Do I have Hip Bursitis or Back Pain?

It’s a common story that I hear in the clinic, and a frustrating one. A patient complains of prolonged lateral hip pain (outside pocket area) that came out of nowhere. They went to see their doctor and the doctor says “Congratulations, it’s a boy!” Just kidding, they take an x-ray which comes back negative (good thing) and then say “You have hip bursitis. Let’s give you some cortisone and send you on your way.” The only problem is that your hip doesn’t improve and you are left frustrated, questioning “Why?” The answer is, you probably don’t have hip bursitis, you probably have a back problem. Allow me to explain further. 

What’s Hip Bursitis?

Hip bursitis is an inflammation of the bursa sac on the outside part of your hip. Its job is to keep your muscles and tendons from rubbing on your greater trochanter and damaging them. Bursitis happens when the bursa sac gets compressed and inflamed which will cause pain in the area.

Most of the time the pain is due to activity and will improve if you rest. The patients that I see are the exact opposite. They hip hurts when they rest and will feel better with certain movements. If that is the case then you probably don’t have true hip bursitis. 

If I Don’t Have Bursitis Then What Do I Have?

Let me introduce you to my friends dermatomes and myotomes. These little characters are areas of the body that are innervated by our back. They tell our brain what we feel (myotome) and how we move that area (dermatome). 

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If you can’t tell from the pictures there are two different areas of the spine that innervate the lateral hip where you might be having pain. Let’s look at the dermatome on the left first. You can see the two blue circles around where the L2 spinal segment innervates the skin. As you can see it starts up high by the hip and travels down the thigh. If your back is causing your “hip pain” you will have irritation all along that pattern. Simply take a fork and lightly press it into your skin and compare your irritated side to your non-irritated side. If your irritated side is way worse, or you don’t feel anything at all, your pain is probably coming from your back. 

Now let’s take a peek at the myotome pattern in the picture on the right. You can see in that blue circle that your L5 controls hip abduction (move your foot out to the side), and external rotation (clam shell exercise). Both those movements might cause pain in a patient with hip bursitis so that doesn’t tell us anything. If you have issues coming from your back we can test other movements though. Hip extension (bridges), knee flexion (hamstring curl), and ankle dorsiflexion (bring your foot up) are all partially controlled by L5 as well. If you test the strength in those movements, and they are weak as well, guess what, its coming from your back not your hip. 

Why Do You Hate My Doctor?

I started this post talking about a problem that I see all the time. It’s true that doctors miss a lot when it comes to orthopedic problems, but it’s not their fault. Most general practitioners are not educated enough in ortho. Most Ortho docs are too busy to try to tease things out. I don’t hate any of them. Heck, some PTs miss this stuff too (I know I did when I was just starting out). I just want to educate you so if you are having a similar issue you can be an advocate for yourself. So if you are someone who has been dealing with hip pain for a while that hasn’t gotten better, it’s time to think outside the box. If you run yourself through these tests and start to get some positive results, stop working on your hip, and start working on your back. 

I hope this helps you if you are having hip pain that hasn’t improved. If you have any questions please contact me here at OrthoCore Physical Therapy. Thanks for reading!