclinic.net/cybertherapist/back/achilles/tendinitis.htm

3. http://physicaltherapy.about.com/od/orthopedicsandpt/ss/Tendonitis.htm

4. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=14&hid=8&sid=d0bd61c6-0854-4357-a1d7-a642a3764b3c%40sessionmgr12 Satyendra  Effectiveness of physical therapy for Achilles tendinopathy: An evidence based review of eccentric exercises

5. http://www.google.com/imgres?imgurl=http://www.empowher.com/files/ebsco/images/si55551225.jpg&imgrefurl=http://www.empowher.com/media/reference/achilles-tendonitis&usg=__7_MZXyQ1QtNaMHFCpzYAejYGkiI=&h=255&w=391&sz=21&hl=en&start=0&zoom=1&tbnid=yfFEf_vnYyoUQM:&tbnh=119&tbnw=183&prev=/images%3Fq%3Dpictures%2Bof%2Bachilles%2Btendonitis%26um%3D1%26hl%3Den%26sa%3DN%26biw%3D1440%26bih%3D708%26tbs%3Disch:1&um=1&itbs=1&iact=hc&vpx=1121&vpy=378&dur=459&hovh=181&hovw=278&tx=229&ty=98&ei=uJOjTLXTDNGUnQfLjYGJBA&oei=uJOjTLXTDNGUnQfLjYGJBA&esq=1&page=1&ndsp=31&ved=1t:429,r:22,s:0

6. http://www.google.com/imgres?imgurl=http://www.joint-pain-solutions.com/images/ice-massage-cup-ready.jpg&imgrefurl=http://www.joint-pain-solutions.com/achilles-tendonitis-treatment.html&usg=__cRE1NJU6-mZe_f0yNXpGTgHWzLI=&h=181&w=200&sz=12&hl=en&start=0&zoom=0&tbnid=7DjQ0q80zjJc7M:&tbnh=94&tbnw=104&prev=/images%3Fq%3Dice%2Bcup%2Bfor%2Bachilles%2Btendon%26um%3D1%26hl%3Den%26biw%3D1440%26bih%3D708%26tbs%3Disch:1&um=1&itbs=1&iact=hc&vpx=179&vpy=248&dur=270&hovh=94&hovw=104&tx=64&ty=13&ei=xpWjTObsApOLnAeZ54iJBA&oei=xpWjTObsApOLnAeZ54iJBA&esq=1&page=1&ndsp=21&ved=1t:429,r:0,s:0

http://sportsmedicine.about.com/od/flexibilityandstretching/ss/FoamRoller_6.htm

http://www.google.com/imgres?imgurl=http://www.systonfootcare.co.uk/images/calfstretch.jpg&imgrefurl=http://www.systonfootcare.co.uk/footexercises.php&usg=__ziad-JspxRCys6fJQ1EtmXMnh84=&h=160&w=481&sz=13&hl=en&start=105&zoom=1&tbnid=N0uPoy86DK2afM:&tbnh=57&tbnw=170&prev=/images%3Fq%3Dcalf%2Bstretch%26um%3D1%26hl%3Den%26sa%3DN%26biw%3D1440%26bih%3D708%26tbs%3Disch:10%2C1653&um=1&itbs=1&iact=hc&vpx=916&vpy=401&dur=207&hovh=128&hovw=384&tx=204&ty=84&ei=lpajTILcLMP58AbkqfGvCg&oei=ZJajTPHNKsmLnAfGtfGIBA&esq=4&page=4&ndsp=33&ved=1t:429,r:13,s:105&biw=1440&bih=708