Outer thigh and hip pain is common in athletes and non-athletes alike. Can’t run, can’t get comfortable at night, can’t do your regular yoga class without pain. What is causing it?
Women in their forties to sixties are especially prone to this type of pain. Specifically, those with leg length inequalities, scoliosis, low back pain, knee arthritis, and those who run. Though increasing your running time or distance is a common risk factor, interestingly, it is just as common in those who don’t or who rarely exercise.
Jenny is an avid runner, attaining 7-10km four days a week. Over the last two months, she had started to feel discomfort over her right thigh, which always got worse during her runs. It had been settling down with rest, but now it seems to be always present. Her hip is tender to the touch and she can’t sleep well at night when she lies on either side.
While all potential causes of hip pain need to be ruled out, she is likely experiencing her symptoms because of a compressed tendon in her hip called the gluteus medius.
We call this greater trochanteric pain syndrome, which is named for the area of discomfort on the outside of your hip. Your strong iliotibial (IT) band, which runs from the hip down to the knee, compresses the gluteus medius tendon when you bring your leg toward midline. When you have a faulty running or walking pattern, or weakness in your hip muscles, this compression can build up over time which will result in pain.
Jenny decided to see her physiotherapist at PhysioActive. During the assessment it was determined that she did indeed have greater trochanteric pain syndrome. This was because of an underlying weakness of her hip abductors - the muscles that lift and rotate her leg outward and keep her pelvis level when upright. When she ran, her right hip dropped, which caused the leg to move inward with each step.
Jenny could pinpoint her painful area near the bony prominence on the outside of her hip. If she ran a lot, pain would get worse and travel down her leg to her knee.
Historically, the pain was thought to be was coming from a bursa, which when inflamed, is called a bursitis. Recent research shows however that a bursitis is not very common in those who report this type of pain on the outside of the hip. MRI has improved our knowledge of the cause of this pain – in a study of 24 patients with these symptoms, a whopping 92% had no evidence of inflammation of the bursa! What was obvious in the majority of those studied was a deterioration of the gluteal tendons.
Armed with a goal of running without pain, Jenny followed her therapist’s advice and stopped running for three weeks. As the tendon in her hip was overloaded and compressed, the offending activity (running) had to be avoided to prevent further damage. Instead, she used the time to improve her swimming speed.
Treatment included soft tissue mobilisation, ultrasound and a specific hip strengthening and tendon loading program, followed closely by her physiotherapist. Occasionally, dry needling or shockwave would be added to the protocol to improve healing.
The exercise program was progressed over a period of 10 weeks, at which time Jenny had built back her running to 4-5km, twice a week. A few weeks later, she was able to attain her full training. The key to her success was the strengthening and balancing of the hip musculature. This allowed proper function of her pelvis and leg as she took each step, and significantly reduced the risk of recurrence.
Simply treating the problem as a bursitis would have led Jenny to a poor outcome. Tendon injuries can be improved, with the proper identification and treatment. One advantage Jenny had was that she did not leave it for too long, hoping it would recover on its own. Tendons heal significantly better if caught early, which in turn minimises the time away from sport.
If you are experiencing symptoms similar to Jenny's, contact us today and get your hip properly assessed!
This post was written by Leah Kieffer.