Pain on the outside of the hip can be a frustrating condition for both patients and physical therapists. Frustrating for patients because almost any weight-bearing activity can be painful and limiting. Frustrating for physical therapists because it can be difficult to determine where the pain is coming from and recovery time may be lengthy.
The trochanteric bursa (a pressure-relieving fluid filled sac located behind the bone on the outside of your hip) was long assumed to be the culprit, but a 2015 research review found that in two studies only 8% and 20% of subjects believed to have trochanteric bursitis actually had an inflamed bursa! So, though bursitis could still be the primary cause in 10-20% of cases, the primary cause of lateral hip pain is believed to be gluteal tendinopathy (degrading of the tendon that connects to the bone).
Risk factors include being a female over the age of 40, and having “knock knees” or a “pear-shaped” body type.
Try this simple test to see if you may have gluteal tendinopathy (note: do not try this if your pain was after a major trauma, such as a fall or accident, or if you feel that your leg won’t support you):
Stand on one leg (the side that is bothersome) and make sure your hips remain level. Hold for 30 seconds or until painful. It is OK to use your fingertips for light support/balance. If you have pain on the outside of your hip before the 30-second mark, the odds are quite good that your gluteal tendons are involved in some way (i.e., tendonitis or a tear of some kind).
If so, there are some easy activity modifications you can perform to ease the strain on the tendon in this region. When sitting, position your knees slightly apart so the muscles on the side and back of your hips avoid getting stretched. When sleeping—if you’re a side sleeper—sleep on the painless side with one or more pillows between your knees, or sleep on your back with a pillow under your knees. When standing, avoid one-legged standing on the painful leg or mindlessly standing with your weight shifted to that side.
If your symptoms don’t get better, come in and see us so we can figure out the cause and get you better!
By Tom Fontana, MSPT