Lateral Hip Pain- A different kind of pain in the butt?

Have you experienced a recent, non-traumatic onset of lateral hip pain? Are you noticing new leg and/or hip fatigue with walking or ascending stairs? Maybe even pain with prolonged sitting or lying on your affected side?  You are not alone!

Image is of an x-ray of the right side of the pelvis, hip, and femur.

Pain located on the side of our hip, also known as lateral hip pain, is common throughout our lives and affects nearly 10-25% of the general population. It is more common in women, and the prevalence increases as we approach middle age.  Patients will often hear a diagnosis with words like trochanteric bursitis, gluteal tendinopathy, or more recently greater trochanteric pain syndrome. But what does this mean? Should we walk or (painfully) run to our nearest provider for an injection? Not necessarily!

Greater trochanteric pain syndrome is the most up to date diagnosis for gradual onset lateral hip pain. It is an umbrella diagnosis for pain localized near the greater trochanter, which is the large bony prominence you can feel on your upper thigh. Structures causing symptoms could include the trochanteric bursa your gluteus medius or minimus tendons, or even be referred from your lower back!

So what does this all mean? The greater trochanteric bursa is a small fluid-filled sac that should act as a lubricating medium for nearby gluteal tendons to glide over during repetitive motions like walking, running, or stair climbing. Inflammation to the bursa is often due to repetitive microtrauma or tendinopathy to the gluteal muscles. After diagnosis, many patients with have a corticosteroid injection that helps with their symptoms in the short term. Although this could significantly help with symptoms, treatment should not consist of more than 1 injection for the health of the surrounding muscles and tendons! If you have had many steroid injections into your lateral hip over the past few years, or are walking with a significant limp, consider following up with an orthopedic physician and a physical therapist.

Recent research has shown that physical therapy (PT) treatments like dry needling are at least as effective over time as cortisone injections! Since lateral hip pain often stems from repetitive microtraumas to hip tissues, PT should focus on identifying your unique movement patterns and deficits. Manual therapy and exercise will be tailored to those specific needs. Most patients with a recent onset of lateral hip pain will improve with patient-specific treatment!

Written by Lara Baum PT, DPT, Board Certified Orthopedic Clinical Specialist

REFERENCES:

Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop. 2016;13(1):15-28. Published 2016 Jan 22. doi:10.1016/j.jor.2015.12.006

Lespasio MJ. Lateral Hip Pain: Relation to Greater Trochanteric Pain Syndrome. Perm J. 2022;26(2):83-88. doi:10.7812/TPP/21.110

Brennan KL, Allen BC, Maldonado YM. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. J Orthop Sports Phys Ther. 2017;47(4):232-239. doi:10.2519/jospt.2017.6994

Pianka MA, Serino J, DeFroda SF, Bodendorfer BM. Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology. SAGE Open Med. 2021;9:20503121211022582. Published 2021 Jun 3. doi:10.1177/20503121211022582