Lateral Hip Pain

Tendons are rope like structures that connect muscle to bone allowing movement every time we contract a muscle.

Recent evidence has shown that pain on the outside of the hip is largely due to the dysfunction of the gluteus medius tendon giving rise to the term Gluteus Medius tendinopathy.

Everyone can get a tendinopathy from elite athletes to sedentary workers. Tendons do not like dramatic change and do not respond to rest alone, so it is important to follow the guidelines and an appropriate graduated strengthening programme.

Tendons are good at absorbing tension but not at dealing with compression. Compression of the Gluteus Medius tendon occurs at the lateral hip by the overlying iliotibial band (ITB) being tight. Changes in exercise/activities and poor daily postural habits can increase this compression. With enough compression, changes occur at a cellular level within the tendon. This involves swelling of the tendon which can be quite painful! If the tendon is left untreated it will progress to the degenerative phase. The good news is that the tendon has the capacity to reverse and change, particularly in the initial phases.

Daily activities that increase compression of the gluteus medius tendon and therefore should be avoided:

  • Hanging off one hip in standing.
  • Sitting with legs crossed.
  • Sitting with knee together and feet apart.
  • Sitting in low chairs with your hips lower than your knees.
  • Sitting with knees spread wide apart. Lying on your affected hip.
  • Lying on your non affected hip without support of pillows between your knees.
  • Running continuously on chamber of road.
  • Running in the same direction of the running track.
  • “Clam” exercises.
  • Poor shock absorption- shoewear and training surfaces.
  • Stretching your leg across your body.

Normal (A) and Abnormal (B) use of Gluteus Medius muscle.

It is very important to unload the compression on the tendon.

Things you can do

  • Avoid sitting and standing postures that increase load/compression on the lateral hip.
  • Avoid stretching the gluteus medius muscle across the body.
  • Sleep on non affected side with one or multiple pillows between knees.
  • Egg shell foam mattress overlay may be helpful.
  • Ibuprofen may be helpful especially initially.
  • Avoid steep hills and high stepping (eg. step aerobics).

Things your physiotherapist will help you with:

  1. Decreasing tightness in the local muscles and maintaining range of movement of the hip and surrounding joints.
    • Deep tissue massage and release of ITB and tensor fascia lata (TFL).
    • Lower limb stretches apart from the glut stretch across your body.
  2. Graduated strengthening program to increase the tendons ability to load
    • Specific exercise advice tailored to your particular problem.
    • Activation of the deep portion of gluteus medius.
    • Functional strengthening to specifically enhance problematic activities.
  3. Decompression taping

Interesting Facts

Some other factors that increase your risk of developing a tendinopathy:

  • Excess abdominal fat and diabetes.
  • Hormonal changes – increase risk for peri/post menopausal women.
  • Real leg length discrepancy.
  • Poor diet.

Tendons slowly adapt to load. Treatment re- quires ongoing management. Failure to do this may result in disrepair or tear.