DEAR DR. GOTT: I am a 60-year-old female teacher, very active and on my feet all day. I go to the gym several times a week and do other activities. I was diagnosed with bursitis nine months ago. I had a cortisone injection at that time and all was well until a month ago. I returned to the doctor, got another injection and an anti-inflammatory script. I quickly felt like a 20-year-old, able to run upstairs, etc. A few days after I finished the prescription, the bursitis returned. I can’t walk without limping due to the pain. I have great difficulty walking up stairs and cannot sleep on that side. I am still going to the gym, despite the pain. I also have arthritis in my knees but not in my hips. What do you recommend?
DEAR READER: A bursa is a fluid-filled sac whose function is to reduce friction between moving tissues of the body. Major bursae are found next to the tendons near all large joints such as the hips, elbows, knees and shoulders. Other areas that can be affected include the heels of the feet, base of the great toes and between the toes. When inflammation occurs, a person is known to have bursitis.
Repetitive motion during work and physical exercise are commonly to blame for the condition to occur. For example, playing a musical instrument, kneeling, gardening or working with your arms over your head for extended periods of time can trigger an attack. Beyond that, medical conditions such as rheumatoid arthritis, diabetes and gout can also increase a person’s risk for developing bursitis.
There are two bursae of the hip known as the trochanteric and ischial bursa. Inflammation in those areas can cause the stiffness and pain you are experiencing. Trochanteric bursitis commonly affects the outer hip area, making it difficult to walk, climb stairs and exercise. Ischial bursitis can cause pain in the buttock area, most noticeable when walking up an incline. The condition may occur following periods of prolonged sitting. The most common causes for your problem to manifest in the hip area are either from an injury (such as banging up against a table) or trauma to the soft tissue (perhaps from a fall).
Diagnosis can often be made by a physician listening to the history of events that occur prior to an attack, with attention paid to the specific pain site. Should questions remain, laboratory testing, an ultrasound or MRI might be appropriate.
Treatment begins on the conservative side — rest, over-the-counter pain relievers and ice. On occasion, aspiration of the bursa fluid might be necessary for relief, a procedure that can commonly be performed in a physician’s office. A cortisone injection might also be provided for pain relief and might be given at the same time as the aspiration.
My guess is that you received prednisone in pill form, a wonder drug that should only be taken short-term. That is why you felt so great until your prescription ran out. Therefore, I recommend you return to your primary care physician or rheumatologist to determine if the workouts you are undergoing at the gym are too strenuous for you. Ask if a break of a week or longer might allow the pain to subside, or if you should consider a physical therapist who can recommend specific movements that will not aggravate your condition. This will allow you to continue to work out several times a week without putting undue stress on your painful joints. Consider using an over-the-counter pain reliever such as ibuprofen. Sleep with a pillow between your knees and avoid aggravating the pain site. Ask if a pain clinic or physical therapy might be appropriate next steps in managing your pain.
On the home front, be sure to warm up by stretching slowly prior to physical exercise. Keep your weight down if appropriate and wear proper footwear, especially when exercising. Avoid movements that aggravate your condition, such as stair climbing and sleeping on the affected side. Perhaps your bursitis cannot be eradicated completely and you may experience future flare-ups, but a few simple steps might make things more manageable. Good luck.
Readers who would like related information can order my Health Report “Managing Chronic Pain” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
