- Kiley Holmes, PT
Lateral Hip Pain
Updated: Feb 6, 2019
Greater Trochanteric Pain Syndrome
You may not be familiar with this term, but it is a catch-all term for a group of conditions affecting the side of the hip. Some of the most common diagnoses that fall into this syndrome are trochanteric bursitis, external snapping hip (coxa saltrans), IT band syndrome, glut med tendonitis/tear, and sometimes piriformis syndrome.
This shouldn't be confused with gunslingers syndrome (which really isn't as cool as it sounds). The problem with this grouping of conditions is that the pain is all very close together and can be hard to differentiate -- also, anytime you have one of the conditions the others are not far behind.
Trochanteric bursitis is probably the most commonly talked about diagnosis, however, I would argue that it really isn't commonly the main issue. The trochanteric bursa is basically a cushion, or fluid-filled sack between the sharper part of your femur and the relatively fragile tendons. Bursitis takes place because it becomes swollen and irritated.
Generally there are three reasons:
1. You were laying on a hard surface on that side for a long period of time
2. You physically hit your bursa when falling or playing a contact sport
3. Your IT band is rubbing it too hard
If the most painful spot on the side of your hip is also the boniest spot, then you have hip bursitis. You just need to get the irritation down and remove the irritant. After a week of treatment and doing your tailored exercise program you should be at least 50% better, if not, back to the drawing board!
External snapping hip syndrome occurs when the IT band catches as it slides over the greater trochanter (the boniest spot on the side of your hip). It can often be heard from across the room and is generally not painful on it's own. It is, however, generally a sign that you may have hip issues coming your way. The test for this is simply the ober’s test.
The problem is that there is an internal snapping hip syndrome that can be painful in the front of your hip, a Thomas test (see below) can rule this out.
Either way core and hip strengthening along with hip and ankle mobility should lead to notably less snapping after about 4 weeks of treatment and/or exercises.
At this point there are arguments as to whether or not IT band syndrome is really a thing or if we have created it by constantly going after it. The IT band is the tendon of the tensor fascia lata (a very small muscle at the side of your hip) and can get irritated. It is a very long tendon and, like every other tendon, it could get tendonitis. It is more likely, however, due to poor hip stability - hip stability can take 2-3 months to completely fix, mainly with a tailored exercise program. You should be noting a significant change in the first week of treatment, otherwise back to the drawing board.
The glutes are a very important part of hip stability - often times they are referred to as the rotator cuff of the hip - and everything goes awry when they aren't working properly. Glut minimis and glut medius both attach onto the side of the hip and, much like the rotator cuff, they can get tendonitis or even a tear. Immediately behind the boniest spot on the side of your hip is the tendon. If that or any thing else behind that is the painful part it's either tendonitis or a tear. To determine if it is a bad tear our just tendonitis the strength of the glut must be assessed. The good news is surgery is typically not needed for a tear, unlike the rotator cuff. Typically you should note at least a 25% decrease in pain after the first treatment and you will be feeling pretty good while keeping up with your exercise program.
Piriformis syndrome can come all the way out to the side of the hip, although the complaint is usually directly posterior. As the piriformis is much deeper you will typically complain about a deep pain. Testing piriformis length and strength to reproduce the pain is the best way to determine this diagnosis. Manual therapy is usually helpful, however, the piriformis tends to be the victim of a bigger issue. Typically it is seen with a low back pain issue, sacroiliac dysfunction, or poor hip stability. As soon as the real issue is addressed the piriformis should feel about 75% better before it has even been addressed.