♪ Bob and Brad, the two most famous ♪
♪ Physical therapists on the internet ♪
(lighthearted music)
- Hi, folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet. - In our opinion,
of course, Bob.
- Today, what is causing your hip pain?
Is it bursitis? How to know?
So let's get to it, Brad.
- Yeah, bursitis is one of those terms that I think people,
it's misunderstood and it's a little more frightening
until you know what it really is.
- So a bursa, just a bursitis,
a bursa is a fluid-filled sac and it cushions the bones,
and the tendons, and the muscles around joints.
- Right, they kind of lubricate the tendons and the,
and the ligaments from getting worn out over the bone.
And you have them all over your body.
- Right, exactly. Especially over all the joints.
- Right. - And most common bursitis
in the hip is trochanteric bursitis.
So this is the greater trochanter.
And if you want to picture, I got this squishy ball,
you can just picture a bursa.
This would be way bigger than that. (chuckles)
- Yeah. They're more like a- - Way smaller.
- [Brad] They're more like a pancake shape.
- [Bob] Sure, but you can see
how this fluid-filled ball would kind of protect the bone
and protect muscles running,
would be running over this and tendons
so they don't rub against the bone and tear.
- [Brad] Yeah, you're right.
- So that's, that's what a bursa is.
So when it gets inflamed, then it becomes bursitis.
So very easy - Right.
- to understand.
- So itis means inflammation simply.
- So yeah, this is trochanteric bursitis.
It would be point, so it's right on the point of your hip.
So generally how you can hurt this,
is through a number of ways.
One it could be just a direct injury.
You could fall on it. - Yes
- Something could bump up against you,
hit you really hard there.
But you can also get it from just putting stress on it
over a period of time.
- You know, I think some people may have,
their gait changes or walking changes because of an injury.
Maybe they have something with their ankle
and they sprain their ankle
so they start walking funny until it gets better.
- Yeah, why don't you show
what like a trendelenburg walk is Brad.
- Sure, trendelen. - Yeah.
- Where you kinda do this kind of thing.
- Yeah, and it might just be one way.
- Right.
- If you're, if we can.
- Just to the left or you might see people do this
to the right and to the left.
And there could be a number of reasons for it.
- But I always think, Brad, that that can lead to bursitis.
- Sure.
- Because you're putting a lot more stress
on those muscles and tendons that go over there.
- In a movement that's not intended to be.
- Right, so you can have the direct injury.
You can just get it from lying on it
for long periods of time. - Sure.
- My hip actually for a while got sore
because of the muscles around it,
but I couldn't even lie on it.
- Oh, really?
- Yeah, I had to avoid lying up on it.
- You had to sleep on the floor
cause your wife kicked you out of the bed or something.
- No, no, that wasn't it. (Brad laughs)
But I did have to lie on my other side so.
- Okay.
- A repeated stress, so like if you're running,
or stair climbing, or bicycling, it could cause it.
Poor position of the hip like with standing,
walking or sitting. So let's say standing,
let's say you always stand like this.
- Yeah.
- You know this hip is taking more stress.
- Yeah.
- This hip is taking no stress.
And if you do that year after year,
and especially when you get into the elder years
as Brad and I have found out. (Brad laughs)
These things start causing pain.
- Yeah.
Another one is, we already talked about the walking.
- Yeah. - The trendelenburg.
But some people sit on one side too.
- Yeah.
- I mean, I actually kind of sit like this when I'm eating
and I don't know, it's bizarre, but. (laughs)
- And it's one of those things - Yeah.
- that develop for who knows what.
- I kinda find it trying to find a stable position.
- I do want to mention, you've mentioned bicycling,
and if you do get it from bicycling,
it's probably cause your seat's not adjusted properly.
- Correct. - It's probably too low but,
and that can go with other things too.
It's just something not done properly
or ergonomically correct, if you will.
- Right, right. If you have medical conditions like gout,
or RA, or pseudogout, that can cause it.
- Sure.
- Previous surgery including hip replacements.
- Sure.
- Get it. Bone spurs or calcium,
especially if they're on the tendons that are attached
to the greater trochanter. - Yes.
- Those spurs can actually dig into that bursa.
- Yeah. That makes perfect sense mechanically.
