Be hip to your glutes

At our sports medicine clinic in Portland, Oregon, we frequently see active individuals with hip pain. From sports activity, to working, to walking, it's common to experience a hip injury when participating in a variety of activities. Common posterior hip injuries along the buttock area include muscle strains like hamstring injuries. Common sources of pain along the front of the hip include groin strains, stress fractures, labral tears, and hip arthritis. Common sources of pain along the outside or lateral aspect of the hip, what we commonly refer to as the greater trochanter area, include iliotibial band syndrome, gluteal tendinitis, and trochanteric bursitis. 

In this blog, we are going to spend some time talking about lateral hip pain because it is a common cause of pain in individuals over age 40. Gluteal tendinopathy is the most common cause of tendinopathy in the leg.  Sometimes lateral hip pain starts acutely from an injury, like a fall off a bike onto the hip, or a muscle strain from a new activity. Some times pain along the lateral hip comes on without a known injury.  While most of us are familiar with the gluteus maximus, there are two smaller muscles that are very important along the outside of the hip facing away from the body called the gluteus medius and gluteus minimus. These muscles attach to the bony prominence along the outer or lateral part of the hip, called the greater trochanter.

Pain in this area can be very challenging to diagnose and treat. Commonly individuals who present to our sports injury clinic with this type of pain report pain at night that awakens them when laying on their affected side. They may also report pain with going up or down stairs, or when sitting in a chair or sofa that puts pressure along that area.  

Hip pain in this area used to be referred to as trochanteric/hip bursitis.  However, we know that very few individuals have bursitis in this area. Instead, most individuals who have pain along the outside of their hip, have tendon pain known as tendinitis or tendinosis. Sometimes, these tendons can become inflamed due to overuse injury, such as jogging or playing a lot of tennis or pickleball.  These sports utilize the gluteus medius and minimus to stabilize the hip when moving side to side.  These outer hip tendons can also become painful due to tendon thickening known as tendinosis.  Think of tendinosis as mild chronic damage to tendons that is incompletely repaired by our bodies and eventually becomes painful. This tendinosis or tendinopathy as it’s sometimes called results is pain along the outer hip that can be constant and made worse with certain activities like sleeping on the affected side or climbing stairs.  

Treatment for this condition can be challenging.  Some people respond to traditional methods, such as a short course of medication, gentle stretching and strengthening, ice, and heat. However, the condition of hip tendinitis along the outside of the hip commonly persists for weeks or even months before finally resolving. At our sports injury clinic, we have a variety of treatment options for individuals with this type of pain along the outside of their hip. Beyond traditional treatments, we offer a variety of ultrasound guided procedures to treat this condition. In addition to corticosteroid injection, we also offer orthobiologic injections, such as platelet rich plasma (PRP) for individuals with chronic pain. Also, we can perform a minimally invasive tenotomy procedure to remove the area of tendinosis causing tendon pain and repair the tendon.  After removing a small area of damaged tendon, the individuals' body can initiate a more active healing response that helps repair the tendon more appropriately and can relieve pain.  This procedure has very little downtime and most people can resume all normal activity several weeks after the procedure. 

At Sports Health Northwest, our sports injury specialists are here to help you recover from hip pain and resume normal pain free activity. 

Author

David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.