Causes of Outside Hip Pain

Whats really causing your hip pain? The term greater trochanteric pain (GTPS) describes a collection of overlapping conditions that cause lateral hip pain including trochanteric bursitis, iliotibial band syndrome, and strain or tendinopathy of the hip abductor muscles

What is Greater Trochanteric Pain Sydrome?

The term greater trochanteric pain (GTPS) describes a collection of overlapping conditions that cause lateral hip pain including trochanteric bursitis, iliotibial band syndrome, and strain or tendinopathy of the hip abductor muscles. Studies show that gluteus medius tendinopathy is the most common issue.

GTPS and its associated disorders result from common biomechanical deficits and produce common complaints. This, or any other bursal inflammation may occur in response to acute trauma, but more commonly develops from repetitive mechanical overload.

The tensor fascia lata muscle hypertonicity and iliotibial band tightness generate excessive lateral hip compression and predisposes the body for greater trochanteric pain syndrome. This may be secondary to hip abductor weakness or a leg length inequality.

Primary symptomatic contributions to GTPS from the hip abductors include muscle trigger points, musculotendinous strains, tendinosis, tendinopathy, and tendon degeneration. Tendinosis or tendinopathy is characterized by injury, failed healing, and subsequent tendon degeneration.

20%-35% of patients affected with greater trochanteric pain syndrome suffer with concurrent lower back pain.

Clinical Presentation

Greater trochanteric pain syndrome presents as a chronic, persistent pain in the lateral hip, glutes, and proximal thigh. GTPS symptoms are often provoked by long periods sitting, especially with the affected leg crossed. Transitioning to a standing position, prolonged standing, climbing stairs, and high impact activity like running can also provoke pain. Sleeping disturbances are common, especially when laying on the affected side.

The most classic physical finding of GTPS is tenderness with palpation over the greater trochanter (hip bone on side of leg). Tenderness along the posterior aspect of the greater trochanter may indicate gluteus medius involvement, while discomfort at the anterior aspect may suggest gluteus minimus involvement.

Patients may demonstrate limited range of motion with pain upon passive adduction or external rotation. Resisted abduction is likely to reproduce GTPS complaints, particularly those with gluteus medius tendon involvement.

Clinicians should assess for biomechanical deficits that may contribute to GTPS including leg length discrepancy, foot hyperpronation, and lower cross syndrome. Clinicians should also assess for the presence of hip abductor weakness, which is prevalent in patients with this disorder.

Diagnosis

In many cases, radiographs are unnecessary for the initial assessment of greater trochanteric pain syndrome. Radiographs are only warranted in cases of trauma or when needed to rule out boney pathologies.

Cases that are unresponsive to a trail of conservative care require further diagnostic work-up. MRIs are the current standard of imaging for GTPS.

Management

The goal of treatment should be to correct faulty mechanics and to prevent future overload. Conservative treatment of GTPS has shown a 90% success rate. Moderate rest, activity modification, and pain relief are the first things that should be addressed with this condition. During the acute pain phase patients may need to temporarily limit or discontinue aggravating activities.

Stretching and myofascial release techniques may be needed for the TFL muscle, IT band, external hip rotators, hip flexors, gluteus maximus, quadriceps, and hip abductors. The addition to IASTM may stimulate remodeling of the gluteus medius and gluteus minimus tendons. The use of a foam roller or massage stick may help with trigger points in the hip and thigh musculature.

A specific emphasis should be placed on strengthening the hip abductor and external rotators. Patients should be taught proper squatting and hip hinge techniques to limit hip internal rotation. Isolated hip stretching and strengthening exercises may be necessary to improve mobility.

A successful treatment program must address the entire mechanical chain. Clinicians should assess for and correct joint restrictions in the lumbar spine, hip, and pelvis.

Surgical treatment is indicated when the patient exhibits gluteus minimus and medius tears. Surgery is also only recommended if conservative care fails or an abductor power deficit is associated with pain.