Hip Pain – lateral tendon

Pain on the side of the hip (lateral hip pain)

Gluteus medius/minimus tendinopathy

gmA 47-year-old woman presented with right side hip pain (on the outside of the hip). She got the pain with running, walking up hills, lying on the side of pain and crossing her Legs. She stated she had the pain for the last two months.

She also stated that she started work in the gym four months ago with the aim of losing some weight. She had been working with a personal trainer who had encouraged lots of squats and running especially uphills with sprint work.

She was otherwise well with no significant health concerns although she felt she may have the start of menopausal type symptoms.

On examination, she had pain and tenderness over the side of the hip and pain with resisted muscle testing of the side hip muscles/tendons. During the physio interview, she reported pain at the time with her legs crossed the pain would reduce when she stopped crossing her legs.

From this ladies history and assessment, it seemed evident she had a gluteus medius/minimus tendinopathy with possible bursa irritation. (a tendon is a spring-like structure that attaches muscles to bone and a bursa is a small sack of fluid that sits between tendon and bone).

This is not uncommon in females around the peri-menopausal stage of life as a reduction in oestrogen causes the tendon to become weaker and more susceptible to getting stressed. This along with increased activity such as squats and running uphills and with habitual postures such as crossing legs all combine together to aggravate the tendon. When the tendon is in an acute or irritated state they will often respond well to sustained contraction/load (isometrics) of the tendon. This will often help the tendon settle down in the irritable stage. The research says ‘Conservative treatment is effective in the management of hip tendinopathies and may be considered the first-line approach for patients affected.’ Ref. 1.

I advised this lady to stop doing certain gym exercises that involved the legs, to stop crossing her legs as it puts compression on the tendon and stop lying on her side in bed at night and put a pillow between her knees when lying on the other side to stop the painful leg coming across her body.

Once the pain had settled over a couple of weeks we started a loading exercise program along with soft tissue manual therapy to desensitise and strengthen the tendon to cope with everyday activities. The evidence states that ‘education plus exercise performed better than corticosteroid injection use’ which is the route we were taking. Ref 2.

When she had adequate strength we could gradually reintroduce her squat exercises in a controlled way as well as increasing the running with intermittent hill work in a much more staged and gradual way to allow the tendon time to adapt to the new load.

In all, it took between 3 to 4 months in the process of setting going down the irritable stage to gradually strengthening to then returning to normal activities. With tendon problems, there is no quick fix as they take time to adapt. When people get over the age of 40 they seem to be more susceptible to tendon injuries as the tendon takes much longer to adapt to any new changes in force or load over them. Tendons don’t like stretch or compression positions during this time period so stretching is not advised. This lady I am glad to say was able to return to her activities.

Mark Brennan

Tendon Compression and Pain from RunningReform on Vimeo.

Ref 1. Evidence for conservative methods of treatment.

Ref 2. Exercise works for gluteal tendons!