Pain felt over the outside of the hip joint, particularly over the bony aspect on the side of the upper thigh.
What causes lateral hip pain?
Pain in the lateral hip most commonly arises from two structures – the gluteus medius tendon (where the muscle attaches to the hip bone on the outside of the hip) and a small fluid pad called a bursa (trochanteric bursa).
Lateral hip pain develops in one of the two following ways; Trauma and Overuse.
Trauma – e.g. a fall or crash from your bike can lead to a heavy landing on your side. If you are struggling to weight bear following the crash then it is essential to get an x-ray to check for any bony injury. If there is no bony injury then it is quite likely you will have caused some damage or irritation to the trochanteric bursa or glute med tendon.
Overuse – This is the more common cause of lateral hip pain in cyclists. During the pedal stroke the glute med tendon slides back and forth around its attachment to the hip. As this happens it is compressing the bursa that lies beneath it. If there is excessive motion of the rider on the saddle (hip drop to one side) or glute med weakness, then inadequate support can lead to more compression and tension on the outside of the hip.
Women are most at risk
Older than 40 years
Low back pain
Previous knee pain
What are the symptoms?
There are a number of clinical tests which can indicate this as a likely diagnosis
Immediate pain or inability to stand on one leg for 60 sec
Pain while hip hitching in standing, this motion puts pressure on the side of the hip and very quickly elicits symptoms if the area is aggravated
Pain while lying on the affected side - particularly on a harder surface
How can I manage Lateral Hip Pain?
The crucial first step is to try and avoid the positions that cause greatest load and compression of these structures. The picture below from research by the ‘Hip Guru’ Alison Grimaldi demonstrates the positions to try and minimise or avoid.
As with most tendon problems there is a good evidence to support the need for specific loading exercises to help return the muscle and tendon capacity that has been lost. These protocols can be moderately painful at first but it is vital to restore the tendon’s capacity for load.
An example of some early glute med tendon loading exercises are shown below. (Source: Research by Alison Grimaldi 2015).
General strengthening is also important to incorporate any muscles in the hip and leg that demonstrate weakness on clinical exam.
Common muscle weakness seen in this population centre on glute med, glute max, and the adductors. Though lower abdominal and core strength may also need to be addressed.
Stretching creates further compression forces around the tendon insertion and bursa which can often make matters worse. As such, stretching is not advocated as part of management of this condition.
See a specialist physiotherapist for guidance and an individualised rehabilitation programme to help you overcome this problem.
Book a Physiotherapy consultation
Clinical exam often reveals pain and myofascial tension in the gluteal muscles which can be alleviated with sports massage treatment. However, as a stand alone treatment it will not resolve the problem at its root. As such it is best incorporated as another helpful adjunct in a comprehensive rehabilitation approach.
It is a major concern when it comes to lateral hip pain. Since compression is a common causative factor the more lateral shifting on the saddle the more likely there is to be aggravation. A saddle that is too high is one of the most common culprits.
Stance width of the pedals
If this is substantially narrower than your natural hip width it can place greater compression force on the lateral hip.
There is growing evidence that shockwave therapy can be effective at reducing tendon related hip pain and indeed kick starting the healing process when it is used in conjunction with a well structured loading programme. The diagnosis must be clearly established as it may aggravate symptoms if they arising from bursitis rather than tendon.
Steroid injections have demonstrated good effect in reducing pain and disability associated with gluteal tendon pain but most recent research actually found that a combined approach of education and loading exercises outperformed the steroid injections at all time points up to 1 year post intervention.
What else could it be?
Hip joint arthritis
Referred pain (spinal)
If you are having issues with you hip and want to get in touch about booking a consultation or a bike fit then please email us: firstname.lastname@example.org.