Don’t let lateral hip pain ruin your quality of life – Act now!!
Lateral hip pain is a common complaint in females over 40 years of age being present in one in four women aged over 50 years. It can occur in males and in younger females, but this is far less common. There are a number of causes of lateral hip pain including referral from the low back and hip joint in addition to acute tears in the gluteal muscle or tendon but the most frequent cause is gluteal tendinopathy. This is commonly associated with trochanteric bursitis which is far more commonly diagnosed. Trochanteric bursitis and gluteal tendon tears are part of the tendinopathy process rather than stand-alone injuries. This disorder presents as pain and tenderness over the greater trochanter (outside of your hip) and often interferes with sleep and physical function. It has been shown to have the same level of disability and quality of life to that of severe hip osteoarthritis which can be hugely limiting. Activity level is often reduced because of pain and in this age group additional complications from this can result in weight gain causing further lower limb joint loading and loss of quality of life.
Gluteal tendinopathy is the most common tendon injury to present to GP’s (general practitioners) for assessment. You may be referred for physiotherapy, given anti-inflammatories, sent for an x-ray and ultrasound, referred for a cortisone or given advice regarding a reduction in physical activity whilst painful. What we know from research completed in 2018 is that the most effective treatment for gluteal tendinopathy is education and an exercise programme.
Corticosteroid injections into the trochanteric bursa are commonly used to manage gluteal tendinopathy. They have been shown in research to have significant benefits from a short term pain relief perspective although long term outcomes are no better than a wait and see approach. Where they are most effective is the patient who is unable to complete an appropriate exercise programme due to their pain levels. The cortisone injection allows a “window of opportunity” – a period of reduced pain that ensures the patient is able to complete an appropriate rehabilitation programme. The aim is that by the time the effect of the cortisone wears off they are making progress in their strengthening regime and pain is therefore reduced.
The approach to managing other tendinopathies throughout the lower limb combines education to reduce load on the tendon during sustained postures and function (that is, load management) with exercises that target impairments present. The LEAP trial was performed to assess if this method was the most appropriate treatment pathway in gluteal tendinopathy. Results confirmed that at both 8 and 52 weeks exercise and education was far superior in treatment effects than any other treatment modality including cortisone and a wait and see approach. It is great to see research supporting our treatment philosophies but what does this mean for you?
- It is unlikely that if you are suffering from gluteal tendinopathy that your pain will go away or improve by itself
- Cortisones are a short term fix for those they provide benefit in and caution must be taken prior to considering a cortisone in the tendon itself due to increased risk of tendon rupture
- Education is an essential element of the treatment programme. Learning about load management, the postures that aggravate your tendon, alterations to sleeping positions, in addition to gait re-education so you can continue to exercise in a modified capacity as required without significant aggravation of your pain. These strategies help give you autonomy and control over your day/week so that you are able to self-manage the largest proportion of your symptoms
- Building capacity from a strength perspective is essential. We know that as females over the age of 40 years our muscle mass declines and yet this is the age group where cardiovascular exercise is most commonly undertaken without any additional weight training. Tendinopathy occurs when the load exceeds the capacity and it is essential from a rehabilitation perspective that this capacity is improved. Building strength and movement control in and around the hip and pelvis is the cornerstone of treatment for gluteal tendinopathy. This incorporates a programme designed specifically for you to address these impairments, regularly monitored and progressed as appropriate.
At Bureta Physiotherapy we are fortunate to have the latest technology in the AxIT system https://www.strengthbynumbers.com. This allows us to accurately assess your strength and design a programme incorporating strength, control and balance in order to help you achieve the best results. It also allows us to ensure you maintain on track as we retest measurements throughout your rehabilitation journey to ensure you are achieving your goals. This helps ensure motivation and compliance to exercise programmes is high which can be a challenge otherwise in chronic conditions such as gluteal tendinopathy.
Don’t put up with lateral hip pain thinking it will eventually go away. Don’t let it disrupt your sleep and affect your ability to live an active healthy life. If you or someone you know is struggling with lateral hip pain call us now and get started on returning to the life you want to live!