Pain in your hip, what is it?

Are you getting pain in your hip? Firstly, I think it’s important to clarify where you mean by your hip. If you were suddenly asked to perform the song ‘Let’s do the time warp again… with your hands on your hips’ then you would put your hands on the side of your pelvis and this is what we are discussing today.

I see many women who complain of pain in the hip area. The pain can be just an annoying awareness that is sore when you lie on your side or sit for too long. But it can also become problematic and affect you when you are running, walking, climbing stairs and ultimately stop you from your exercise.

Let’s take Sue, she’s a keen tennis player and has played for years, that hasn’t changed. She plays 3 times per week in social tennis as well as competing in a league. Recently she started Pilates and also as she is hitting the 50 mark this year has decided to do more walking.

Meet Beth, she’s 43 and a running fanatic, always runs and always will, nothing will stop her. She runs 5miles x2 per week and a 10miler at the weekend. She occasionally has had some tightness in the side of her hip, but she stretches it and gets the tennis ball into those sore spots which normally does the trick. Beth’s youngest daughter has just started full time school so as a treat to herself she has started to enter events and has signed up for a half marathon in 6 months’ time.

Two ladies doing different things but a common problem.

What can cause pain in the side of the hip?

Often, we don’t know what is there… is it my hip? My back? Or my leg? This makes it hard for us to know what to do.

As a physiotherapist, the main sources for pain around the outside of your hip area can be:

• Your lower back

Often there is a mixed picture which means that you may have some problems with multiple areas. If you have a problem in your back it will tend to radiate or travel down into the side of the hip, if the problem is from the Gluteus Medius tendon then it will start at the side of the hip and sometimes travel down the side of the leg. If there is some low back pain and it feels connected with the pain at the side of the hip, then it is probably coming from your back.

• Hip joint

If you have a hip joint problem often you will get pain into your groin. There will be pain when are walking putting weight through the leg and you may also notice reduced movement in the hip. People often describe stiffness in the leg when sitting crossed legged or when putting on socks. You may get pain at the back of the hip joint and this generally would be considered if treatment of the gluteus Medius was not successful. MRI would be the best way to decipher this.

• Your Gluteus Medius tendon

If we have excluded the back and the hip joint then another possible cause could be the Gluteus Medius tendon. This isn’t the brother of the famous Gladiator although perhaps it is because it’s the smaller muscle to Gluteus Maximus.

• Trochanteric bursitis

Trochanteric bursitis is something of an old-fashioned term now and many clinicians now believe that this diagnosis was often Gluteus Medius Tendinopathy as the symptoms are the same.

Your Gluteus Medius is the muscle that is on the side of the hip and helps you with any activity on one leg such as walking or running. This tendon as with other tendons can become aggravated when it takes on more than its capable of.

So, in our two cases above Sue’s Gluteus Medius could cope with the 3 days of tennis but couldn’t cope with the Pilates or the increased walking. Pilates is an interesting one and something I am aware of as I have seen a growing number of women who have developed gluteus Medius pain since starting Pilates and this I believe is due to either over working the gluteus Medius (too many clams or oysters) or often because of lying on your side on a hard surface. Often on a studio floor on a mat.

With Beth her Gluteus Medius was able to cope with the amount she was doing but as she picked up her volume of exercise, the gluteus Medius probably was not strong enough to keep her going.

So, what can you do when your Gluteus Medius tendon is irritable?

The first thing to do is settle it down. You can do this by:

• Ice on your painful hip- twice a day for 5 days.

• Massaging Ibuprofen Gel in to the area, 1 per day for 5 days (unless you cannot use Ibuprofen Gel)

• AVOIDING THE FOLLOWING:

• Compression- Do not sleep on the side of the pain and sleep with a pillow in between your legs.

• Too much stretching- Do not cross your legs, sit in deep chairs, stand on one leg.

• Too much load- Stop running and Pilates for 1 week

• Reducing the amount, you are walking

Try this plan for 1 week to see if it settles, you can also try using a tennis ball to massage around your buttock muscles.

If things settle down, then the trick is to stay off all the stretching and lying on that side and start to build up the strength.

If things do not settle down, then it’s worth checking with a professional.

Things that may help

• If you do a lot of mat work at your gym or at home, try getting a thick mat to use or ask your instructor to give you substitute exercises for those that are painful.
• Build up the strength of your gluteus Medius muscle. This can be with specific gluteus Medius exercises but also building up your strength in standing with squats and single leg squats.

Strengthening the Gluteus Medius is key and it depends on what you are trying to achieve to which exercises you need. In our two case studies, the ladies’ goals are different and each will need to work out how much strength they need to do to get back to their sport.  A thorough programme is also useful as with most injuries as these muscles don’t work in isolation.

As the tendon settles and you can do more, make sure you have some form of regular strengthening for the Gluteus Medius in your programme. As with other tendon problems, once a tendon… always a tendon.