Lateral Hip Pain
Do you have hip pain over the outside of your hip? Does this disrupt your sleep if you lie on it at night? How to differentiate between Gluteal tendinopathy and Hip bursitis and what to do about it…..
The hip is an incredibly complex joint with numerous structures with different responsibilities. In this article I’m going to dissect the lateral (outer) part of the hip. Take a look at the image below and notice how closely and compacted the structures lay beside each other. Several hip muscles have a common attachment to the outside of the hip – a bony prominence called the Greater Trochanter. These muscles include the Glute Medius, The Glute Minimus and Piriformis being the most famous! What about the bursae? A fluid-filled sack providing a friction free surface and a padding between anatomical structures. On the outside aspect of the hip there are 3. A bursitis can be very tender if irritated or inflamed.
Labelled ‘C’ below is the Greater trochanteric bursa being the most common site of pain on the outside of the hip.
(Reid, 2016)
Causes of the Greater Trochanteric bursae pain?
- The most common of causes is an overuse injury, a tendon of one of the muscles mentioned or in the diagram above can cause a compressive pressure on the bursae especially if there is a lack of support of the musculature, a weakness or tightness in your hips, pelvis or trunk musculature. Overstretching through the common ‘Pigeon’ stretch, sitting cross legged or standing on a slant can all compress the bursae.
- Trauma is another cause of injury, perhaps a heavy landing or a fall onto the side of your hip might have left you bruised. This could also cause a disruption in the gluteus medius tendon and or the bursae causing irritability and inflammation.
Risk factors
- Woman increased risk than men due to the morphology of the female pelvis
- > 40 years old
- High BMI – increased waist hip and thigh girth
- Low back pain
- Gluteal weakness or Pelvic weakness
- Previous lower limb injury ie the knee.
That’s my injury – HELP!
- Modify your sleep position. Do not sleep on your painful side (I know this sounds obvious!) Pressure increases pain levels. Use pillows between your knees for a better alignment
- Physiotherapy – soft tissue therapy intervention to reduce tight musculature, notice the tensor fascia latae (TFL) which sits above the muscle tendons. Release work of the TFL can assist to offload the compression on the bursae. Do not squash it with a foam roller!
- Exercise therapy by addressing the mechanical issues – the pelvis or glute weakness.
What about Gluteal tendinopathy?
- A tendon develops pain when it is pushed beyond its capacity. It is relatively overloaded OR decreased stress or load through the tendon can also cause excessive tendon compression. At a cellular level its physical properties change often resulting in pain. The most common muscle affected is the glute med tendon.
- A tendinopathy will also likely be irritated by side-lying, but typically not to the level of that experienced with a bursitis.
- Have you recently introduced a new activity or sport? Perhaps a different surface? A hilly terrain? Try to decrease your weekly load and just ever so slightly back off your regular routine and try to establish a comfortable, stable baseline so that your musculature can adapt to this load – then progress.
- This is where a skilled Physiotherapist can help. They will slowly and steadily increase the load making the movement specific and functional to your goal.
Risk Factors
- Woman increased risk than men due to the morphology of the female pelvis
- > 40 years old
- Low back pain or previous history and increased duration = increased incidence of lateral hip pain.
- SIJ pain
- High BMI – increased waist hip and thigh girth
TOP 3 Glute Medius exercises……
Level 1: Side Lying isometric hip abduction (with neutral alignment)
Level 2: Side Lying hip abduction
Level 3: Side plank with hip abduction
Double leg Glute Bridge
Single leg Glute bridge
Side Plank
Side Plank with Hip Abduction
Closing Thoughts….
It is possible that you could be dealing with elements of both the gluteal tendinopathy and the greater trochanteric bursitis. Symptoms may well overlap. Once a working diagnosis is in place a thorough Physiotherapy treatment plan consisting of manual therapy, dry needling and an exercise programme is established as the first form of treatment and most conservative intervention. An appropriate referral will be made to a Sports Physician or Orthopaedic consultant for further intervention if required.