Physio Penrith Lateral Hip Pain Treatment
Treatment of Lateral Hip Pain at Sydney Muscle & Joint Physio Penrith
What is lateral hip pain?
Lateral hip pain has traditionally been referred to or blamed on as trochanteric bursitis, but more recent evidence has demonstrated that bursal distension is an inconsistent feature of lateral hip pain. Furthermore, these bursa had no signs of acute or chronic inflammation. Many research papers are now showing that bursal distension is almost always a secondary finding associated with a primary pathology of gluteus medius or minimus tendinopathy. Therefore, lateral hip pain is often referred to as greater trochanteric pain syndrome and it means that your more likely have a gluteal tendinopathy and/or hip bursitis.
How might I irritate my lateral hip pain?
At Sydney Muscle & Joint Physio Penrith our physiotherapists pride themselves on research supported interventions in the management of lateral pain pain. Treatment of lateral hip pain needs to be in two equal parts. One settling the tendon down and then building it back up. Reducing irritation is key and interventions like stretching, foam rolling, massage and using a spiky ball are not helpful or recommended. One very important factor to consider in the treatment of lateral hip pain is that compressive loads against the tendon and bursa is a major source of irritation.
Therefore, tendon decompression strategies aim to minimise the amount of compressive loading that may occur over a 24-hour period and this is the key to early symptom control. Positions to avoid include standing hanging on one hip in adduction, sitting with legs crossed, or sitting with the feet wide and knees together. Sitting in low seats, such as lounges and car seats with more than 90-degree hip flexion for prolonged periods can also be a problem and can result in ‘start up’ pain on rising to stand. avoiding low chairs and using a wedge cushion to bring the hips higher than the knees can be very beneficial.
Further, consideration needs to be at night tine with sleeping as patients may be most painful at night, particularly lying on their side, or when initiating rolling over. Sleeping in side lying with a pillow between the knees with your affected hip up may provide some sleep relief. Lastly, stretching, while a common strategy, will only aggravate the situation due to the associated prolonged compressive loading.
How does Sydney Muscle & Joint Physio Treat for lateral pain?
Pain relief
At Sydney Muscle & Joint Physio Penrith pain relief modalities for the management of lateral hip pain include heat and ice, topical NSAIDs, oral NSAIDs and low load isometric contractions. Further, bursitis and gluteal tendinopathy injuries do not like to be stretched or compressed- as a result our physiotherapists do not stretch the hip joint or do massage at the site of pain.
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Passive modalities
Traditional treatments for lateral hip pain from greater trochanteric pain syndrome are generally aimed at reducing pain and inflammation, rather than altering the tendon structure. There is generally a lack of evidence for modalities such as deep transverse friction massage, therapeutic ultrasound or acupuncture.
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Exercise-based therapy
Exercise is the most usual treatment for tendinopathy and at Sydney Muscle & Joint Physio Penrith isometrics, heavy slow resistance and eccentric loading are the most favourable exercise regimes. Tendons respond best to high load movements that avoid aggravation of pain. For greater trochanteric pain syndrome a progressive exercise program to strengthen the tendon and allow the bursa to settle down is best practice. Starting with various isometric contraction exercises, progressing through to high load heavy resistance exercises and ending with stairs and/or jumping type movements.
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Corticosteroid injection
Local corticosteroid injections are commonly performed for greater trochanteric pain syndrome. The precise mechanism of how corticosteroid injections effect tendon pain is unclear, because it is likely due to effects on inflammatory and nociceptive pathways. There is strong evidence of a short-term benefit with corticosteroid injections for greater trochanteric pain syndrome . Studies show significant early improvement of greater trochanteric pain syndrome up to 3 months, with greatest effect at 6 weeks, but often recurrence in the longer term. Corticosteroid injections may be most appropriately used to reduce pain which would enable physiotherapy to be most effective. A concern for use of corticosteroid injections is the possibility for weakening the tendon structure in the long-term.