Signs, symptoms and treatment advice if you have pain on the outside of your hip.
Lateral hip pain is a pain in the butt……. quite literally. The pain of lateral hip pain (also known as greater trochanteric pain syndrome, gluteal tendinopathy or bursitis) is usually located on the outside of the hip over or just behind the bony lump which is called the greater trochanter. This pain can radiate down the outside of the leg but rarely moves below the knee. it can be constant or intermittent but is often very difficult to shift. Here is a blog to try to help you if you have lateral hip pain although, as always you should seek professional advice if you are not sure of your diagnosis.
Who gets lateral hip pain and why?
Lateral hip pain is common in runners who have increased their mileage or intensity of training and also people who are in their 50\’s, 60\’s and 70\’s. It affects females more than males; which is thought to be due to the wider hips that females have. It is often reported to be a deep aching or burning pain which gradually comes on in most cases.
There also appears to be a high prevalence of lateral hip pain in people with osteoarthritis of the peripheral joints or spine and rheumatoid arthritis. In fact, it has been suggested that 91% of people with lateral hip pain have one of these co-existing pathologies.
Pain is widely accepted to be a result of a tendinosis; ie. chronic irritation of the tendon. In the case of the lateral hip, the gluteal (bottom muscle) tendon is irritated by the load placed on it. This may be load from exercise or from the compression of the tendon on the bone caused by the iliotibial band. This irritation builds up until it eventually becomes painful and limits function.
Aggravating factors
There are many aggravating factors, but some of the more common are:
- Laying on the affected side (although this can also be painful laying on the other side too).
- Prolonged standing
- Sit to stand
- Running
- Climbing stairs
- Crossing your legs
What can I do to make it better?
Firstly, the good news is that roughly 2/3 of people with lateral hip pain will find that their symptoms resolve within a year without doing anything. However, a year is a long time to be in pain, and it may be useful to try one or two things.
With lateral hip pain (and most injuries when I think about it) there are 2 key principles to help make it better as the first port of call:
- Try not to irritate it
- Exercise the gluteal musclesSounds obvious right? But how do you do this? Well if we are avoiding irritating it, firstly I would suggest that you avoid stretching the area – that\’s stretching the gluteal muscles and causing discomfort in the lateral hip. Stretching can be an aggravating factor – it is not a case of \’no pain no gain\’. Taking into account the aggravating factors mentioned earlier I would also advise:
Laying down – Try to sleep on the unaffected side with a pillow between your knees to stop them from crossing over. Or, alternatively lay on the affected side but put something soft underneath such as another duvet.Prolonged standing – I know it\’s obvious, but try not to stand until your pain comes on. However, it may also help to not \’hang\’ on your hip to avoid compression of the area.
Sit to stand – Try to sit in taller chairs with you knee below the height of your hip, it may also be helpful to use your arms to assist you when standing from sitting.
Running – This is tricky, but in my experience, it is best to do some running rather than avoid it completely. It can help to shorten your stride or slow your pace. Keep running but do it within acceptable limits of pain.
Climbing stairs – Try going upstairs leading with the unaffected side and the affected side on the way down.
Crossing your legs – Don\’t do it!!!!!!!!!!!
And exercising the gluteal muscles?????
There are many gluteal exercises and depending on your personal situation and level of pain, you may require different levels of exercise. However, a good place to start is with side-lying abduction. This exercise can be seen demonstrated here by the guys at Chelmsford Physio.
With lateral hip pain, I would make a slight adjustment to the demonstration by placing a towel or pillow between your knees for comfort. If this exercise is uncomfortable, then you may need to change it so that instead of lifting and lowering, you just lift the leg and hold it for 30 seconds to 1 minute and repeat this about 5 times a day.
This is a good place to start and may help, however, you may also need to work on balance and stability around your trunk so that you can stop irritating it when you return to full activity. However, these may need to be personal to you and therefore advise from a professional is necessary.
What else can be done?
The first line of treatment is physiotherapy, and the majority of cases will resolve with conventional physiotherapy involving exercises and possibly some hands-on treatment alone. However, in some instances, it does not resolve, or pain levels are not manageable. In these instances, corticosteroid injections can be used for short term pain relief. This, however, is not without its risks and does seem to only be a short term fix, with pain often returning – it\’s like treating the symptoms, not the cause.
Shockwave therapy can also be used to help with lateral hi pain that has been ongoing for more than 3 months. There is some literature to suggest that although it may not be as effective in the short term as steroid injections, it can help with a better long term effect. NICE has produced a summary on shockwave for lateral hip pain for patients which you can see here, but if you want more information contact us and we will be more than happy to answer all your questions.
Thanks for reading, Josh.