How to Beat Hip Pain

What Is Hip Pain?

Hip pain can present itself in a myriad of ways. It can feel like pinching at the front of your joint, a deep, dull ache in the buttock, or burning pain on the side of the leg. It can even be felt as referred pain in the groin and knee region or present with associated stiffness and tightness across your whole leg. Lateral hip pain is a particularly common problem – prevalent in women between 40-60 years old and in 25% of the general population (Williams and Cohen, 2009).

If you have a hip problem, it can affect many of your day-to-day functions negatively, for example:

• Putting weight on the leg
• Walking, or taking large steps
• Getting in and out of a car
• Sitting or driving for long periods
• Sporting activities like running, change of direction, kicking a ball, etc.

So What Structures Can Be Involved?

Your hip is a ball and socket joint made of the head of the femur sitting in the pelvic acetabulum. While it has good mobility in all directions, it is also one of the most stable joints in the body. There are numerous muscles, tendons, and ligaments crossing the region and if any of them become dysfunctional, it can set off a host of problems in your hip. Here are the common structures that can cause hip pain:

• Glute maximus, which is the main power muscle of the leg and helps generate force in many activities
• Smaller muscles like the glute medius, tensor fascia lata, and piriformis, which help stabilise your hip joint and pelvis
• The gluteal tendon, which is where your gluteal muscles attach to the hip bone itself
• The psoas and iliacus muscles, aka your hip flexors, which originate from the spine and attach the hip bone
• The sciatic nerve, which passes through under the piriformus muscle before it travels down the rest of your leg
• The labrum, which sits inside your joint to help keep the ball in the socket
• The trochanteric bursa, which helps the tendons glide smoothly over your hip joint

However it is important to remember that the hip joints connect closely with the pelvis and spine, so it is common for dysfunctions in these areas to present as hip pain – this is a good reason to make sure you explore thoroughly for the source of the pain before settling on a diagnosis. In our clinical practice, we have found sources of hip pain coming from problems in the spine and trunk, but also areas as remote as the foot or the shoulder. When diagnosing the cause of an injury, it is best to leave no stone unturned!

Let’s Get Specific: Gluteal Tendinopathy

The gluteal tendon connects your gluteal muscles to the side of your femur. When this tendon degenerates, this is called gluteal tendinopathy and can often present as pain and tenderness on the outside of the hip, as well as any number of symptoms mentioned earlier. You might also notice pain and stiffness upon waking up in the morning that improves with activity and then becomes painful again as you cool down.

This degeneration can result from repetitive movements of the hip that cause compressive force over the tendon – typically when the leg crosses the midline of the body (e.g. when crossing your legs or when your knees knock together) (Segal et al 2007). This compressive force, if persistent and beyond the tolerance of the tendon, will cause microtrauma and degeneration (tendinopathy) to occur.

Fortunately, gluteal tendinopathy can be fixed! Read on for info about how.

How Did This Happen To Me?

The reasons for why injuries happen are always individual to your lifestyle and activity. A sedentary office worker presenting with hip pain will have a very different cause than the runner who is running a mileage of 80km per week. Among our clients, the most common reasons for hip pain to occur are:

• Sudden increase in training loading
• Poor postures, like slouching or crossing legs
• Asymmetries in strength and stability around the body
• Poor technique in training and sport
• Structural deformities in the ball or socket of the hip which result in impingement with certain movements

Do’s & Don’ts

The basic rule of thumb: do not push through pain. Pain is a warning signal coming from your brain that tells you when your hip is not happy so when you push through pain, you risk aggravating your condition. Here are examples of activities and postures that can put stress on your hip:

• Sleeping on your side
• Sitting with crossed legs
• Standing with uneven weight on each leg
• Stairs
• Wearing heels
• Running
• Overstetching (if you feel more pain after stretching, this is not the intended effect!)

If any of these positions aggravate your problem, do your best to modify or avoid them where possible.

What Can I Do About My Hip Pain?

The good news is that you don’t have to put up with it! If you are experiencing hip pain, there are a few options for you to start fixing your problem straight away. Watch our video series on gluteal tendinopathy – it includes more information as well as key exercises to try at home. Exercise and strength work have been proven to improving function and decreasing pain, so keep moving where possible (Mellor et al. 2018).
If you are not finding improvement on your own, it is best to speak to a health professional you trust and get it checked out. Remember, the problem may not be coming from the place you are experiencing the pain! If you would like more personalised advice, our physios are available to answer your questions so feel free to call our clinic on (03) 9370 5654.

References

1. Segal NA, Felson DT, Torner JC, et al, Multicenter Osteoarthritis Study Group. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 2007;88:988-92.
2. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009;108(5):1662–70.
3. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercises versus CSI use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BJSM 2018; 52(22):1464-1472.