If you have been feeling pain on the outer side of your hip, you could have a gluteal tendinopathy. This is a condition that is part of the Greater Trochanteric Pain Syndrome. It occurs from the degeneration of the tendons of a hip muscle called gluteus medius. This deep hip muscle is located on the lateral (outside) side of your hip. It’s mainly works in bearing weight and stabilises your hip joint. Gluteus medius plays a role in walking, lifting and supports your body weight when standing.
On the other hand, trochanteric bursitis pain comes from the inflammation of a small fluid filled sac called a bursa. We have many bursas throughout our bodies. They are located where a muscle tendon passes over bony a prominence or joint.
The trochanteric bursa lies over the greater trochanter on the outside of the femur (thigh bone). There is also a deep bursa that sits between the gluteus medius tendon and the greater trochanter. On the outside of the hip there is a superficial and a deep bursa. The superficial one lies under the ITB and the deep one under the gluteus medius tendon.
Symptoms of the Conditions
1. Gluteal Tendinopathy
• Pain in regular activities that use the tendon such as climbing stairs and hills and sit to stand
• Stiff hip joint when getting up in the morning or during the night
• Pain when trying to lie on the side of the affected hip
• It can be warm, tender, red or swollen over the lateral hip due to the inflammation
2. Trochanteric Bursitis
• Pain when you sit with the legs crossed
• Swelling and pain that travels from the outer thigh to the knee
• Pain when you try to lie on the affected hip
• Pain trying to stand up after sitting on a deep chair for long
• Instances of pain as discussed for gluteal tendinopathy
Diagnosis of the Condition
The diagnosis of the condition starts with a physical examination of the back, pelvis and hip. This is done to eliminate other possible causes. The significant sign is when you feel some tenderness when pressure is applied over the hipbone or the bursa.
On the other hand, gluteal tendinopathy is diagnosed by the use of muscle and weight-bearing loading tests and palpation of the muscle and tendon attachment. If you have pain over a wide area or it is not responding to treatment an ultrasound or MRI may be suggested.
Your clinical history is vital in differentiating any of the conditions from similar ones that affect the area.
You can manage this hip pain with conservative interventions that can include relative rest while avoiding actions such as crossing your legs. Cold packs for at least 20 minutes a time 4-5 times per day within the first three days of the onset of the pain can also work.
Physiotherapy treatment is also a great option. This could include Shockwave, dry needling, Computerised GaitScan and specific exercises. Sometimes, the cause of the pain for this condition is the weakness or tightness of the underlying muscles. In such a case, corrective exercises are the best way to strengthen and stretch the muscle.
Other interventions may depend on the risk factors. Poor gait, incorrect shoes, pain in the lumbar spine, a sudden increase in strenuous exercise and diseases such as thyroid function and diabetes. In some cases, an ultrasound-guided steroid injection may be an option.
If you would like advice on treatment for these very common conditions, give us a call on 9144 1510 and talk to one of our physio’s today.