Lateral hip pain has been given many names, both in the literature and by health professionals. You may have heard terms like "bursitis", "trochanteric bursitis", "tendinopathy", "arthritis" or even "greater trochanteric pain syndrome" used to describe your symptoms. These terms are often used interchangeably which can mean understanding your condition is difficult and can lead to a lot of confusion and worry about what is actually going on
Lateral hip pain refers to pain that centres over the outside of your hip, or over the "greater trochanter" - an important anatomical structure that acts as a major tendon attachment site, and many soft tissue structures, such as the bursa, surround it. A bursa is a fluid filled sac which acts as a shock absorber, but can commonly become irritated.
This often severe and disabling condition is surprisingly common - experienced by 1 in 4 women over the age of 50. Men can develop symptoms too, but are at much lower risk. It causes difficulty with mobility, physical activity, sustained periods of sitting and sleep so can have a huge impact on the quality of life for the people it affects.
Another unfortunate statistic is the long period of time that symptoms grumble on for, with over 60% of people diagnosed with this issue experiencing pain for over 12 months. The onset of symptoms is generally "insidious" - that is, starts with no particular trigger at all. Others can put it down to a change in lifestyle or activity levels. Recent evidence tells us that there is likely to be a link with "hormonal status", so whether you are pre, peri or post-menopausal can have a significant impact on your risk of developing symptoms, and also how long it takes for them to improve. Post-menopausal women account for roughly 45% of lateral hip pain sufferers.
What is really going on, and what can you do about it?
The good news is, help is out there! The bad news is, there can be a lot of information around that is misleading. This mostly comes from a poor understanding of the condition itself among health professionals - the poor old bursa has gets a lot of the blame. Historically, treatments that focus solely on relief of "bursa pain" i.e. steroid injections, ultrasound therapy, even surgical removal are very unlikely to be effective, as the underlying cause of why the bursa is inflamed has not been addressed.
What is causing the pain?
The truth is, we can't apportion all blame to a single structure as this particular area is a lot more complex. The current understanding of what causes symptoms from the lateral hip is actually the gluteal tendon, and so the proper term for this type of pain is "gluteal tendinopathy".
The "glutes" are a very large, very robust group of muscles that act around your hip. The gluteal tendon attaches the muscle belly onto the bone (a bony part of the femur called the "greater trochanter"). If you try and find this bony point on yourself by pushing onto the outside of the hip, it is likely it will feel sore - even if you've never had a problem there (try the non-painful hip to see what I mean!). It is a highly sensitive area with a lot of soft tissue attachments, and also houses the infamous bursa.
The most robust evidence we have on gluteal tendinopathy theorises that this is largely a compressive problem - that is to say, the tendon is no longer tolerating the amount of compressive load that it once happily did. Because the bursa's job is to cushion the space between the tendon and the bone, it will often become inflamed & sore, because the more significant structure on top of it has often become weak, inflamed & sore!
How can I start reducing the pain?
Movements that compress the tendon have to be avoided, or at very least minimised. The main movement to limit is hip adduction (moving the leg inwards), especially for a sustained period!
- Sitting with legs crossed (even at the ankle!)
- Lying on the painful side where possible - if you HAVE to lie on this side, try an extra duvet or mattress topper underneath so at least there is some extra cushioning, but move off it regularly
- Lying on the OTHER side with the painful leg flexed and across midline - if this is how you sleep, it is very important there is a pillow underneath the knee to minimise hip adduction
- Standing with all the weight on the painful side (you may do this without realising it- for example when you're waiting in a queue)
- Sitting for long periods
- Overdoing painful activities - it is easy to "push through the pain" in the hope that you will still be able to do the things you love but this will not be useful in the long term
If you can only walk 5 minutes without significant pain, only walk 5 minutes. You will need to plan where you park, where you rest, how long you will need to rest for before you can comfortably walk another 5 minutes. This concept is called pacing and in theory is very simple but is very difficult to properly implement as our busy lives get in the way.
Following this advice as closely as you can to try and reduce and control the pain is the most important first step. However, the only way to achieve permanent change is to get the tendon structure itself to adapt so that you are addressing the underlying cause of the problem. Adaption only occurs through sufficient challenge to the tissue, over a sufficient period of time. In this case, we must allow at least 12 weeks of progressive rehab (including strengthening exercises), which can be provided by a Chartered Physiotherapist.
Luckily, the soft tissues in our body are wonderfully adaptable; if the right balance is struck between sufficient challenge without significant increase in symptoms, things will keep improving.
There is a huge body of emerging evidence about what treatments REALLY work and you CAN get back in control of your life, you just need to have the right knowledge, therapist and commitment to rehab.
If you need more advice or would like to book an initial assessment please contact us at firstname.lastname@example.org or phone 01788331570.
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