The surprising secrets to fixing sore hips
Sore on the outer hip? You’re not alone. 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) . Surprisingly though, 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).
So why do women in their 40s and 50s commonly have this problem? There's usually many causal factors, with hormonal changes likely to play a prominent role. Outer hip pain sometimes linked to going through menopause, weight gain and a sudden increase in activity levels. This pain arises when the tendons, which attach the muscles to the bone, are under more pressure than they can cope with. These types of pressure increases happen when we take up new exercises, rapidly increase exercise length or intensity, come back to exercise after a break or walk up steep inclines. In younger women, it can come on at the time of pregnancy or soon after, again associated with the increased demands on the body of pregnancy, childbirth and caring for and carrying young children. Slips, falls, gaining weight, sitting more and back pain and problems can also trigger or perpetuate the problem. Women may be anatomically predisposed to this issue too. We know women’s femoral head – the ball which fits into the hip socket – is smaller in women, and the female pelvis is wider than men's. This may increase forces on the tendons at the outer hip.
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. Recent Australian based research, which compared a Physio based exercise and education with having a cortisone injection for gluteal tendinopathy, showed Physio exercises and education to be superior in alleviating short and longer term pain (2) . 82% of the study's 204 subjects were women aged between 35 and 70, which reflects the spread of this problem across the normal population.
Results showed 4 key Physio led actions helped sufferers:
1) Specific exercises
2) Avoiding certain common exercises and stretches which might actually make things worse!
3) Education to give an understanding of the problem and how best to manage it
4) Gradual introduction of resistance exercises, and steady increases from higher impact activities, done under guidance when the body is ready to handle it
1) Doing static exercises, such as bridges, pelvic lifts and 1:1 heavier exercises with a physio were shown to have better reductions in pain, both 8 weeks after starting rehabilitation and after a year. It's vital to know which exercises to do and avoid some commonly done ones which actually effectively press on the painful area.
2) 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.
3) The way you walk and run, the way you sit, how you stand and how you lie to sleep at night can all affect your pain, positively and negatively, so it's important to get pointers on how to move in a way that won't aggravate you from a Physio who can go through your daily activities and exercise regime.
Want to stop it hurting?
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)
That said, don't avoid activity! Rather, just be aware that spending a lot of time doing activities which compress the hip, like hill walking, sitting cross legged or incorrect stretching can make the problem worse.
4) It's progressed, resisted exercises, against weights and bands and with the feet on the ground which have been shown to make the greatest difference. 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.
You can 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.
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/