What is it?

be various reasons why someone would experience lateral hip pain but the most common reason is due to a breakdown of the gluteal tendons (also known as gluteal tendinopathy). 
Tendons are strong fibrous collagen tissue which connect muscles to bone. In this condition, the gluteus minimus and gluteus medius tendons are specifically involved in causing the problem. Both these muscles are important for stabilising the hip. When these tendons are exposed to excessive amounts of load, it results in a breakdown of the tendon fibres at the point where it inserts into the hip joint, causing hip pain and weakness in the hip muscles. If excessive load continues over a period of time, micro tears develop in the tendon which can progress to partial and full tears. 
Lateral hip pain commonly coexists with conditions like lower back pain, hip osteoarthritis and obesity.

What causes it? ​

• Sudden increases in training load 
• Lack of hip strength and stability
• Excessive cross legged sitting 
• Increase in hill running load too quickly

Who is most at risk of developing this condition? ​

• Women aged between 40 to 60 years old. Women tend to be more at risk than men due to women naturally having wider hips 
• People who are overweight 
• Long distance runners

What are the symptoms? ​
People with lateral hip pain commonly present with : 

• Pain at the side of the hip (in some cases, may radiate to the outside of the thigh) which is often worse at night 
• Difficulty sleeping on affected hip
• Pain with walking up hills, stairs and with running 
• Pain with sitting (especially cross legged)
• Symptoms may improve as you warm up but return after you cool down. In some cases it may worsen over 24-48 hours after activity.
• ​If it is severe, it may be painful to stand on one leg

Other causes of lateral hip pain

• Pain referring from your lower back into the hip
• Hip Osteoarthritis 
• Meralgia paresthetica - a nerve condition that causes pain in the outer thigh

Cortisone injections?
Cortisone injections are effective in relieving lateral hip pain in some individuals. It is generally recommended as a complementary treatment to physiotherapy to help relieve symptoms so that the patient can commence a hip strengthening program. The injection is more likely to be successful when guided by ultrasound rather than based on point tenderness. ​

How long does it take to get better?
Your rate of progress will vary depending on the severity and duration of your symptoms, how it occurred, age, gender and exercise history. For most people, it will take 6 to 9 months of focused rehabilitation to make a return to full activities without pain. It is normal to have periods of increased pain or flare ups during this time. If this happens, you may need to reduce your exercise load until the pain settles down. ​

What can I do about it? ​
Just like most injuries, lateral hip pain is often caused by excessive loading. Exercises to help strengthen the area will help healing and returning to normal activity. Below are the steps we would typically follow to help our patients return to their meaningful activities.
Calm symptoms down
Ice 
Anti-inflammatories (short-term only)
Reduce / modify training loads
​
Reduce aggravating activities 
Avoid crossing legs 
Avoid sleeping on symptomatic side of hip
Use pillow between legs when sleeping on side at night 
When you are standing still, avoid leaning on one hip and keep your weight evenly through both feet
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Graded strengthening and gradual return to activity 
Graded exposure to load 
Sports/activity specific training
​

Calf pain can be due to a specific incident or insidious onset. In this blog we will be dealing with the first type.
The calf is separated into a superficial and deep compartment. In the superficial compartment we find the gastrocnemius, soleus and plantaris muscles. These make up the majority of the calf muscle bulk, with the gastrocnemius and soleus the most commonly affected.

The gastrocnemius muscle is formed of two muscle bellies (see above picture). When activated it assists in bending the knee and the foot i.e. pointing the toes away from the body. It is the most commonly injured muscle of the calf for two main reasons. Firstly, the muscle crosses two joints - the knee and the ankle. The second reason is due to the high density of type-two fast twitch muscle fibers. Due to these reasons it is seen as a more high risk injury. An injury to the gastrocnemius most commonly occurs in the medial head - which is the inside part of your calf.
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As can be seen in the picture above, the soleus muscle sits deeper and lower to the gastrocnemius muscle, when activated it flexes the foot. In comparison to the gastrocnemius, the soleus is considered to be a low risk injury as it only crosses one joint, the ankle, and consists mostly of type-one slow twitch muscle fibers. As the muscle sits deeper to the gastrocnemius it can often be mistaken for a gastrocnemius injury. 

A Calf Strain - what is it?​
Acute calf injuries often follow a sudden acceleration, such as over stretching or increase in running speed e.g. to run across the road quickly. A calf strain, like any muscular strain in the body is an injury to the muscle resulting in a tear in the fibers of one or multiple calf muscles. The severity of the tear dictates the clinical diagnosis i.e grade I, II or III. A runner usually knows when they have strained their calf, they will often note hearing a tear or popping sound and pinpoint the specific area quite accurately. 
Depending on the severity of the strain there may be swelling and/or bruising around the calf area down to the ankle. This may start within the first few hours of the injury. Usually it is painful and difficult to walk pain free, with people initially putting their weight through their toes, not wishing to put their heel to the ground.

Rehabilitation
Clinically, it is important to determine which muscle has been injured as this will play a role in the specific rehabilitation for the strain. It is also very important to understand the multitude of different factors which may have contributed to the injury. This is vitally important as without this understanding the probability of a re-occurrence increases significantly. 
Rehabilitation following a calf strain begins straight away with acute management over the initial few days. The main focus of this is to decrease swelling/bruising around the area and to return to walking pain free as soon as possible.This is a good indicator of recovery rate going forward.  
Rehabilitation exercises progressively increase in intensity through the rehabilitation process. They will focus on a variety of areas, with the main aim being on regaining:

1. Full range of movement through the calf area and ankle
2. Full return of the strength/power in the surrounding musculature
3.  End stage / sport specific exercises to have you fully prepared for your return to activity/hobbies. 

These two videos show the gastrocnemius calf raise and soleus calf raise, which  are the two fundamental strength exercises for calf strains. Through the rehabilitation process these can be progressed from from two feet to one foot, on the flat ground to off a step.

Any Questions?
Let us know if you have any questions/queries, or if you need guidance with managing your calf injury and helping you return to your activities and hobbies pain free.

1. Swiss Ball Arm Raises
2. Swiss Ball Crunch
3. Swiss Ball Bridge
4. Swiss Ball Hamstring Roll Ins

The lower back muscles are a group of muscles that are often neglected in strengthening programs. So here are a few different exercises to strengthen the lower back.

At movement 101 we work on a home and gym exercise program suited to your preferences and time availability.