Lateral Hip Pain

What is lateral hip pain?

This is pain that is felt on the outside of the hip often around a boney prominence called the greater trochanter. This is why it is also sometimes referred to as greater trochanteric pain syndrome (GTPS).  It occurs more frequently in women than men by a ratio of 3-4:1.  It is most commonly associated with females post menopause however it can also affect males and females in sporting populations such as runners.

What are the signs and symptoms?

Pain over the outside of the hip. This can radiate down the outside of the thigh but rarely below the knee.

Pain on lying on the affected side

Pain on crossing legs

Pain and/ or weakness in the lateral hip on prolonged standing and walking

Pain on climbing stairs

What are the possible causes?

Historically healthcare professionals would commonly diagnose pain in this area as trochanteric bursitis. This refers to pain and/ or inflammation within a soft tissue structure called a bursa. Bursae are fat pads that are found in many different junctions in the body either between bone and soft tissue (such as over the greater trochanter) or between layers of soft tissue as seen in areas such as the hamstring tendons. They are innervated structures which means that if they are irritated then they will produce pain.

Bursae are however not solely responsible for pain in the outside of the hip. In fact one study by Long in 2013 showed that bursae only account for less than 20% of all cases of lateral hip pain in over 800 symptomatic patients when ultrasound imaging was used.

Pain in this area can therefore be attributed more to the disruption of the tendons of two muscles; gluteus medius and gluteus minimus. They are responsible for stabilising the hip and pelvis as well as abducting the hip, which is to move the limb out sideways away from the midline.

How is it diagnosed?

A thorough clinical examination by a healthcare professional such as GP or physiotherapist should be sufficient to accurately diagnose this condition.

The pain that is described would be reproduced by palpating the outside of the hip. There can be concurrent weakness of the muscles that abduct the hip. In rarer cases a Trendelenburg sign can be seen where the pelvis drops slightly on the weight bearing leg during the stance phase of walking.

If any further imaging is deemed to be necessary then ultrasound, MRI or x ray may be recommended depending on whether the problem is suspected to be as a result of joint or soft tissue pathology.

It is worth noting that the lumbar spine can refer pain to this region as well and this should be discussed in any consultation. 

What can I do if I think that I have this condition?

Firstly try and think about what positions you adopt on a daily basis. Try and keep your hips in as much of a neutral position as possible. Try and avoid or modify the following activities:

• Sitting with legs crossed
• Lying on the affected side. This is difficult as we all move when asleep but pillows between the legs can be used to good effect to provide pain relief.
• “Hip hanging” that is standing with the pelvis shifted to one side so that you lean through one leg more than the other. Bring yourself back to the point where equal weight is through both legs and practice holding that position. It may feel strange at first but practice!

Seeking physiotherapy can be particularly helpful for this condition. They can:

• Help with modalities for pain management
• Provide education and practical advice about the condition and its management
• Check for and address any other contributing biomechanical issues
• Provide an appropriate targeted and graded exercise plan as well as monitor your progress.

A study by Mellor published in the BMJ in 2018 found higher rates of improvement in groups of patients with lateral hip pain that were exposed to exercise and education than those who were exposed to corticosteroid injections.

References:

Long, S.S., Surrey, D.E. and Nazarian, L.N., 2013. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. American Journal of Roentgenology, 201(5), pp.1083-1086.

Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H. and Vicenzino, B., 2018. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. bmj, 361, p.k1662.

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