Lateral hip pain
Written by Mitchell Robinson
Pain on the outside of the hip, or lateral hip pain, is a common condition that we see in the physiotherapy clinic. It’s a very painful condition which can stop you from running, walking, exercising or doing all the things that you love to do. The good news is that with some simple strategies, this pain can be reduced and you can get back to enjoying life.
What causes lateral hip pain
Researchers previously thought that lateral hip pain was caused by trochanteric bursitis, which is an inflamed bursa (a fluid filled sac designed to reduce friction caused by tissues moving over each other) at the side of the hip. Evidence is now showing the majority are actually caused by compression of the gluteal tendons (1). The gluteus medius and minimus tendons attach to the great trochanter (bony prominence at the side of the hip) and sit underneath a thick band of connective tissue called the iliotibial band. When the leg crosses the midline of the body (hip adduction) and when the leg moves forward (hip flexion), the gluteal tendons become compressed, and if this happens repeatedly and with rapid onset, changes to the tendon occur, and pain often results.
What factors lead to compression of the gluteal tendons?
There’s a number of factors which can lead to the gluteal tendons becoming compressed, including:
- A sudden increase in exercise, such as walking up hills or stairs
- Regular habits and sitting positions which can irritate the tendons on the outside of the hip (1)
- Poor control of hip muscles
- Having a large angle between the hip and knee (more common in females)
- Being overweight
"With the right management, a lot of people with lateral hip pain will find that their symptoms start to settle..."
Common signs & symptoms
People who are experiencing lateral hip pain often present with:
- Localised pain on the outside of the hip, which can also radiate down the leg as far as the knee, and into the buttock, knee and low back (4)
- History of recently starting an exercise program (4)
- Pain with walking up hills, stairs, crossing the legs, sitting in low chairs, side sleeping (4)
Who usually gets lateral hip pain?
The largest group that lateral hip pain affects is women (ratio of 4:1 compared to males) (1), and those who are peri-menopausal or post-menopausal. This is often because during and post-menopause, changes to hormonal levels occur, which can lead to weakening of the gluteal tendons and an increase in abdominal fat (which is linked to higher rates of tendon changes). This condition is often commonly misdiagnosed as lower back pain (3).
How does physiotherapy help?
- Advice & education to help manage the cause of the pain, including:
- Modifying the amount and types of activities you are doing to manage your pain
- Temporary positional changes including:
- Learning how to stand correctly to avoid compression of the gluteal tendons
- Avoiding sitting on low chairs, crossing legs, stretching the glute muscles, and sleeping on the painful side
- Sleeping on the non-painful side, with a pillow between the knees
- A progressive exercise program
With the right management, a lot of people with lateral hip pain will find that their symptoms start to settle within 4 weeks or so (2). This begins with static exercises for strengthening the gluteal muscles in sidelying and progresses to more difficult and challenging exercises in standing once strength and endurance of the hip muscles has improved (1). It is important when managing irritated tendons to perform an adequate amount of exercise to encourage healing and strengthening of the tendons, but not so much that the tendons become overworked. Our physiotherapists are experienced in helping to guide people through this treatment plan, so that you can enjoy life pain free.
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1. Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal tendinopathy: A review of mechanisms, assessment and management. Sports Medicine Journal, 45, 8, 1107-1119.
2. Grimaldi, A. (2017). Conservative management of lateral hip pain: the future holds promise. British Journal of Sports Medicine, 51, 2, 72-73.
3. Bahr, R., & Khan, K. (2009). Management of lateral hip pain. British Medical Journal, 338.
4. Mellor, R., Grimaldi, A., Wajswelner, H., Hodges, P., Abbott, J., Bennell, K., & Vicenzino, B. (2016). Exercise and load modification versus corticosteroid injection versus ‘wait and see’ for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for randomised clinical trial. BMC Musculoskeletal Disorders, 17, 196, 1043-1046.