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EPISODE 41: Lateral Hip Pain - Causes & Treatment

Shakira

If you have experienced lateral hip pain, you understand that hips don't lie! Especially the lateral hip. When you have pain in your lateral hip, it can be debilitating and stop you from doing simple tasks each day. In the physical therapy setting, lateral hip pain is a common issue that we are presented with- especially among athletes and active individuals. In this blog post, we will discuss the structures of the lateral hip, common pathologies, mechanisms of injury, and a variety of treatment options that can help reduce symptoms and assist you in getting back to doing the things you love pain-free (whether it's dancing like Shakira... or not ;))!


ANATOMICAL STRUCTURES

Hip Anatomy

As mentioned in our last post on Anterior Hip Pain (this is the plug to go check that out! ), the hip joint is one of the more complex joints in our bodies as it is a "ball and socket" joint that allows for movements in multiple planes of motion and also supports our body weight. The lateral hip region consists of bones, muscles, tendons, ligaments, and bursae that work together to provide both movement and stability at the hip. Below is an outline of common structures of the lateral hip:

  1. Bones

    1. Ilium: The ilium is the largest of the three bones that make up the hip bone. It forms the upper part of the hip bone and provides attachment sites for several muscles of the hip.

    2. Greater Trochanter: This bony prominence is located on the lateral side of the femur (thigh bone). It is the attachment site for muscles and tendons, including the gluteus medius and minimus.

    3. Femur: The femur is the long bone of the thigh that articulates with the pelvis to form the hip joint. The greater trochanter, located on the lateral aspect of the femur, is an important landmark in the lateral hip region.

  2. Muscles

    1. Gluteus Medius: Originating from the outer surface of the ilium, the gluteus medius inserts onto the greater trochanter of the femur. It plays a key role in hip abduction and pelvic stability.

    2. Gluteus Minimus: Situated beneath the gluteus medius, the gluteus minimus has a similar function in hip abduction and pelvic stabilization.

    3. Tensor Fasciae Latae (TFL): The TFL is a small muscle located on the outer side of the hip. It originates from the iliac crest and merges into the iliotibial (IT) band. The TFL assists in hip abduction and also plays a role in stabilizing the pelvis and knee.

  3. Tendons

    1. Iliotibial (IT) Band: The IT band is a thick band of connective tissue that runs down the outer thigh. It originates from the TFL and gluteus maximus muscles and inserts onto the tibia. The IT band provides stability to the hip and knee and plays a role in various lower limb movements.

    2. Gluteal Tendons: The tendons of the gluteus medius and minimus muscles insert onto the greater trochanter of the femur, providing attachment points for these muscles.

  4. Ligaments

    1. Iliofemoral Ligament: Also known as the Y-shaped ligament, it is one of the main ligaments of the hip joint. It attaches from the anterior inferior iliac spine of the ilium to the intertrochanteric line of the femur, providing stability to the front of the hip joint.

  5. Bursae

    1. Trochanteric Bursae: Bursae are fluid-filled sacs located around joints that providing cushion and reducing friction between tendons, muscles, and bones. The trochanteric bursae are situated around the greater trochanter of the femur.


LATERAL HIP PATHOLOGIES AND RISK FACTORS

  1. Greater Trochanteric Pain Syndrome (GTPS)

    1. GTPS is characterized by pain and tenderness over the greater trochanter of the femur caused by repetitive activities such as walking, running, or lying on the affected side.

    2. Causes include overuse, muscle imbalances, IT band tightness, and trochanteric bursitis

  2. Iliotibial (IT) Band Syndrome/ "Snapping Hip"

    1. IT band syndrome involves inflammation and irritation of the IT band, resulting in lateral knee and hip pain from activities such as running, cycling, or stair climbing.

    2. Contributing factors may include overuse, muscle imbalances, and biomechanical issues such as excessive hip adduction or internal rotation.

  3. Trochanteric Bursitis

    1. Trochanteric bursitis involves inflammation of the bursae located around the greater trochanter of the femur, leading to lateral hip pain that may radiate down the thigh and localized pain and tenderness on the lateral aspect of the hip.

    2. Causes include overuse, direct trauma, muscle imbalances, or biomechanical abnormalities.

  4. Gluteal Tendinopathy

    1. Gluteal tendinopathy refers to degeneration or irritation of the tendons of the gluteus medius and/or minimus muscles, resulting in lateral hip pain and dysfunction.

    2. Causes include overuse, repetitive activities, muscle weakness, and biomechanical issues.

  5. TFL Tendinopathy

    1. TFL syndrome often develops due to repetitive movements or overuse of the TFL muscle, such as prolonged standing, walking, running, or cycling.

    2. Causes include muscle imbalances & biomechanical factors


Hip pain

TREATMENT

Depending on the pathology or mechanism of injury ("MOI"), there's a variety of treatment interventions that we will take our patients through here at PTSP.

Some of these interventions may include:


  1. Patient Education/ Activity Modification: Learning about your condition and the activities you should be temporarily avoiding to allow your hip the time it needs to heal and avoid re-injury is crucial. For acute conditions, rest is definitely necessary ("pain is gain" is not always the motto). Athletes may need to adjust training routines or cross-train with low-impact activities during this phase of rehabilitation. A personalized home exercise program designed by your PT can also help get the ball rolling on corrective exercises that you can do outside of the clinic to continue care and manage your symptoms.

  2. Gait and Functional Movement Analyses: Identifying biomechanical factors associated with lateral hip pain, such as improper walking, running, or movement mechanics (think squats or lunges), can help immensely with rehabilitation. This may involve gait analysis and correction, orthotic prescription, footwear modification, or a series of isometric exercises associated with leg length discrepancy (ie. Dr. Yana's "hip reset") that will also help decrease your lateral hip pain.

  3. Manual Therapy: Hands-on techniques such as joint mobilizations, soft tissue massage, and myofascial release can help reduce pain and improve tissue mobility and range of motion. The use of modalities (ie. cupping/ "cupping with movement) along with manual therapy are also beneficial techniques.

  4. Strengthening Exercises: Weakness can most definitely lead to pain, as it causes other muscles in our bodies to compensate and/or overwork. Targeted exercises to strengthen the hip abductors, external rotators, and gluteal muscles can improve biomechanics and reduce strain on the lateral hip structures. A few examples of exercises that you may see in our clinic are bridging, resisted sidestepping, and TRX lunges (just to name a few!).

  5. Stretching: Overly tight muscles can also lead to compensatory patterns or pain. Learning specific stretches (static or dynamic) from your PT that include your hip flexors, quadriceps, gluteal muscles, and hamstrings are also incredibly important in the rehab process.

  6. Gradual Return to Sport: Once your pain levels are reduced, and strength and flexibility are restored, a gradual return-to-sport program will then be implemented. We will work with you and your specific sport needs to tailor a more advanced and functional return-to-sport program. This will include progressive loading and sport-specific drills that will help you get back to your sport/activity safely via sports- specific drills and functional movement training.


We hope you've learned a lot in this post :) If you've been dealing with lateral hip pain and it's starting to interfere with your daily life, sport, or hobbies, don't hesitate to book an evaluation with our team here at PTSP! Together, we will create a thorough rehab program designed just for you and get you excited about returning to whatever it is that you love to do! We work with clients on-site and virtually through Telehealth.


Click here if you are interested in booking a session or getting more information! https://www.physicaltherapysanpedro.com/sports 

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All the best,


The PTSP Docs

Dr. Yana, Dr. Brown, Dr. Bay


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