Greater Trochanteric Pain Syndrome (GTPS) is a term often used to describe lateral hip pain. The term Lateral Hip Pain is more accurate as inflammation of the bursa is usually not the main culprit of pain on the outside of the hip but it could be present in conjunction with gluteal tendon issues or snapping hip syndrome (External Coxa Saltans).
It is very rarely serious although it does need treatment and action to resolve. There are several scenarios where external hip pain may be indicative of a more serious pathology and we will discuss these in this blog post.
What is Trochanteric Pain/Lateral hip pain?
Lateral hip pain is pain that is felt on the outside portion of your hip pain. It can be local to this area or even refer down your leg to your knee. The bursa which is a fluid-filled sac can sometimes become inflamed or the local tendon structure can become worn or torn leading to pain.
CAUSES
- Direct Trauma
- Mechanical Overload
- Overuse/Repetitive Strain
- Compression of the bursa
- Poor pelvis strength/stability
- Being female 40-60 years old
- Snapping Hip Syndrome
- Obesity
SIGNS AND SYMPTOMS
- Several characteristics identify Lateral Hip Pain. The main one is pain in the lateral (outside) portion of the hip. This pain can refer down the leg to the knee at times.
- There can be pain when this area is palpated or when lying on the affected side. There can also be pain when lying on the opposite hip due to the legs being adducted together causing pain.
- Pain can often be felt with standing and walking, particularly up stairs or inclines.
- Sitting for prolonged periods and crossing your legs when sitting can cause pain.
- Lateral Hip Pain is diagnosed through a clinical history. Imaging is rarely required unless conservative treatment has failed. In this case, MRI scanning is indicated to check the health of the gluteal tendons and to rule out other pathology.
DIFFERENTIAL DIAGNOSIS
Lateral Hip Pain is thankfully very rarely serious but multiple structures can present as Lateral Hip Pain.
If inflammatory signs such as heat, redness and swelling are present, you should make an appointment to see your doctor so that conditions such as gout, rheumatoid arthritis and cellulitis can be tested for.
In the absence of inflammatory markers, pain in the lateral portion of the hip can also be caused by:
- Osteoarthritis
- Referral from Lumbar Spine
- Labral Tears injury to the cartilage within the hip joint
- Femoral Acetabular Impingmenert
- Stress Fracture
- In rare cases bony metastasis
- Gluteal tears
If your physiotherapist suspects any of these conditions they will refer you to your doctor for further investigations.
TREATMENT OPTIONS
Conservative Treatment
Most cases of Lateral Hip Pain can be resolved with a course of Physiotherapy which addresses the underlying muscle imbalance, gluteal tendinopathy and bursitis. This is achieved with a bespoke series of exercises to help and addresses the specific root cause of the pain.
Medical Treatment
If conservative treatment has failed or the pain is significant, Corticosteroid Injection can be indicated but provides only a short-term benefit.
Platelet-rich injections can also be considered.
In severe cases where pure bursitis is suspected surgical measures can be considered.
PHYSIOTHERAPY FOR LATERAL HIP PAIN
Physiotherapy for Lateral Hip Pain will focus on addressing pain, improving the range of muscle of the hip and associated structures, improving the loading of the hip and knee, strengthening the gluteal muscles as well as addressing any secondary factors associated with the condition such as diet and obesity.
Muscle restrictions below the hip, over the hip and also of the lumbar spine can contribute to the symptoms and these would be addressed with myofascial release, manual therapy, dry needling and or muscle energy techniques.
If this is something you would like to see me about you can book to see me here.
SELF MANAGEMENT
If you are concerned about your hip you should seek professional help from your local physiotherapist, especially if the pain is not settling after several weeks but in the meantime, there are several things that you can do to help yourself.
90% of Lateral Hip Pain is resolved via conservative management.
1. Strengthen Your Gluteal Muscles
It is important to improve the strength of your gluteal muscles when managing Lateral Hip Pain. As a physiotherapist, I will make the exercises that I prescribe patient-specific. However, improvements can be made by performing general strengthening exercises to improve the lateral hip/gluteal muscles.
An example of a great place to start would be Glute Bridging or Standing Hip Hitching.
2. Load Management
Load Management could be described as a temporary reduction in exercise volume. For example, if you are a runner or a gym goer, you might look to reduce your current activity by up to 50%. The amount of time that you reduce the load is directly linked to your pain levels. Once your pain starts to resolve you can look to reintroduce the running and/or gym work back to your usual levels.
3. Avoid Over Stretching the Lateral Hip/Gluteal Muscles
When managing this condition, your initial focus should be on increasing the strength of the gluteals. One of the major causes of lateral hip pain can be insertional tendinopathies of the gluteal muscles. These can be improved with strengthening and worsened if overstretched in the initial stages of management.
4. Manage Your Weight
There is a direct link between being inactive and being overweight in the development of Lateral Hip Pain.
Even a small reduction in weight can lead do a decreased demand on the lateral hip and gluteal tendons.
By remaining active we can make sure that the muscles remain strong and the tendons are adequately loaded and exercised.
Self Management Takeaways
All the strategies presented above are all easily implementable. Start slowly with the strengthening programme and be sensible when it comes to managing your load through the hip with the amount of other exercises you do and your hip pain will settle.
If your hip pain is not settling within 4 weeks you should seek the help of a Physiotherapist and you can book to see me here if you’d like a tailored and professional plan
