Distinguishing Greater Trochanteric Bursitis vs Other Muscle Damage

[Wcentauri]

Hi Everyone,

I have developed irritation in my outer left thigh as a consequence of squatting in the last month. There were two acute events (on 5/29 and 6/5) in which I felt a "movement" (but heard no sound) in the upper outer thigh, on the ascent, during the fifth rep of sub-maximal back off sets.

Following each event, the left leg (particularly the outer thigh) was very tight and exhibited pain when bearing weight and moving up/down stairs. Each time, the tightness was improved over a few days with stretches for "IT band syndrome", lacrosse ball rolling / PVC on the IT band, and ice. There was never a bruise in the upper/middle thigh where I felt the "movement".

The second acute "event" felt more extreme, and the ensuing symptoms were worse (especially in the middle and lower of the outer thigh). My chiropractor thinks it is a bad case of greater trochanteric bursitis. An MD with sports medicine specialization later inspected me and concluded "irritation in the trochanteric; probably tendon related". Both indicated I did not severely injure anything. I'm not sure anything they told me explains the "movement".

An IT band release on 6/11 relieved much of the remaining pain in the IT band. The massage therapist suggested the issue was with the muscles. The following day, the outer left quad still felt slightly sore during stairs and body weight squats.

Fearing muscle damage, I started high volume squats for three ascending sets of 25. The first several sessions were initially uncomfortable, but the discomfort always improved by the end of each session. I think the light squats have been a significant net positive (they have not been a source of re-injury or increased irritation in the greater trochanter). Today was the eighth session and I did 105/115/125 for 25 each; there was no pain in the leg on any of the sets.

In addition to the daily squats, I am making heavy use of the lacrosse ball and PVC pipe, doing various stretches for the TFL and "IT band syndrome", exercises for the gluteus medius, and other mobility work (such as the "couch stretch").

I would appreciate any input on the following questions or anything else I have written:

1. Do any of these details make bursitis vs some other injury the more likely underlying cause?
2. Should I be doing anything differently in terms of rehab work?
3. At what pace should I continue adding weight back to the Squat?

Appendix (timeline around the two injuries and a video of the set when injury first happened):

• On 5/25, I did one set of 350x5 followed by three sets at 10% reduction. After the third set, I recall being slightly sore on the outer left leg below the hip. On the following light (20% reduction) day, I experienced noticeable pain in the left leg (outer thigh and upper calf).
• [First injury] On the medium day (10% reduction), there was no pain on the first set. However, on the rep five I felt "a movement" on the outer thigh that could be described as an inaudible "snap". There was no immediate pain that prevented me from re-racking the bar. I waited about 15 minutes and tried the same weight again for one rep. The left left was stiff and there was pain all along the outer thigh and calf; I probably did not reach full depth.
• Here is a video of that first set (youtube). The angle is not ideal for a form check, but perhaps it is useful in some way. I think there is some minor twisting to my left that might be putting extra strain on the left leg (especially on the fifth rep).
• One 6/1, I aggressively rolled the IT band and managed to squat 275x5x3. On 6/3, I did 285x5x3, experiencing pain in the outer left calf during the warmups and first two sets.
• [Second injury] On 6/5, there was no pain during warmups. After the first set of 320, the outer upper thigh and the outer calf was sore. The re-injury happened during rep 5 of the second set (no video).

Thanks for reading!

[Mark Rippetoe]

The first thing you should do is top bruising the lateral thigh with your lacrosse ball and PVC pipe. Maybe just let it heal while you train through it. And it might be time to get another IT band release.