- If you have a leg length discrepancy,
if one of your legs is longer than the other,
so that's gonna kinda put you in that position,
where you're gonna put more pressure on one hip.
That can certainly cause it.
And in that case you might wanna correct it
and put a small lift in your shoe.
- Right, right.
- Rarely an infection causes bursitis.
I think I've seen a case like that one time.
- New Jersey. - Yeah.
That was interesting so.
So do you have it?
Let's, let's answer that question, Brad.
- Yes.
- It's more common in women.
Definitely more common at the middle-aged or elderly.
- You don't, you don't see it in young people that often.
- Nah, I've never.
- I don't think I've never seen it.
- Right
- Pain is on the outside of the hip.
And we say outside of the hip,
that might be the side of the hip for some people.
- Yeah.
- Cause we always talk about this, Brad,
that when people ask where the hip pain is,
what do they do? They'll point here or back here.
- Yeah. A lot of time,
they, they think their pelvis bone is, is the hip up here,
that ilium actually. - Right, right, way up.
- When actually they're a few inches too high.
- So pain on the outside of the hip,
pain with lying on the hip, that's a big one.
- Yep.
- Pain with getting up from a low seat or chair.
- Yep.
- And pain with the use of stairs again.
- Sure. - Which is real common.
The single best test,
and this is gonna, might be disappointing
to a lot of you, (Bob and Brad laughing)
is simply to like, let's say the bursa is right here.
You're gonna find that bone and press on it.
- Right. - And see if it's tender
right over the bursa.
Now, you might feel some swelling,
you might feel some warmth,
but generally the pain is right over that bone.
Brad's gonna show you kind of a way to find that bone,
right? - This is the way,
this is the way I have my patients do it
and this is the way I pretty much do it too.
I'll have them, you can do it lying down,
I usually do it standing.
And then I say put your foot out so your,
just your toe is touching on the floor
and rotate back and forth.
You know, this is what, you know, I don't know,
this is probably not politically correct.
- I know. - But like I throw a cigarette
on the ground and you're gonna smash it out.
- Right. - Both my parents smoked
when I was young and it was like one of those things.
- That's what they did all the time.
- And they taught us that in PT school back in the '90s.
But when you do that motion
and you put your finger right here, you're gonna feel
that greater trochanter rotate very clearly.
- You feel it under your fingers.
- Yep. - Kinda moving.
- Exactly. Even, and it's one of those places where
if you're a heavier person, you can just push in there
and you'll still feel that distinct trochanter.
- Yeah. - It's right there.
- And then it typically does not have,
it has no muscle over it.
And not a lot of, you know,
fat tissue will go over that as well.
It will, but you just push through it, you'll get there.
- You got tendons and you got the bursa so.
- Yep.
- Just beware though, this is often misdiagnosed, Brad.
- Sure. - And quite often,
it might be a muscle or tendon tear
and that would act the same way.
You know? - Right.
- If the tendon is torn right over the trochanter,
it's gonna feel the same. Irregardless,
you probably treat it fairly similar cause that's.
- That's what I was thinking too,
if there is a different diagnosis.
Same area, similar treatment.
- Although I would maybe try a massage to a tendon muscle
and I wouldn't do that to a bursa.
- Right, that's true.
- All right. Remember this is, this is part of a program,
a series of programs, a series of videos on hip pain.
- Yes.
- So if you go to Bobandbrad.com
and go to our program section, look under it,
and you'll find one on hip pain.
- Yep.
- We've got about, I don't know, 25, 30 videos on this,
I believe, we got. And just look at the ones
that you think would be helpful to you.
- Yeah. You look at the titles.
You certainly don't have to look at them all.
I mean, if you want to, you can.
But you'll find that there's titles that say,
"Yeah. I think that's gonna fit me."
Look at it. There's a PDF printout on all of them,
so you can print out the video
so you don't have to go back and look at it.
You got a nice,
- Portable digital format, is that what we decided?
- The PDF, that's what that stands for.
And then you have something on paper to refer back to.
- And this is all the way, by the way, all free.
- Right.
- This is Brad and I's goal of we're trying to help
as many people in the world as we can.
- Yep, and this is, this is a service
and we don't even ask for your email.
- No, thanks for watching.
(lighthearted music)