Current Evidence for Lateral Hip Pain
How many time have you heard someone say, “I have ‘bursitis’”, when pointing to the outside of their hip?
It has been a very common diagnosis with fair response to treatments, including: use of modalities, stretching and even injections. In 2013, a study of 877 patients with lateral hip pain showed 20.2% of patients actually had primary bursitis and 78.5% had gluteus medius tendinopathy. If the condition is related to the tendon vs the bursa, then how do we best treat tendons? Throw away any previous thoughts on tendon treatment for a minute – I know this can be hard to do. Tendons are meant to handle tension, but do not like compression, and they really do not like both together. Compression of the gluteus medius tendon occurs with positions like lying on your side or stretching the ITB, which will put your hip into an adducted position. You don’t want to stretch tendons. Your overall goal is to load the tendon that stimulates recovery rather than symptom aggravation. Gluteal tendinopathy occurs as a result of increased loading that surpasses current capacity of the tendon (think walking, running, jumping, etc).
Current evidence for treatment includes reducing the load by decreasing provocative activities and avoiding compressive positions (side sleeping, NO stretching or sitting crossed legged). Starting with activities like isometrics are a good way to perform loading and promote remodeling of disorganized tissue that may feel “bumpy” with palpation. Allowing for proper recovery of 2-3 days after loading activities and progression to more aggressive strengthening may begin once symptoms have reduced. The best exercises for gluteal medius recruitment per EMG studies are side planks (involved side down), single leg squats and clam shells in side lying. It is important to view this problem correctly from a histological and physiological perspective to properly treat to allow the best chance for recovery.