I also think the diagnosis of throcanteric "bursitis" should better be left out from the "physio-dictionary".

The main reason being that you would think you treated an inflamed bursa, something I believe would be difficult to prove and treat clinically. I find no trouble in adopting to the term "greater trochanteric pain syndrome" as the greater trochanter serves as attachment of five muscles (gluteus medius/minimus, piriformis, obturator externus/internus) and is closely surrounded by 3 bursas, the subgluteus maximus bursa, the subgluteus medius bursa and the gluteus minimus bursa. Considering that the subgluteus maximus bursa is subdivided into at least 4 smaller bursas and together with the subdivisions of the subgluteal and gluteus minimus bursa, you'd have a minimum of 9 or 10 bursas all together. On top of that, taking into account the individual anatomical differences AND that there is no bursa that is really anatomically named the trochanteric bursa, well............ Making a differential diagnosis between the 5 muscles and the 10 bursas would also make up a good challenge, considering that passive/active movements could both stretch myofascial structures and/or compress the bursas.

I think it's a bit dangerous to "conclude" that the diagnosis was accurate, based on improvement to the specific treatment given, as someone suggested earlier (but he was probably just playing devils advocate ). It could be several reasons for that improvement (placebo, regression to the mean, natural history of condition, etc, etc) and I personally try to challenge myself always suggesting the opposite, to never believe that the patient is improving due to anything I do. I find this keeps me on my toes, as I then always have to clinically prove to myself (and the patient), that what I did/said, really had a positive influence on the impairment.

I also honestly believe, that the management of this/these condition(s) would be exactly the same, pain being caused either from structural myofascial/bursa or due to central modulatory issues, appreciating the fact that there is never either the one or the other alone. Obviously, the stage of the condition (acute, subacute, chronic) would dictate the progression (how much time spent on each intervention, manual work vs. exercise) throughout management, thinking of the possibility of gluteal tears as mentioned in previous posts. I'd focus on a functional approach, starting with nailing down exactly where in the step the patient gets the pain. I'd then analyze what component in that position could be contributing to the gaitdysfunction (pain, stiffness, weakness) and then manage the main component (painmodulation, stretching, strengthening) alongside a gradual exposure approach in terms of functional motor control exercises (taking feedforward-mechanisms, neuroplasticity, movementspecificity into account).

And I would also ALWAYS check the lumbar spine (and hip joint) thoroughly, also as mentioned in previous posts, as possibly a primary source of pain (somatic referral from segmental structures or neurogenic interface) or as a contributing/maintaining/predisposing factor feeding into the hip pain. I guess this is where the real discussion started . I assume it is clinical experience/observation talking when the L4 is mentioned so specifically? Personally I haven't found one of the lower lumbar segmental levels to be dominant in hip pains, as the hip could in reality be the endpoint of both sensation/motor innervation from almost any structure of the lumbar spine...?

Referring back to katiemac70 initial post, I'd think that walking on even ground and rough terrain would be two quite different motor tasks (also possibly requiring different brain "maps" in the motor cortex) and would use the same approach as mentioned above, but considering that this is a whole new setting (rough terrain). I'm tempted to think that if the patient is able to walk perfectly on even ground, that there is no longer any issues about local hip pathology (or never were), and focus even more on the functional task-specific movement components required for walking on rough terrain. Identifying where in the movement (dominantly while stepping up or stepping down from a height vs. timefactor) would probably be a good place to start.