Surprising secrets fix sore hips
Sore on the outer hip? You’re not alone. Nearly 1 in 4 women over 50 suffer with this pain, with women are three times more likely to develop this problem than men. A tender outer hip can disturb sleep and make exercise uncomfortable, difficult and demoralising, It's often hard to get rid of, often persisting over months or years. It’s not just the pain that’s the problem here either. Lack of sleep, psychological distress and sometimes, failed treatment are common by-products (1) .
Outer hip pain is extremely common in women - understanding causes, dos and don’ts helps reduce pain.
Surprisingly, some standard hip stretches and side stretches which were previously thought to be pretty harmless, or possibly helpful can make things worse! It turns out understanding the problem, its causes, changing daily habits and very specific strength work holds the key to getting better (2).
Why do women in their 30s, 40s and 50s commonly have this problem?
Hormonal change
Outer hip pain sometimes linked to going through menopause and the reasons for this are complex. One theory is that the perimenopausal changes in oestrogen levels affect our response to inflammation and tendon repair.
It can also come on during or after pregnancy, with the changes in hormones and resulting changes in the pelvis and our ligaments, the increased demands on the body during childbirth, breastfeeding, caring for and carrying young children.
Sudden changes in activity
Doing more or going faster? Pain worsens when tendons, which attach the muscles to the bone, are under more pressure than they can cope with. Pressure increases when we take up new exercises, are more active for longer (e.g. run or cycle further than usual) or intensity (e.g. run faster, do a more high impact aerobics class), come back to exercise after a break or walk up steep inclines.
Slips, falls, gaining weight, sitting more and back pain and problems can also trigger or perpetuate the problem.
Outer pain can stop you running and moving well.
What's actually causing the pain?
The most common causes of this pain are gluteal tendinopathy and trochanteric bursitis.
Gluteal tendinopathy occurs when excess pressure on the tendons which insert onto the top of the outer thigh bone (femur), causes tendon breakdown, while trochanteric bursitis arises when there’s inflammation of the bursa, or sac, which sits over the outer hip. Classic symptoms of these problems are pain when lying on your side, especially in bed, walking up an incline or stairs, sitting in low chairs, sitting cross legged or standing on one leg. Most people with these symptoms have an issue with either the strength, control or activation of their deep gluteal muscles. Getting a diagnosis through Physio and/or medic is the first step to addressing it.
Physio and cortisone (steroid) injections are often used to address this problem. Steroid injections can have good results in the short term, but often have poor longer term outcomes and don’t necessarily address the cause of the problem. Patients are often left facing the option of having a cortisone, intensive physio or adopting a ‘wait and see’ approach.
Hip tendon problems (gluteal tendinopathy) and the hip bursa (trochanteric burstitis) can cause pain on the outer hip.
3 things which are certain to help help:
1) Avoiding certain common exercises and stretches which might actually make things worse! Static stretching can actually be counterproductive as they can compress the painful area, such as iliotibial band stretches or gluteal stretches which bring the bent leg up and across the body. Get sound information on which exercises will actually compress the hip and make it sore.
2) Education to give an understanding of the problem and how best to manage it.
3) Resistance exercises, done under guidance when the body is ready to handle it.
According to a recent Australian study (2), it's progressed, resisted exercises, against weights and bands and with the feet on the ground which have been shown to make the greatest benefits for women. These need to be really quite challenging, and increasingly so over many weeks. There's no recipe, but definitely proven standard way which can be adapted to your needs. Physio gait analysis will also help you get back to running and sport.
Exercises to try
Exercises such as bridges, pelvic lifts and heavier exercises recommended by a Physio reduce pain, both 8 weeks after starting them and even a year later. Exercise smarter, not harder, and you will get results. In the later stages, when pain is resolving and you are getting back to exercise, walking sideways against a resistance band can help.
Extra top tips to stop pain:
Changing sitting postures ( including sitting with knees uncrossed)
Standing in a position where the hip 'sticks out''
When going up stairs, walk with the legs slightly wider and use a stair rail
Don't '"overstride" (make strides longer than you naturally would)
Don't avoid activity.
Take charge of the situation by avoiding aggravating actions, managing pressure through the leg and doing the right exercises to get on top of your pain.
References
1 Fearon AM et al. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplasty 2014;29:383-6 doi:10.1016/j.arth.2012.10.016pmid:24210307
2. Mellor et al, Education plus exercise vs corticosteroid injection use vs a wait and see approach on global outcome and pain from gluteal tendinopathy: a single blinded, randomised clinical trial. British Medical Journal 2018;361:k1662 https://www.bmj.com/content/361/bmj.k1662
3. Grimaldi A et al. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med 2015;45:1107-19 https://pubmed.ncbi.nlm.nih.gov/25969366/
