Lateral Hip Pain a.k.a Greater Trochanteric Pain Syndrome

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
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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
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