Trochanteric Hip Bursitis Treatment in NYC | NYDNRehab

Greater Trochanteric Pain Syndrome (GTPS) – Also Known as Trochanteric Bursitis

About Trochanteric Hip Pain

GTPS is a painful condition affecting tissues surrounding the greater trochanter of the femur (the “ball” in the hip ball-and-socket). Once called “trochanteric bursitis,” the name was modified after multiple studies revealed that the greater trochanteric bursa — the fluid-filled sac that separates the trochanter from surrounding soft tissues — was not involved in 85% of patients suffering from the condition.

GTPS is marked by pain and tenderness around the lateral hip, but does not affect the bursa, or the hip joint itself. Once believed to be caused by inflamed bursae, GTPS is now believed to be a degenerative overuse condition. Running and jumping activities are thought to contribute to GTPS.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Hip Pain Specialist Dr. Lev Kalika

With over 20 years of clinical experience, Dr. Lev Kalika embraces a conservative, minimally invasive approach to hip injury treatment and rehabilitation. The NYDNRehab clinic in Manhattan features a broad range of cutting-edge technologies and innovative therapies for treating musculoskeletal pain.

Dr. Kalika studied under world renowned specialist Christopher Powers PT, PhD, and became certified in Advanced Functional Biomechanics by the University of Southern California. Under Dr. Kalika’s care, scores of athletes and physically active New Yorkers have successfully overcome hip pain and enhanced their overall physical performance.

Dr. Kalika uses the highest resolution diagnostic ultrasonography and research-grade motion and gait analysis technology to provide an in-depth and accurate diagnosis for hip pain. His high-tech diagnostic and treatment modalities and his extensive expertise are rarely found in ordinary physical therapy practices.

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GTPS Symptoms and Causes

Symptoms

  • Pain on the outer hip, thigh and/or buttock

  • Pain when pressure is applied to the outer hip

  • Pain that worsens when rising from sitting to standing

  • Pain when climbing stairs

Causes

  • Overuse from sports, exercise or occupation

  • Poor posture and excessive sitting

  • Previous hip surgery

  • Calcium deposits or bone spurs

Get Faster and More Effective Therapy
for Hip Bursitis and GTPS

Hip mobility is fundamental to everyday movement, and hip pain can really slow you down. As a ball-and-socket joint, the hip has a broad range of motion, governed by multiple structures, including muscles, tendons, ligaments and nerves. Because of the complexity of hip and greater trochanter anatomy, it can be difficult to pinpoint the exact cause of hip pain. This often leads to misdiagnosis, excessive use of pain pills and unnecessary surgeries.

At NYDNRehab, we use high-resolution diagnostic ultrasound to visualize the structures surrounding the hip in motion, in real time, to accurately pinpoint the underlying cause of hip pain. We then create a personalized treatment protocol, based on your unique diagnostic results.

Unlike run-of-the-mill physical therapy clinics that take a one-size-fits-all approach to patient care, and divide their attention among multiple patients at once, our one-on-one therapy sessions ensure that your therapist is focused on getting you the best results, saving you time and money. Our high-tech regenerative tools help to speed up the healing process, so you can get back to normal activity in the least possible amount of time.

Accurate Diagnosis is Fundamental
to Successful Treatment

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Any of the complex structures that make up hip and greater trochanter anatomy can contribute to GTPS, and misdiagnosis is common. When diagnosis is based on symptoms alone, serious issues can be overlooked, and the wrong treatment protocol can prolong your pain and suffering while draining your resources.

At NYDNRehab, we use the most advanced high-resolution ultrasound equipment to visualize the structures of the hip in motion. Our high-tech 3D gait analysis lab is able to detect and quantify gait deficiencies that may contribute to your pain and disability.

Dr. Kalika is an expert in diagnostic ultrasonography, and has published multiple scientific papers on the topic. His experience and expertise ensure that your hip condition is accurately diagnosed and appropriately treated.

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Please explore more advanced diagnostic option unavailable anywhere else:

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Our Regenerative Technologies are Game-
Changers for Hip Bursitis Rehab

Prior to beginning physical therapy, we make sure your hip joint is both stable and mobile, so you get the most from your therapy sessions. Our regenerative therapies reduce pain and inflammation, and jump-start the healing process by stimulating your body’s own healing mechanisms.

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.


Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields to trigger a regenerative response.

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.


High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes.

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Ultrasound Guided Injection
Therapies

Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Focused Shockwave Therapy

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.


Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution that irritates the affected tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new cells.

Electromagnetic Transduction Therapy (EMTT)

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to hip bursitis pain. Dry needling for hip bursitis is an outpatient procedure where non-medicated needles are inserted into the trigger point to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Preventing Hip and Greater Trochanter Injury

Staying physically active is key to maintaining good health, avoiding metabolic disease and remaining pain-free from musculoskeletal issues. Your body is designed to move and perform physical work. Sitting all day in front of a screen is the fastest route to poor health and reduced mobility.

At the same time, relentless exercise without adequate recovery time, combined with suboptimal movement mechanics, can lead to repetitive use injuries, and set you up for acute injuries.

Take the following actions to avoid greater trochanter injury, hip bursitis pain, and other pain syndromes:

  • If you work online, get up and move at least once per hour. You don’t necessarily need to exercise — routine housekeeping tasks provide physical activity with the added benefit of a clean and clutter-free work environment.
  • Do at least some of your online work at a standing desk or kitchen counter.
  • If you are sedentary, now is a good time to start a simple walking program. Walking is a primary activity that the human body is uniquely designed for. Start easy, and gradually increase your speed, distance and time.
  • If you exercise or play sports, tune into your body. What begins as an annoying ache can quickly degenerate into a serious injury. Early treatment can save you pain, time and money.
  • Incorporate stretching into your daily routine, to keep joints mobile and promote good posture.
  • Add whole-body resistance training at least twice a week to promote strength and stability.
  • Allow adequate recovery time between workouts, and increase your intensity gradually.

Anyone can benefit from a 3D gait analysis, or a total body biomechanical analysis, to identify motor deficits that could cause pain and injury down the road. Catching them early and correcting them can help you stay active and pain-free for years to come.

Preventing Hip and Greater Trochanter Injury

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    Greater Trochanteric Pain Syndrome

    Greater trochanteric pain syndrome (GTPS) is a condition that was formerly known as trochanteric bursitis. Bursa are fluid-filled sacs located in your joints that prevent friction between your bones and soft tissues as you move. In your hip, a bursa is positioned tocks.

    In the past it was thought that the bursa itself becomes irritated and inflamed, causing hip pain and discomfort. However, recent research has revealed that hip pain at the trochanter is not cause by an inflamed bursa, but rather by inflammation of the tendons that attach muscles to the hip joint.

    Symptoms of GTPS

    GTPS is marked by pain and tenderness at the side of the hip that becomes worse while standing, and during physical activities like walking, running and jumping.

    Causes of GTPS

    Degenerative repetitive overuse is the primary cause of GTPS. The syndrome is most commonly seen in middle aged runners, middle aged females, and patients suffering from low back pain.

    Other causes include:

    • Instability of the hip and pelvis
    • Imbalance between abductor muscles
    • Abnormal weight bearing while standing and walking
    • Faulty running gait mechanics
    • Poor physical conditioning
    • Poor posture
    • Unequal leg lengths

    Diagnosis

    A health histo diagnose GTPS. However, real-time diagnostic ultrasound can be useful in confirming diagnosis, and in determining the severity of GTPS.

     

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    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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