Finding relief for lateral hip pain

As common as lateral hip pain is, especially in women over age 50, many often don’t know the cause and reliable ways to ease it.

Lateral hip pain can be unusually distressing: A deep pain in the side of the hip that may travel down the side of the thigh and sometimes onward to the knee, it can be a major disruption to regular life activities.

Of the three main causes of chronic lateral hip pain (gluteal bursitis, gluteal tendonitis, and gluteal tendinopathy), tendinopathy seems to be the least understood. The pain, caused by a diseased or torn tendon, can be severe and interfere with physical activity, sleep, and overall enjoyment of life. Unlike bursitis or tendonitis, tendinopathy doesn’t usually improve with rest.

“While all three syndromes can have waxing and waning,” said Kevin Dwyer, MD, an orthopedic surgeon practicing at Cape Cod Orthopaedics and Sports Medicine in Hyannis, “tendinopathy is often the most difficult to treat.” He sees it often in his patients.

One summer resident of Falmouth, a woman in her late 60s, finds the suffering unlike anything else she has experienced.

“On a scale of one to 10, with 10 meaning I am completely undone mentally and physically by the pain, it’s about an 8,” she said. It often occurs without warning, she added, and stops her in her tracks, no matter what she is doing. It usually begins for her with a dull ache in the mid-glute area. “But if I continue doing what I'm doing, like walking, it progresses to an intense, sharp pain that radiates throughout my right hip and sometimes down the leg.” An MRI and advice from a physical therapist led to a diagnosis of gluteal tendinopathy for the woman, who chose not to be identified.

Diagnosis and Treatment

While an MRI can be useful for identifying tendinopathy, Dr. Dwyer said, it can be difficult to diagnose and treat.

“I’m not sure we know the exact etiology of gluteal tendinopathy in each case,” he said. “Sometimes it’s from compressive forces and micro-tearing of the tendon, which inserts into the greater trochanter, a bony part of the side of the hip that you can feel with your hand.” (Lateral hip pain is also known as “greater trochanteric pain syndrome.”)

Some experts estimate that one in four women over age 50 deal with gluteal tendinopathy. “Estrogen plays a role,” explained Dr. Dwyer. “The connection to estrogen is not totally understood, but estrogen likely helps maintain tendon strength.”

Anti-inflammatory medicine can help, as can laying off repetitive activities. When sleeping, lying on the unaffected side of the body also helps, he said. But physical therapy to strengthen the abductor muscles, and particularly eccentric strengthening, plus regular exercises after PT, is his go-to advice for long-term relief.

Cortisone injections can help, but it is a last resort.

“I try not to do this unless an intensive PT course has failed,” Dr. Dwyer said. Surgery is very rare, he added, but there is increasing interest in using surgery to help treat tears in the abductor tendons.

Exercises to strengthen the abductor muscles, prescribed by a physical therapist, require discipline, but is well worth it, according to Dr. Dwyer.

There is good news on the other side: “Most people get better over time.”