A 10 day period of high pressure has settled over Teton Valley bringing with it crystal blue skies and miles of freshly groomed trails for cross country skiing. The track is fast this week and the first of the winter’s Nordic Ski races are just around the corner. While cross country ski enthusiasts have been increasing their mileage a common complaint has begun to surface.
These endurance athletes, like cyclists, runners and backcountry randonnee skiers, participate in sports that involve repetitive hip flexion and extension performed in the single plane of movement.  Such athletes commonly complain of having a deep ache on the lateral aspect of the hip that may refer to the groin and distally into the lateral thigh.  Pressure on the greater trochanter, such as when sleeping on the affected side, increases these symptoms. While going up stairs many experience a “click” or a sensation that “something” is flipping over the side of their hip. This chronic condition has an insidious onset and often flares up during training cycles of increasing duration (distance) or intensity. Diagnosis from a physicain is often trochanteric bursitis and is an inflammatory condition NSAID’s are traditionally prescribed in addition to rest and ice.Â
In the general population trochanteric bursitis afflicts the middle aged and elderly resulting from muscular weakness and the inability to stabilize the hip during the gait cycle. However, with endurance athletes such as cyclists and Nordic skiers inflammation of the trochanteric bursae is more commonly associated with compression from the iliotibial band. Length of the iliotibial band and therefore its possible involvement in the compression of the bursae, can be assessed with the Ober’s test. Bodywork should include releasing the iliotibial band, tensor fasciae latae and gluteus maximus. Additionally the gluteus medius and minimus are often found to be hyper-tonic in this condition and may have active trigger points that mimic the referral patterns of trochanteric bursitis. Assisted stretching (PNF or AIS) of the medial hip rotators and hip abductors are also indicated in releasing tension and can be easily taught to your client.
Even though trochanteric bursitis is an inflammatory condition and contraindicates direct manipulation, in the endurance athlete, bodywork can be the key to resolving chronic compression the bursae by the iliotibial band.
