Pain over the side of the hip is commonly due to a condition affecting the local soft tissues at the greater trochanter (the prominent bony bump at the side of the hip). The primary pathology is tendinopathy of the glute medius and/or minimus tendon, referred to as “gluteal tendinopathy”. Tendinopathy is primarily caused by repetitive overloading of the tendon, where the load applied to the tendon exceeds its capacity to tolerate that load.
Common signs and symptoms of gluteal tendinopathy are:
- Lateral hip pain which may spread down the thigh
- Pain with single leg loading tasks, such as walking and stair ambulation
- Moving from sitting to standing resulting in pain
- Pain with sitting on a low couch
- Pain from sitting with legs crossed
- Pain from side lying
Gluteal tendinopathy is a common condition, with research showing that it affects one in four women over the age of fifty. It can be a severely disabling condition, having been shown to have similar effects on an individual’s quality of life as severe hip arthritis. Surprisingly, for such a severe condition, there had been, up until recently, a paucity of research investigating possible treatment options.
Research on Gluteal Tendinopathy
The recently published ‘The Leap Trial’ (Mellor et al. 2018) was therefore a significant and much needed study. It compared the effects of (i) load management education plus exercise, (ii) a corticosteroid injection, and (iii) a wait and see approach (no treatment). In total, there were 204 participants in the study with ages ranging from 35 to 70, with all participants having experienced lateral hip pain for more than three months. The results of the trial demonstrated that the education and exercise group experienced significantly lower pain after eight weeks compared to the other groups.
The education component of the study encouraged participants to stay active with their normal daily activities and to avoid certain positions and movements that place greater compression on the tendon insertion at the side of the hip. In particular, the participants were asked to reduce exposure to:
- Stair ambulation
- Hill walking
- Side lying
- Standing on one hip
- Sitting on low couches
Progressive Loading Program
The exercise component of the study focused on a progressive loading program to improve the load capacity of the gluteal musculotendinous unit. A key conclusion of the study was that identifying an individual’s current physical level and goals was essential in creating an effective individualised exercise program, rather than providing a generic exercise program.
If you think you may have gluteal tendinopathy, our physiotherapists at Excel Physiotherapy and Wellness are able to perform a comprehensive examination as well as provide an individualised exercise program to help you reach your goals. You may call us on 1300 650 510 to schedule a consultation.