Lateral Hip Pain Cause and Treatment
By Eric Finger, PT, OCS, FAAOMPT
If you’re a female over the age of 40 and have lateral hip pain, it can be a real pain in the butt. First, it may start with a mild ache on the bony aspect outside your hip when going down steps. Then, a couple of weeks pass, and then you notice that ache becoming more frequent and limiting you from lying on your side in bed. Finally, you may have talked to a friend or Googled about your pain and determined it may be hip bursitis. If this scenario sounds like you, then definitely read on because the likely culprit of your symptoms could be gluteal tendinopathy.
What is causing my lateral hip pain?
Gluteal tendinopathy, previously known as trochanteric bursitis (inflammation of the fluid-filled sac around your hip joint), is believed to be caused by compression injury of the tendon of the Gluteus medius. The compression is thought to happen from the pressure of the Iliotibial band as the thigh is Adducted or brought across the midline. A good example is a standing posture in the woman below. Notice how her right leg is coming towards the midline, shifting her pelvis and compressing her right outside hip.
(Image credit: Hippainhelp.com/ Alison Grimaldi)
Tendons like to be under tension. They are designed to handle those types of forces all day. Compression, however, is different. Tendons can handle some compression, but it becomes too much when done for too long or in conjunction with tensile forces.
The tendons first response is to create swelling around the affected area, creating a protective “force shield” around the irritated tendon region. The problem is the “protective swelling” causing an increase in tendon size, leading to more compression and usually results in pain if the overload or reduction continues for the long-term degenerative changes to occur.
Tips for avoiding compression and ease your hip pain:
• Eliminate running on the camber of road (a sloped portion of the road near the curb)
• STOP “hanging on your hips” standing posture (see pic above)
• AVOID crossing your legs when sitting
• When lying on your side, place enough pillows to keep your sore hip level and not angled towards your midline.
Common Symptoms and Characteristics of Gluteal Tendinopathy
• Pain to the bony aspect of outside or lateral hip
• Pain when lying on painful and sometimes both hips
• Pain down the outside of the thigh
• Increased pain or stiffness to the hip 24hrs after activity
• Tenderness to touch the outside of the hip
• Pain walking upstairs and up hills
• Female over the age of 40
• Post menopausal women
How do I know my lateral hip pain is caused by the tendon and not from the hip or something else?
The truth is we can’t be 100% confident without imaging. However, your symptoms can give you a lot of information. For instance, an issue with your hip joint or hip cartilage typically refers to pain in the front of the thigh or groin. Another classic hip joint pain is difficulty putting on your socks or shoes in the morning. Another factor to consider is age. A 2012 study by Fearon et al. showed that the average age of gluteal tendinopathy was 53.8 years old and 62 for hip osteoarthritis.
Pain or numbness and tingling that runs down the entire leg is not related to gluteal tendinopathy. Instead, this is likely due to a lower back issue. It should be noted, though, that Gluteal tendinopathy can occur with other regional issues. The most common is lower back pain. A study by Tortaloni et al. (2002) found that 20% of those referred to a spine specialist had gluteal tendinopathy.
Ok, I think I have gluteal tendinopathy! Now what?
The key to eliminating your hip pain is determining what stage your injury is in. For example, if you are in your 30’s and noticed your pain just a week ago after a run, then vs. someone in the ’50s or 60’s who has dealt with their hip pain for five months. This can best be done by visiting a physical therapist.
What is exciting for you, the hip pain sufferer, is that you can get better! Even more exciting is that research has shown that specific exercises targeted to the tendon can be very beneficial.
Steps to treating your lateral hip pain:
- Step 1: Eliminate the aggravating activities
- Avoid crossing your legs
- Use pillows between legs to keep the affected from dropping below parallel
- Avoid “hanging on your hip” postures
- Step 2: Activate the Glute Medius in Side-lying with Pillow Support. Set up and technique is critical with this exercise to reap the full benefit.
- Assume a side-lying position with the sore hip towards the ceiling.
- Bend the bottom knee to ~60*
- Align yourself, so your top shoulder, knee, and hip are all in alignment
- Place 1-2 pillows between your knees, so your top leg is parallel to the bed or ground.
Feel the burn here:
Lift up and slightly backward
Holding: 5-10sec, rest 5 sec
You should perform this exercise 5x/week.
The key to determining if this exercise is appropriate for you is using the “24-hour rule.” If you experience increased pain ( pain 4/10 or higher) with increased stiffness 24hrs your exercise bout, then you likely that exercise bout was too much load for the tendon at this time. Don’t give up, though. Instead, try dialing it back by reducing repetitions or the hold time and reassess how the hip responds the next day.
Lateral hip pain is no fun. It can significantly disrupt one’s active lifestyle. Although the information provided above is helpful, your best bet to eliminate your lateral hip is being evaluated by a physical therapist.
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