EMI.AI

Hip Bursitis / sciatic nerve

November December January journey

1) Sciatica (lumbar radiculopathy) — what it is

  • Meaning:
  • Pain/tingling/numbness running from low back →
  • buttock → down the leg because a lumbar nerve root
  • (often S1 at L5/S1) is irritated or compressed.
  • Cleveland Clinic+1
  • Why it happens in my case:
  • Your MRI/CT show an L5/S1 posterior disc bulge on the left that abuts the left S1 nerve root;
  • MRI also shows a left annular tear
  • (tiny split in the disc’s outer ring).
  • Why it can feel “out of proportion”:
  • Besides mechanical contact,
  • leaked disc material from an annular tear can inflame the nerve root (chemical radiculitis),
  • amplifying pain/itch/tingle even without tight narrowing. AJNR

Typical course & outlook

  • Many people improve within weeks to a few months;
  • about half recover by ~6 weeks with conservative care. Persistent symptoms beyond 12 weeks are “chronic.” NICE

2) Hip bursitis / Greater Trochanteric Pain Syndrome (GTPS) — what it is

  • Meaning: Pain on the outer hip/lateral thigh from irritation of the trochanteric bursa and often the gluteal tendons (GTPS is the modern umbrella term). OrthoInfoNHS inform
  • Typical features: Pain lying on the affected side, with walking or stairs; local tenderness over the bony point (greater trochanter). nhs.uk
  • Prognosis: Usually self-limiting; >90% improve with rest, physio, and (if needed) steroid injection. Many see progress in weeks, with most improving by 3–6 months if loads are managed. NICEGeorge Eliot Hospital

3) How these two problems link

(why I can have both)

  • Radiculopathy → altered gait/posture.
  • When the S1 nerve is angry, you unconsciously offload that leg, changing hip mechanics.
  • That extra side load/limp compresses the outer-hip tissues, provoking GTPS.
  • (Clinical reasoning consistent with GTPS being irritation of bursa/tendons on the outside of the hip. NHS inform)
  • GTPS can also mimic or aggravate sciatica.
  • Outer-hip pain can radiate down the thigh,
  • making leg symptoms feel worse alongside
  • true S1 nerve pain. Patient

4) Reasons you feel pain the way you do

  • From the disc/nerve (S1):
  • Mechanical touch + inflammatory chemicals
  • from the annular tear irritate the nerve →
  • burning/itching, pins & needles, calf/foot symptoms
  • (S1 dermatome). AJNR
  • From the hip (GTPS):
  • Compression of the outer hip tissues
  • (lying on that side, crossing legs, standing “hip-dropped”),
  • plus, weak or fatigued gluteus medius/minimus tendons,
  • keeps the bursa/tendon inflamed. royalberkshire.nhs.uk

5) Treatment plan (practical & phased)

A) Calm the nerve root (sciatica)

  • Activity: Keep moving, but avoid twisting/side-bending under load; use neutral-spine, front-facing lifts only.
  • Medication: Short course NSAIDs/paracetamol if tolerated; consider neuropathic agents if nerve pain dominates (via GP).
  • Physio: Nerve-glide (“sliders”), core control, hip hinge patterns, graded walking/cycling; progress by next-day symptom rule (≤3/10).
  • Escalation if severe/persistent: Image-guided epidural steroid injection can offer short-term relief for radicular pain; surgery (e.g., microdiscectomy) only if red flags or failure of conservative care. NICE

B) Settle the outer hip (GTPS)

  • Unload compression: Don’t lie on the sore side; if on the opposite side, put a pillow between knees; avoid prolonged side-leaning/cross-leg sitting. elht.nhs.uk
  • Targeted strength (2–3×/week): Isometrics → side-lying abduction → standing hip hitch/hip hike → banded side-steps/monster walks; add hip external rotation (clamshell variants) as tolerated. royalberkshire.nhs.uk
  • Flexibility: Gentle ITB/piriformis mobility (no aggressive stretching if it reproduces outer-hip pain).
  • Adjuncts: Short course NSAIDs, shockwave or corticosteroid injection if rehab stalls. royalberkshire.nhs.uk

6) Expected healing timelines (realistic)

  • Sciatica (disc-related): Many improve within 6–12 weeks; some need 3–6 months. Discs can shrink/resorb over time, which often tracks with symptom improvement. NICEBioMed Central
  • GTPS (bursitis/tendon): Often settles in weeks to a few months with load management and rehab; most see major gains by 3–6 months. NICEGeorge Eliot Hospital

(You’re ~12 months in, so progress is still possible, but pacing and consistency matter. Expect a gradual curve, not overnight fixes.)

7) Can it cause permanent nerve damage?

  • Usually no. Most people fully recover from sciatica without permanent deficits. Rarely, severe/prolonged compression can lead to lasting weakness/numbness (e.g., foot drop). Seek urgent care for red flags: new/worsening leg weakness, numbness in the saddle area, or bladder/bowel changes. Cleveland ClinicNICE

Your day-to-day “do this, avoid that”

  • Do: Walk daily, gentle cycling/pool; neutral-spine lifting; symmetrical carries; strengthen glute med/min; limit loads (≤10 kg while reactive).
  • Avoid (for now): Side-bending with weight, twisting under load, deep lumbar extension, sleeping on the sore hip, long static sitting.