Lateral Hip Pain

There are a plethora of musculoskeletal structures which can cause or contribute to lateral hip pain. The hip is a region of converging information and tends to muddy the water when is comes too diagnosis based on symptoms only. What I mean is that there are multiple musculoskeletal sources of adult hip pain. Pain sources can include lumbar spine, femoroacetabular (hip) joint referral, sacroiliac joint pathology, piriformis syndrome, and proximal hamstring tendinopathy, gluteal tendinopathy, and bursitis Hip pain is further divided into causes that are intra-articular (ie, labral tear, osteoarthritis, osteonecrosis) and extra-articular (ie, snapping hip and inguinal disruption [athletic pubalgia]). Entrapment neuropathies and myofascial pain should also be considered in each compartment.

The hip is a place where a lot of structures can cause pain and the longer standing the problem, increases the probability of multiple structures involved.

So what do we do with lateral hip pain? The best action plan is to have a physiotherapist perform a differential diagnosis with a thorough clinical examination to determine source of pain and contributors to pain. Unfortunately, in the current environment of high probability of communicable disease, you might have to wait for that examination.

Today I will specifically address a gluteal tendinopathy with a mild underlying labral tear. One of the main features of this clinical diagnosis is pain with muscle contraction ie: lifting leg up laterally or into flexion to put on pants. Pain is typically located on the greater trochanter bone on lateral hip region. With the labral tear, it is similar to an impingement problem, where flexing or extending hip excessively is very painful. There is typically a profound weakness with hip abduction (raising leg to the side) and/or hip flexion (sitting in a low chair, putting on pants, etc…).

This targeted exercise program is inspired by an actual patient. This is your workout… THE BOB

Abdominal crossover isometrics 2×30 sec holds, push hand into knee matching resistance of hip and arm, this is a progression with trunk slightly rotated to the side

lateral hops/side to side 20-30 seconds to start advancing to 1 min. Gentle hops over a line side to side, this will get your heart pumping.

Squat Pullups 2x1min resistance band tied around thighs just above knees, push laterally into band, squat down keeping heels on floor, pull up with arms.

Lateral walks with slight lift of leg into abduction 1x1min theraband tied around legs as squat pull up. side step into resistance band and slightly lift leg laterally, change direction and do the same thing on the other side

Lateral planks 1x1min each side. Laying on side, lift up onto forearm with hip off floor, make sure shoulders and hips are lined up.

Lateral leg lift/holds with progressive resistance 2x1min each side, resistance can be added by tying theraband around ankles