Runners are accustomed to a certain amount of discomfort in their lower bodies. Some of that discomfort is normal: Running causes microtears in the muscles, which your body repairs during recovery so you’re stronger for the next workout. But discomfort that surpasses soreness, is sharp or shooting, or lingers longer than a couple weeks can be a red flag from your body that something else is going on.
For runners, the knees and hips can be major problem areas—and if you’re experiencing abnormal aches or stiffness in either, knee bursitis or hip bursitis could be to blame.
What is bursitis and what causes it?
“Bursitis refers to a condition where the bursae, or small sacs of fluid that typically populate around high friction areas of the musculoskeletal system, become irritated or inflamed,” explains Julia Bruene, M.D., a sports medicine physician at Midwest Orthopaedics at Rush. These bursae are often located underneath tendons or over bony parts of the body and offer shock absorption or lubrication, adds Claire Morrow, an orthopedic clinical specialist and senior physical therapy consultant at Hinge Health.
Bursitis can be caused by a number of things—like direct trauma (such as tripping and landing on your hip or knee) or an infection. However, “it usually occurs primarily as a result of repetitive stress on a joint,” says Amol Bakre, an RRCA-certified running coach, NASM-certified performance enhancement specialist, and physical therapist at the University of Maryland Rehabilitation & Orthopaedic Institute. Considering running involves 1,700 steps per 10-minute mile, it can certainly cause that stress.
Abnormal biomechanics can also up your risk of hip or knee bursitis. “When strength or mobility deficits are present, they can lead to altered movement patterns or asymmetries,” explains John Schilkowsky, a physical therapist at Pappas OPT Physical, Sports and Hand Therapy in Johnston, Rhode Island. “This can cause increased friction of the bursa during movement, which can then lead to inflammation and swelling of the bursa.”
Weak hip abductors—a.k.a. your gluteus maximus and gluteus medius, which stabilize the pelvis while running—could be to blame, says Bakre, as could stiffness in the lower back (which limits mobility), and overpronation (where your feet collapse inwards and put extra stress on the hips and knees).
Outside of biomechanics, increasing your training load too fast, suddenly changing your footwear, or navigating new or uneven terrain (like downhills or trails) could put abnormal stress on parts of the body, leading to that increased friction.
How to avoid arthritis pain at work
If you’ve ever felt joint stiffness, tight hips, or lower back pain after a long day of work, you’re not alone. Sitting at a desk all day every day isn’t necessarily a good thing for anyone. Even if you don’t have arthritis, sitting too much or too long is thought to be bad for your health. However, there are 54 million adults in the U.S., or 23% of people, who have arthritis, according to the Centers for Disease Control and Prevention. The joint condition can be so painful that about 8 million of those people find that it interferes with their ability to work. In fact, arthritis is the leading cause of work disability.
There are many different types of arthritis, including osteoarthritis, rheumatoid arthritis, gout, and lupus, among others. While the causes and symptoms for each type of arthritis varies, they all can cause stiffness; aching, painful joints; and swelling. If you do have arthritis and find sitting at a desk for long periods of time difficult, here are some expert tips that might help.
What does bursitis feel like?
Pain is the most common symptom of knee bursitis. “Although symptoms can vary, many people complain of sharp or burning pain in the front of their knee with bursitis,” says Schilkowsky.
You might also notice swelling either above or below the kneecap or increased pressure around the knee: “Knee bursitis can also manifest as a visual or palpable lump around the knee,” adds Bruene. “This often feels like a squishy sac that can be tender to touch.”
Things like going down stairs, running downhill, and doing squats can exacerbate these symptoms.
Hip bursitis, on the other hand, “typically manifests as outside or lateral hip pain,” says Bruene. You might even feel it on the front of the hip, depending on which bursa sac is affected. “This pain can be sharp, dull, or burning and sometimes can result in stiffness of the hip,” says Schilkowsky. You might notice it while walking or standing, or when laying on your side and putting direct pressure on the hip, says Bruene. Continuing to run, walking on uneven surfaces, and going up stairs could make the symptoms worsen.
Since residual aches and pains are pretty normal in running—especially after a particularly intense workout session—it’s important to know what feels normal or not for your body. Don’t ignore little niggles; pay attention to to what’s going on and how those sensations are trending, so you can take action earlier rather than later.
How to Prevent and Treat Bursitis
When it comes to common, minor injuries, so much of the time “the best strategy is partial rest,” says Morrow. “Make a small reduction in your training load until the discomfort has subsided and then gradually work back up to your prior training volume. I always say, ‘calm it down, and then build it back up.’”
If you do suspect bursitis in either your knee or your hip, you should head to a pro—like a sports medicine doctor or physical therapist—for a thorough evaluation and treatment recommendations. “The good news is bursitis can be managed with preventative and rehabilitation exercises,” says Schilkowsky. “When bursitis is in its early stages, relative rest through cross-training or decreasing volume of training, as well as icing for 10 to 15 minutes following exercise can help calm the symptoms.”
Otherwise, “one of the most important strategies for prevention and treatment of bursitis would be the implementation of lower-body strength-training into your training,” says Morrow. “This helps increase how much load your body is able to manage, so you’re less likely to notice new aches and pains when you make changes in training.”
It’s important to strengthen your glutes (they power your runs)—but targeting all areas of the legs and hips is key. “Strength training should include quads and calves, particularly single-leg training, such as lunges and single-leg deadlifts,” she adds. “Cross-training with functional stretching activities, such as yoga, can be a helpful tool to prevent bursitis as well,” says Bruene.
As always, increasing your training volume gradually—and prioritizing proper rest and recovery—can help you avoid potential injuries so you keep running strong.
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