LATERAL HIP PAIN
What is lateral hip pain?
Lateral hip pain was previously thought to be caused by inflammation of the bursa, which is a fluid filled sac that provides cushioning and reduces friction between the hip bone and the surrounding muscles and tissue. The term for this condition is Trochanteric Bursitis.
However research has now shown that 90% of cases of lateral hip pain are not in fact Bursitis. The cause of the problem has now been linked to irritation, degeneration or tearing of the hip muscle tendons where they attach to the hip bone. The muscles that are most commonly affected are gluteus medius and gluteus minimus, which act as important stabilisers of the hip joint. This condition is called Gluteal Tendinopathy.
When the tendons are exposed to excessive load, particularly compression, they begin to break down, leading to pain.
Is it arthritis of the hip?
It is important to note that this is different to hip osteoarthritis. Arthritis of the hip is generally felt at the front of the hip in the groin, and can also radiate down to the knee but is rarely felt on the outside of the hip.
Who gets lateral hip pain?
It can occur in young athletes, especially runners as an acute tear to the lateral muscles.
Poor biomechanics with running often contributes to this. For example: knees crossing the midline when running, leg length difference, hip muscle weakness. Training errors such as running on the camber of a road, or always in the same direction around a track can also predispose athletes to this condition.
Lateral hip pain is also common in people over the age of 40, and is more common in women in the perimenopausal age group. This is a more degenerative problem where the muscles and tendons weaken and may tear. It can be caused by biomechanical imbalances, leg length issues or sport.
Common symptoms of lateral hip pain
- Pain on the outside of the hip
- Pain when lying on the affected side and can even be sore with sidelying on the good side if the sore leg is stretched right across the body and the muscle is put on stretch.
- Pain and fatigue with prolonged walking
- Pain getting out of the car on the affected side
- Pain walking up hills and climbing stairs
- Pain with sitting in a low chair or lounge or carseat
- Pain with sitting crosslegged
What is the best treatment?
Traditionally first line of treatment focused on stretching, however it has been found that this may actually increase the amount of compression on the tendon and therefore irritate it further. Therefore our approach to management of lateral hip pain now has a very large emphasis on strengthening.
Recruiting the deep gluteal muscles is essential in learning to move correctly and is effective in improving pain. It is important to address and correct poor movement patterns, and any underlying muscle weaknesses. Tendons require appropriate gradual loading to become stronger and more resilient.
Examples of exercises:
How about corticosteroid injections?
Corticosteroid injections have traditionally been used as the go-to treatment for gluteal tendinopathy. When injected, corticosteroids aim to reduce inflammation in the nearby area. This can help relieve pain. They have been found to be beneficial in the short term, however their effect on long term outcomes have been shown to be less promising.
A study in 2018 (Mellor et al.) compared the effects of exercise and corticosteroid injection use on pain and overall improvement in individuals with gluteal tendinopathy. There were three different groups: a physiotherapy led education and exercise programme of 14 sessions over eight weights; one corticosteroid injection; and a wait and see approach. They found that the education plus exercise group performed better than the corticosteroid injection group at 8 weeks. At 52 weeks, education plus exercise also lead to better global improvement in terms of function. These results therefore support the use of exercise as an effective management approach for lateral hip pain.
Quick tips to help relieve pain
- Use a heat pack for 20 minutes before bed
- Avoid sitting with your legs crossed to reduce the compression on the tendon
- Avoid stretching the hip muscles too vigorously
- Sleep on your back with a pillow under your knees, if this is too uncomfortable then sleep on your unaffected side with a pillow between your knees
- Use a tennis ball to massage through the gluteal muscles to help reduce the tightness
- Seek guidance from a physiotherapist who will prescribe you with a specific exercise program tailored to your needs to gradually increase strength and endurance of the hip muscles
- A physiotherapist can also assess and correct any poor movement patterns that may be contributing to your pain
If you would like more information or help with lateral hip pain please call us on 98753760 or email on firstname.lastname@example.org. We would love to help.