Trochanteric (Hip) Bursitis, my Impex Seat, and Necky relief

[subaruguru]

By mid-May I was barely able to sleep on my right side due to pressure-point hip pain.

My GP and even a radiologist chalked it up to degenerative arthritis, but an ortho fortunately disagreed, confirming "hip" bursitis, referring me to 6 weeks of PT.

Google results indicated that 80% of the afflicted are women, prompting a suggestion by a Manhattan ortho in the mid-90s that the cause was the repetitive bouncing of large shoulderbags! When not caused by blunt trauma, the afflicted seem to be only runners and bicyclists from wear and tear.

PT massages showed me that this bursa is a couple inches BELOW the hip bone, cushioning theanchor-point of the very large trochantera (sp?) muscle. When inflamed, pain appears mostly at the bursa, radiating somewhat down the muscle at the front upper thigh.

Gee, I had already removed and splayed my Impex Force5's rigid, narrow glass seat a full inch at the attachment points (from a measly 15" intersidewall width to 16"), but it slowly dawned on me that the forward edges of these sidewalls, which can only be budged about 1/4" before cracking the gelcoat, were providing significant... although no longer obviously painful... side pressure a few inches forward of the hip joint...right at the trochanteric bursa!

I remained doubtful of possible causation, as there was nothing in the literature, and finally found full relief after 8 or so ultrasound massages. My daughter's intervening wedding kept me off the water coincidentally. But then when kayaking in my Impex again it became clear after about an hour that the same pain was reappearing.

So I again removed the Impex seat and brought it to my last PT session for a show 'n tell.

Not being able to find a loose new P&H seat to try to retrofit, I grabbed the $40 Necky Chatham high density foam seat now offered. Although I quibble a bit about how its molded shape's underside velcro anchor strips hit right on one's sitbones...suggesting shaving them off and thereby dropping the seat another 1/4"...it's quite clear that removing any sidewall pressures is a huge improvement for me.

Removal of pain is sufficient motivation, but the resultant ease in edging from being able to finally "drop a butt" is VERY gratifying. Suddenly the Force5 gets up on edge much more linearly, and thus carves a turn without as much need for a sweep. I suppose I might add a bit of hip side foam if learning to roll requires more side anchoring, but for now I relish the new-found freedom. Makes rotation for forward strokes easier, too.

I've listened to a couple of dealers complain about how Impex simply doesn't respond to repeated complaints about their narrow hard seats, and given the significant cost of hand-laying them, I'm a bit surpised they haven't simply gone to a hard plastic (like P&H) or foam (like Necky) one. (Impex's reshaping of the lower back corner last year only addressed one area of complaint, and they remain reluctant to further modification.)

Given the normally wider pelvic floor of most women, the fact that 80% of trochanteric bursitis victima are women, and that kayaing favors lower gravity centers, I'm a bit surprised to not find other references.

I'm not ready to suggest that the Necky cheapie is a panacea...at least until I soften its mounting "pedestals", but it has transformed this Force5 to being more nimble and friendlier as it approaches edge limit, and of course without affecting its great tracking and lack of weather cocking....and allows me to sleep facing my wife!

Hope this helps. Ern

[EEL]

This is a very individualized issue. The other side of the coin is that others find the Impex seat very comfortable. Just as many find NDK and Valley seats very uncomfortable and pain producing while others find them fine. Fortunately, it is usually easy to change seats to get the fit and shape needed if the stock seat does not work well.

Ed Lawson

[bob budd]

The stock seat in my new Force 4 is the first stock seat I have not removed and replaced with closed cell foam, etc. Other seats have left me in pain and/or numb in the legs. Glad you found a solution.

[Pintail]

"...the Necky cheapie..."? It would have been cheaper still, had you made your own foam seat, Ernie! As for sleeping, facing your wife: what about simply changing sides of the bed -- or is that too tough a habit to kick? ;^)

[djlewis]

Hi, Ernie:

Glad to hear that you've found a way to relieve the pain and make it possible to edge.

