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Lateral Hip Pain: what you need to know

Lateral hip pain is a common issue, especially for women, who are affected more frequently than men. Research shows that 1 in 4 women over the age of 50 experience this condition. The primary causes include:

  • Gluteal tendinopathy: Often due to tendon compression at its insertion along the greater trochanter .
  • Referred pain: Can be coming from the lower back
  • Hip joint issues: Such as arthritis, labral tears or impingement.

For the sake of today, we are going to be discussing gluteal tendinopathy. This condition is when the outer hip muscles, the glute medius most commonly, has degenerated to the point where it becomes sensitized. It can be painful with adduction and internal rotation of the hip because it compresses the tendon. To manage this, avoiding behaviors and movements that exacerbate compression is critical in the early phases. Let’s explore the most common mistakes when managing gluteal tendinopathy and how to address them.

Behavior Modification and education

Common Aggravating Activities that need changing:

    • Adduction (crossing legs or standing with one hip dropped).
    • Contralateral pelvic drop (allowing one side of the pelvis to dip during activities like walking or running).
    • Sleep: Lying on that same side or lying on the other side but letting your top leg cross md-line. TIP: use a pillow between your legs!
  • Overstretching: Many people think stretching will relieve their pain, but in the case of gluteal tendinopathy, it can worsen the problem by increasing compression on the tendon. 

Managing compression is key to reducing pain. Tendons are sensitive to certain movements, so temporarily avoiding these positions allows sensitivity to resolve. Then we can build back up the ability to tolerate compression and stretch. 

 


 

Common running errors that can contribute to lateral hip pain: 

  • Pelvic Drop 
  • Crossing over 
  • Knees rotating towards each other

Running Tips:

  • Imagine your knees can never touch.
  • Imagine a small line that you are running along, the right leg stays on the right side of the line and the left leg stays on the left side of the line. 
  • Picture your pelvis as a bowl of water — don’t let it spill over the sides!

 

Good education is the foundation of recovery. Patients need to understand that:

  • Tendons are strong and resilient when properly loaded.
  • Insufficient loading leads to stiffness, weakness, and potential long-term issues like arthritis.
  • Overloading/doing too much load irritates the tendon, so finding the “sweet spot” is crucial.

Guidelines for Exercise:

  • Acceptable pain level: Minimal discomfort during exercise that returns to baseline within 24 hours.
  • Gradual progression ensures both safety and effectiveness.

 


Soft tissue massage might feel nice but it’s not effective at fixing the hip pain!

 

While manual therapy can provide temporary relief, it is not the solution for long-term improvement. Studies show an 80% success rate at 8 weeks with activity modifications and specific exercises alone. Now don’t write off manual therapy completely, it has a time and place, however exercise and education needs to be a part of that thorough plan. Dry-needling is incredibly effective at managing lateral hip pain but needs to be combined with the activity modifications and the progressive rehab. 


Ensure a formal Treatment Plan:

A formal treatment plan is essential for recovery and your doctors at Core Values Physical Therapy will create an individualized plan for you. It will include:

  1. Thorough Assessment to include where they are now.
    • Range of motion (lumbar spine, hip, ankle).
    • Control and strength of the hip and pelvis.
  2. Goals: Define where the patient wants to be 
  3. Roadmap: Outline steps to achieve these goals, focusing on progressive exercises and reintroducing aggravating factors as tolerated. 

The fun stuff! Progressive Rehabilitation

Rehabilitation should follow a systematic progression to restore strength and function and might look something like this:

    1. Isometric Exercises:
      • Low-intensity holds to reduce pain and build tolerance.
    2. Eccentric Loading:
      • Controlled lengthening movements to strengthen tendons.
    3. Combination Loading:
      • Heavy, slow resistance training to build resilience.
      • Low-level activation for movement control.
  • Reintroduction of plyometrics, agility and running
      • Pogos/hopping
      • Double leg → single leg
  • Run drills 


Summary: A Step-by-Step Approach to Recovery

  1. Reduce Pain:
    • Educate the patient.
    • Modify activities to offload the tendon.
    • Introduce low-level activation exercises.
  2. Build Control:
    • Focus on exercises that manage hip motion in daily activities and running.
  3. Strengthen:
    • Gradually increase load while monitoring response.
    • Progress to more challenging drills and movements.
  4. Reintroduce Compression:
    • Safely return to activities like yoga or side-lying positions.
  5. Maintain the progress:
    • Create a maintenance program to prevent recurrence.

With proper education, a structured treatment plan, and progressive rehab, lateral hip pain can be effectively managed and resolved, allowing patients to return to the activities they love.