A frustrating condition for both patients and physical therapists is pain on the outside of the hip. It’s frustrating for patients because almost any weight-bearing activity is painful and can be quite limiting. For physical therapists, this is often frustrating because it is difficult to determine where the pain is coming from and recovery time may be lengthy.
For a long time, the trochanteric bursa (a pressure-relieving fluid filled sac behind the bone you can feel on the outside of your hip) was assumed to be the culprit, but a 2015 research review found that in two studies only 8% and 20% of subjects who were believed to have trochanteric bursitis actually had an inflamed bursa. So, though this could still be the primary cause in 10-20% of cases, it is now believed that the primary cause of lateral hip pain is 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 standing on the painful leg or mindlessly shifting your weight 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