The lesson I draw from this as an instructor is to ask someone who is having trouble with basic maneuvers (like edging, but also many others) if they are getting any pain or serious discomfort from trying. If so, then they are either doing them wrong, have equipment fit problems, have a personal injury or physical limitation coming into play, or some combination.

Nothing in everyday kayaking should hurt, and there are only a few places where there might be even some discomfort until you get accustomed to it (like really winding up the hips to the max for a model forward stroke).

Now, I heard that Greg Barton told someone after the Blackburn that he is essentially in constant pain during a race, but he's (obviously) learned to expect, accept and cope with it. That's different!

--David.

[Brian Nystrom]

...but fortunately, it was only once each. Same thing with both elbows. Perhaps it just age related, since I never had it when I was younger. It seems to be triggered by single stress events that sometimes don't seem particularly significant at the time, but the inflamation builds over the next few days to a week and eventually becomes intolerable.

What I've found works best is an anti-inflammatory like Naproxen, which is also the active ingredient in Aleve (2 Aleve is almost the same as one 500mg Naproxen). It knocks the inflammation down VERY quickly, providing substantial relief within an hour or so and dramatic relief within a day or less. I usually only have to take it for 2-3 days and I'm back to normal in 4-5 days, without recurrences or need for further treatment of any kind. It seems like all that's necessary (for me at least) is to knock the inflammation down to allow my body to heal itself faster.

Although I did go to a doctor the first time it happened, I haven't needed to since then, as I now recognize the symptoms and treat it before it becomes problematic. I never did any PT for it and frankly, I can't think of any good reason to do so, since in my case it's an acute - not chronic - problem. If you have chronic condition, that's another story.

BTW, I'm not a medical professional, nor do I play one on TV; I'm just an achy old fart. ;-)

[subaruguru]

Hi Brian,

I've been on 1/2 g naproxen sodium (version of naprosyn that's better for inflammation rather than as an analgesic) for years as prophylaxis for my psoriatic arthritis (mostly affects my iris, but occasionally joints), so had bumped up to 1g/day for the past month, with little effect on the bursitis. Really did require ultrasonic massages with 2.5% corticosteroids, but fortunately no direct injections.

I SWEAR the secondary on the Force is simply much farther, and I can hang statically on edge without high knee-thigh pressure. So now to learn to scull and roll. Yippee!

Ern

[eneumeier]

Been there. Done that. I had it bad in both hips, likely related to my then spinning addiction and learning to down hill ski which resulted in many falls on hips landing in New England's soft powder - NOT. With the pain but no diagnosis I set off on a week long kayak trip in Glacier Bay, AK, where my thermarest went bad and I ran out of Ibuprophen. Could not sleep. Things got worse, but that is another tale.

Once diagnosed I did all that you are doing and a few more things. Contact me off line and we can chat. Most important, long term, is to make sure the fascia on the outside of my thighs does not tighten. Sitting on the floor a lot, cross legged, does the trick.

The first thing I do with a new kayak is remove the seat and make a foam one.

Liz N.

[djlewis]

>...Most important,

>long term, is to make sure the fascia on the outside of my

>thighs does not tighten. Sitting on the floor a lot, cross

>legged, does the trick.

Is the standing, one leg over another stretch of the outer hip tendons (fascia) a good exercise for this? I think I showed it to Ernie once. A heaven-sent PT showed me when I was on the verge of a permanent limp, about 10 years ago, and it's been the main thing keeping my hips relatively healthy all these years. (I can't find a picture online.)

--David.

[eneumeier]

>...Most important,

>long term, is to make sure the fascia on the outside of my

>thighs does not tighten. Sitting on the floor a lot, cross

>legged, does the trick.

