There are several causes for pain in this area including;
- Gluteal tendinopathy
- Trochanteric bursitis
- Referred pain from the lower back
Gluteal Tendinopathy is the most common cause of pain on the outside of the hip. It is an injury to the Gluteal tendons which connect the muscles (Gluteus Medius and Minimus) to the bone.
It is commonly confused with Trochanteric Bursitis which also gives pain in this area and although both can commonly occur together, the two conditions are separate.
Who gets Gluteal tendinopathy?
What causes Gluteal Tendinopathy?
The job of tendons is to cope with the load we put on them every day. As we get older, the collagen fibres in the tendon degenerate, so the tendon becomes worn. If we overload the tendon, it can cause pain. The most common type of overloading is when the person makes the same movements repeatedly either in their job, daily activities or in their sport, for example running.
An example would be a runner who trains for a race and rapidly increases the intensity and frequency of their training. When the tendon is loaded, it causes small tears which heal quickly if there is sufficient rest time between runs.
However, if the runner continues to train without gradually increasing the load and without sufficient rest time between runs, the damage becomes worse and symptoms such as pain develops. This is known as tendinopathy or tendinosis.
What are the symptoms of Gluteal tendinopathy?
Pain on the outside of the hip which comes on gradually and gets worse with activity as time goes on. The pain can radiate into the groin and the outer thigh but rarely below the knee. It is worse when the tendon is active, for example during sport or activity and can be very painful during the night when lying on the hip and going upstairs.
Stiffness on the outside of the hip, particularly in the morning when you get up.
Gluteal Tendinopathy is not associated with swelling so taking anti-inflammatories has little effect.
In the acute phase,
- Use ice to reduce pain
- Avoidance of painful positions in the acute stage such as crossing legs and don’t do any stretching exercises which will increase the pain of the inflamed tendon
- Avoidance of high loading exercise such as plyometrics
- Sufficient rest time between activity to allow healing
- Do static strengthening exercises as instructed by the physio which has an analgesic effect on the tendon
What can physio do to help?
The best treatment is functional rehabilitation which involves a gradual reloading of the tendon. This will reduce pain, improve muscle strength and increase function to get you back to your activity as soon as possible.
Rehabilitation starts with static muscle exercises which helps to reduce the pain. Your physio can then guide you through a progression of exercises to increase the strength of the tendons by using eccentric, then concentric strengthening exercises, finishing with sport/activity specific training.
It is essential to regain full Gluteal and abdominal strength with good pelvic control before starting training.
There are many examples of exercises including the ‘clam’ exercise below. However, it is important to get advice from your physio regarding the type of exercise to do, particularly related to the velocity, load and compression progression and pelvic control training that is required.
How long does Gluteal Tendinopathy last?
Tendon injuries take time to heal. They are made of fibrous connective tissue and unlike muscle, as tendons do not have a significant blood supply, there are less nutrients available to heal the injury so repair will take longer. Severe cases of tendinopathy can take up to 12 months.