A small, fluid-filled sac called a bursa sits near the hip joint, specifically cushioning the bony prominence on the outer side of the thigh bone, known as the greater trochanter. This sac minimizes friction between the bone, muscles, and tendons during movement. When this bursa becomes inflamed, the resulting discomfort is typically localized to the hip area, but the pain signals can sometimes be confusing. Inflammation originating at the hip can manifest as discomfort much further down the limb. This article explores the relationship between trochanteric bursitis and the potential for pain felt near the knee.
Understanding Trochanteric Bursitis
Trochanteric bursitis refers to the inflammation of the bursa sac located over the greater trochanter of the femur, the large bone in the thigh. This condition is frequently grouped under the broader term Greater Trochanteric Pain Syndrome (GTPS). Inflammation typically begins when the bursa is subjected to excessive pressure or friction.
The most common causes involve repetitive motions, such as running, cycling, or standing for long periods, which create cumulative microtrauma to the area. Direct injury, like a fall onto the hip, can also trigger an acute inflammatory response in the bursa.
Biomechanical factors contribute to the development of this condition. Differences in leg length or underlying spinal conditions, such as scoliosis, can alter a person’s gait, placing abnormal stress on the hip complex. Existing health issues like rheumatoid arthritis can also predispose the bursa to inflammation.
The Mechanism of Referred Pain
The connection between hip inflammation and knee discomfort lies within the interconnected network of fascia and muscle that spans the length of the thigh. The iliotibial (IT) band, a thick strip of connective tissue, attaches to muscles in the hip and runs down the entire outer thigh, inserting just below the knee joint. The trochanteric bursa is situated directly beneath this dense band.
Inflammation or chronic tightness in the hip muscles, particularly the gluteus medius and minimus, can increase the tension in the IT band. This heightened tension pulls the IT band taut, causing friction over the inflamed bursa. This pulling force can transmit pain, tightness, or a deep ache along its path and around its attachment point at the knee.
Changes in walking or running patterns due to the initial hip pain also contribute to secondary knee discomfort. A person instinctively alters their gait to minimize weight-bearing on the painful hip, which can overload the knee joint or surrounding structures. This mechanical compensation places unnatural stress on the lower leg. Significant inflammation at the hip can also irritate nearby nerves, leading to a sensation of radiating pain, sometimes described as sciatica-like, that travels down the leg.
Recognizing the Full Spectrum of Symptoms
The pain profile associated with trochanteric bursitis typically begins with localized discomfort at the hip. Patients report a sharp, aching pain felt directly over the bony prominence on the side of the hip. This primary pain is often aggravated by lying on the affected side, making sleep difficult, or by activities such as climbing stairs.
The pain can extend beyond the hip, following the course of the lateral thigh. This referred pain is usually described as a dull ache or tightness that runs down the side of the leg. The discomfort may reach the outside of the knee, but it rarely travels past the knee or is felt deep inside the joint itself.
If the knee pain is primarily located within the joint capsule, it is more likely indicative of a separate issue, such as arthritis or a ligament problem. The defining characteristic of bursitis-related referred pain is its superficial location and connection to activities that strain the hip. Tenderness upon direct pressure over the greater trochanter remains the most reliable indicator of the condition.
Conservative Treatment Approaches
The initial approach to managing trochanteric bursitis focuses on reducing inflammation and addressing the underlying mechanical issues. Relative rest and activity modification are recommended to stop the repetitive friction that caused the irritation. This may involve temporarily avoiding activities like excessive stair climbing or high-impact running until the pain subsides.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help decrease pain and reduce swelling in the bursa. Applying ice to the outer hip for 15 to 20 minutes several times a day aids in controlling the inflammatory response.
Physical therapy is a cornerstone of recovery, concentrating on restoring proper hip mechanics and flexibility. Specific exercises target stretching the iliotibial band to reduce tension and strengthening the hip abductor muscles, like the gluteus medius, to improve stability. Using proper footwear or custom orthotics can also correct subtle leg length discrepancies or gait imbalances that contribute to the problem.