Is the standing, one leg over another stretch of the outer hip tendons (fascia) a good exercise for this? I think I showed it to Ernie once. A heaven-sent PT showed me when I was on the verge of a permanent limp, about 10 years ago, and it's been the main thing keeping my hips relatively healthy all these years. (I can't find a picture online.)

--David.

Sure, that would help. But reading the newspaper while sitting on the floor is a longer, slower stretch. :-))

[djlewis]

Sure, that would help. But reading the newspaper while sitting on the floor is a longer, slower stretch. :-))

The exercise I have in mind -- and do every day -- stretches things quite differently than sitting cross-legged on the floor. (I just tried both). It's hard to explain and I cannot find a picture online, probably because I don't know what it's called. But it really stretches the bands on the outsides of the hips.

Lemme try. Stand with your feet a few inches apart. Put your left foot on the ground to the right of your right foot at least an couple inches away (if you can; anywhere to the right will do to start). Lean to the left and stretch your right hip, especially at the lump on the outer side of the right leg, right where the leg enters the hip. Hold it. The point is to stretch the band that goes over that hump, so when you lean, feel that. Repeat at least twice on each side.

Do this daily, with the left foot farther and farther to the right of the right foot every day (and vv on the other side). I can now get it 14-15 inches away, but when I started I could barely even get the left foot over the right foot and down on the ground.

This -- and one other exercise -- have saved me from a lifetime limp or worse. Bless that PT!

--David.

[Phil Allen]

The exercise I have in mind -- and do every day -- stretches things quite differently than sitting cross-legged on the floor. (I just tried both). It's hard to explain and I cannot find a picture online, probably because I don't know what it's called. But it really stretches the bands on the outsides of the hips.

Lemme try. Stand with your feet a few inches apart. Put your left foot on the ground to the right of your right foot at least an couple inches away (if you can; anywhere to the right will do to start). Lean to the left and stretch your right hip, especially at the lump on the outer side of the right leg, right where the leg enters the hip. Hold it. The point is to stretch the band that goes over that hump, so when you lean, feel that. Repeat at least twice on each side.

Do this daily, with the left foot farther and farther to the right of the right foot every day (and vv on the other side). I can now get it 14-15 inches away, but when I started I could barely even get the left foot over the right foot and down on the ground.

This -- and one other exercise -- have saved me from a lifetime limp or worse. Bless that PT!

--David.

Dont have a name for your stretch David, but the stretchs the IT band (illiotibial band), which runs from the hips down to the outside of the knee. Over tight IT bands can lead to poor tracking of the knee which can lead to osteoarthritis in the joint. The Anderson stretching book describes stretch for that region but there all based on lying down (not a bad thing). As for your stretch (which I also do), its good to have a wall or door in the diretion your leaning in case you loose your balance.

Phil

[djlewis]

Put your left foot on the ground to the right of your right foot at least an couple inches away (if you can; anywhere to the right will do to start).

Clarification -- cross your left leg in front of your right leg and put your left foot on the ground to the right of your right foot.

[djlewis]

Dont have a name for your stretch David, but the stretchs the IT band (illiotibial band), which runs from the hips down to the outside of the knee. ... As for your stretch (which I also do), its good to have a wall or door in the diretion your leaning in case you loose your balance.

Right, that's it -- the illiotibial band! And yes, having a wall to stop your lean is good. I often do it on the treadmill just after my session, using the railing. But after years at it, I'm also pretty good at balancing if I have to.

The doctor did not know why my bands got tight, but my hypothesis is actually too much sitting cross-legged with my knees pressed toward the ground. Unfortunately, that contradicts Liz's idea about cross-legged being curative. But maybe she has a different problem.

And that reminds me -- before doing any of these, one really should get: (1) a diagnosis from an orthopedist; (2) instructions for specific stretches and exercises, either from the orthopedist or from a good PT who has the diagnosis in hand. Doing the wrong exercise for what ails you can make it worse -- I've been there too!

--David.