Hip Bursitis, glute tears or tendinopathy all fall under an umbrella term which is now called greater trochanteric pain syndrome (GTPS). If you experience lateral hip pain, which is worse with prolonged sitting, weightbearing activities or lying on the that side sleeping; chances are you may have GTPS. There may also be accompanied pain radiation down the outside of the thigh to the knee that comes with this. Your hip pain may have started by sudden unaccustomed exercise, falls, prolonged weightbearing, or activity overuse or it may just have progressively worsened over time without any idea of a particular cause. So if you’ve noticed getting up stairs has been a lot harder or your balance isn’t so good as it used to be these are all indicators we look out for and can be assessed whether they’re contributing to your hip pain.
Potential causes for GTPS are compressive forces of the Illio-tibial band (ITB) and tensor fascia lata (TFL) over the greater trochanter (thigh bone) and impinging bursae and gluteal tendons [1-3]. Compressive forces are increased where there is weakness of the hip abductor and gluteal muscles due to lateral pelvic tilt and poor single leg stability; leading to inflammation, tendon degeneration and further increased pressure on the side of the hip [1,4]. Pelvic control in single leg stance is controlled 70% by the hip abductor muscles and the ITB tensioners (glute max, TFL, vastus lateralis) account for the remaining 30%. People with gluteal tendinopathy tend to have glute medius/mini atrophy and TFL hypertrophy. Weakness and/or muscle bulk changes impact the balance of the abductor mechanism and increase the compression of the gluteal tendons [5]. GTPS is more frequently diagnosed in females between the ages of 40 and 60 due to pelvic biomechanics [1-3,6]. Other risk factors include age, obesity/BMI, osteoarthritis of the knee or hip, lower back pain and leg length differences [3]. Approximately two thirds of patients with GTPS will have co-existing hip osteoarthritis or low back pain [7].
Your lateral hip pain can be successfully managed with weight loss, anti-inflammatory’s, targeted physiotherapy, load modification, and optimising biomechanics via strengthening the correct movement patterns [1].
Our Physio can provide the guidance you need to recover from your hip pain to living happy and healthy.
Assessment and diagnosis
Education and advice
Structured hands on treatment and exercise therapy to facilitate recovery
Home exercise prescription
Return to pre-injury activity
There are 3 stages to making a full recovery
Phase 1: [Re-education; mobility; activation]
Gluteal activation/strengthening [1,6,8]
Load management, activity modification - avoid stretching ITB/glutes, sidelying, sitting cross-legged [6]
Restore hip range of motion, correct lower-limb biomechanics and alignment [1,5]
Dry needling [9]
Phase 2: [Strengthening]
Lumbarpelvic/ core and postural control [1]
Progress gluteal exercises (increased resistance/single-leg load) [6,8]
Maintain alignment, ongoing gait training [1,5,6]
Phase 3: [Specificity/functional training]
Increase hip and lower-limb strength/power and endurance specific to individual needs. E.g Sport, walking, gardening.
Assessment and diagnosis for each individuals injury should always be conducted prior to developing a treatment plan with exercise prescription and appropriate progressions. Should you have any further questions or would like to discuss your heel or foot pain with a physiotherapist, please contact Our Physio Central Coast (02) 4339 4475.
References
[1] Speers, C. J., & Bhogal, G. S. (2017). Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. British Journal of General Practice, 67(663), 479-480.
[2]Reid, D. (2016). The management of greater trochanteric pain syndrome: a systematic literature review. Journal of orthopaedics, 13(1), 15-28.
[3]Pianka, M. A., Serino, J., DeFroda, S. F., & Bodendorfer, B. M. (2021). Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology. SAGE Open Medicine, 9, 20503121211022582.
[4]Govaert, L. H., van Dijk, C. N., Zeegers, A. V., & Albers, G. H. (2012). Endoscopic bursectomy and iliotibial tract release as a treatment for refractory greater trochanteric pain syndrome: a new endoscopic approach with early results. Arthroscopy Techniques, 1(2), e161-e164.
[5]Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine, 45(8), 1107-1119.
[6] Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy, 45(11), 910-922.
[7] Collee, G., Dijkmans, B. A. C., Vandenbroucke, J. P., & Cats, A. (1991). Greater trochanteric pain syndrome (trochanteric bursitis) in low back pain. Scandinavian journal of rheumatology, 20(4), 262-266.
[8] Ebert, J. R., Edwards, P. K., Fick, D. P., & Janes, G. C. (2017). A systematic review of rehabilitation exercises to progressively load the gluteus medius. Journal of sport rehabilitation, 26(5), 418-436.
[9] Brennan, K. L., Allen, B. C., & Maldonado, Y. M. (2017). Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. journal of orthopaedic & sports physical therapy, 47(4), 232-239.