Lateral Hip Pain
Pain at the side of the hip is a painful, frustrating and often debilitating condition. Many people have had the pain for years but have had no success with treatment. Others brush it off as the onset of arthritis and old age and put up with the pain. It can affect athletes, office workers and retirees alike. Luckily, over recent years research has shed more light on the condition and now there are evidence based ways to manage it.
Previously called Trochanteric Bursitis the condition was thought to be caused by inflammation of the bursa, or fluid filled sac, over the greater trochanter, which is a bony prominence on the side of the thigh bone (femur). Treatments were aimed at reducing inflammation and included icing, anti-inflammatories and stretching the iliotibial band overlying the bursa, in an attempt to take pressure off the bursa. Patients would then be offered a cortisone injection if they failed to improve. These injections would occasionally work but the effects would be short lived, or for others the injections wouldn’t work at all.
We now know that in 90% of cases of lateral hip pain that the bursa is not the cause of the pain. It is in fact the gluteus medius or gluteus minimus tendons which are the cause of the problem and the condition is called Gluteal Tendinopathy. The gluteus medius and gluteus minimus are important hip stabilising muscles. They are attached to the femur or thigh bone by tendons. When these tendons are exposed to excessive load (amount of work), usually compression, the tendon begins to breakdown and become disorganised. This leads to pain. If the excessive load continues microtears develop in the tendon which can progress to partial and then to full tears.
Causes of Gluteal Tendinopathy
The excessive compressive load is caused by poor postural and movement habits. This includes:
- standing with most weight on one leg (“hanging on one hip”);
- sitting with the legs crossed; or
- walking, squatting, stair climbing or running with excessive hip adduction and pelvic drop.
Over time, this leads to a loss of strength and control at the hip and pelvis. Gluteal tendinopathy affects 25% of women and 10% of men over the age of 50. It is affected by hormone levels and one of the most commonly affected groups is the peri-menopausal and post-menopausal women. There is a link with increases in abdominal fat which often occurs at this age for women, and also with sudden increases in exercise as they commence exercise in an attempt to reduce their weight and to tone up. It can also occur in active fit runners or people doing step aerobics who lack sufficient strength and control around the hip.
Symptoms of Gluteal Tendinopathy
- pain over the greater trochanter;
- lateral thigh pain and upper lateral shin pain, some groin and buttock pain;
- painful sleeping on the affected hip, but also pain with the affected leg on top;
- it may be painful walking up hills, climbing stairs and running;
- if it is severe, it may be painful to stand on one leg to dress, to walk on the flat, for the first few steps after sitting and even be painful during sitting.
There are 2 essential steps to managing tendinopathy:
1. Reduce excessive load (compression) on the tendons
- Standing evenly, not hanging in hip adduction;
- Sitting without crossing the legs, or sitting with knees together and feet apart;
- Avoiding sitting on seats which are too low, or using a wedge cushion
- At night using an eggshell mattress overlay, as firm mattresses can add to compression – this is more effective than a pillow top
- Using a large pillow to allow the affected top leg to rest horizontally and not drop down into adduction
- Modify load – such as reducing or avoiding hills, not overstriding
- It is important to continue to exercise if able, unless severe symptoms when a short break from exercise may be necessary.
- Learning how to monitor load looking at pain levels and night pain
2. Increase the tendons capacity for load to allow the person to return to all of their previously painful activities
- Exercise – using real time ultrasound to learn how to recruit the deep gluteal muscles, which is essential in learning to move correctly and is also effective in improving pain. The exercises are started in lying and progressed to standing to improve postural control, movement patterns and strength in standing, sit to stand, single leg stand, squats, climbing steps and running.
- Poor movement patterns and habits are assessed and corrected, and weaknesses which can include other areas of the body such as abdominals, gluteus maximus and quadriceps, are strengthened.
- Clinical pilates is a very effective way to progress your rehabilitation program allowing you to complete supervised exercise and to improve whole body control and strength.
- Avoiding flexion adduction stretches of the gluteal muscles, avoiding ITB stretches and avoiding clam exercises all of which increase compression!
Your physiotherapist at Midland Physiotherapy is skilled in managing tendinopathy and will work with you to achieve great results. It is important to note that correcting tendinopathy will take many months. Your Physio will work with you to design a comprehensive management and rehabilitation plan to get you back to doing the activities that you love.
If you or any of your friends or loved ones are suffering from lateral hip pain please contact Midland Physiotherapy for an appointment on 9274 1482 or via Health Engine.
References: Dr Alison Grimaldi – dralisongrimaldi.com
Susan worked for 4 years in public hospitals in musculoskeletal outpatients and orthopaedic wards, before moving to private practice in 2008. Susan has a broad range of experience treating musculoskeletal and sporting conditions. She is passionate about helping her clients to find long term solutions to pain and injury using the latest evidence-based treatment and exercise techniques. Her treatments combine manual therapy, soft tissue work, acupuncture, and individualised exercise programs including clinical pilates.
Outside of work, Susan is a busy mum of 3 beautiful children. She loves the outdoors, keeping fit and coffee catch ups!
- Managing low back, pelvic and hip pain
- Managing neck and shoulder pain