Condition guide
Pain on the outer side of the hip is usually known as “bursitis”; yet the real problem is generally overload of the tendons that attach the muscles on the side of the hip to the bone. It gets worse when lying on that side, climbing stairs and walking for a long time. In a trial of 204 people, education and exercise gave better results than both a steroid injection and waiting.
It is irritation of the tissues over the bony point you can feel on the side of your hip (the greater trochanter). Most often the cause is that the tendons of the muscles on the side of the hip, which attach there, are loaded more than they can bear; sometimes the small fluid-filled sac in the area (the bursa) becomes inflamed as well.
It is most common in middle-aged women but can occur at any age. A direct blow such as a fall, weak hip muscles, prolonged walking or running, and excess weight set the scene; often no clear cause is found.
The LEAP trial, carried out in Australia, tested this question directly. 204 people aged 35–70 who had had lateral hip pain for at least three months were divided into three groups: eight weeks of education and exercise with a physiotherapist, a single steroid injection, or information and waiting only.
At eight weeks, the share of people saying they were “markedly improved” was 77% in the education and exercise group, 58% in the injection group and 29% among those who waited. After one year the figures were 79%, 58% and 52%: education and exercise kept its lead, while the difference between injection and waiting was no longer significant. Pain intensity at one year was similar in the injection and exercise groups. No serious side effects were reported.
The programme in the trial had two parts: learning what strains the tendon and adjusting the load, and a home programme of 4–6 exercises a day that strengthen the muscles on the side of the hip. In other words, posture and habits during the day are as much a part of treatment as exercise.
Exercises at home
Mild discomfort during the exercises is acceptable; the pain should not be severe or long-lasting. If the pain increases, reduce the number of repetitions or the difficulty. Muscle ache felt a day or two after exercise is normal.
Lie on your back with your knees bent. Fasten a belt or elastic band around your thighs. Gently push your knees outwards just enough to tension the belt and hold; your legs do not actually move.
Hold for 10 seconds, 10 repetitionsStand beside a wall with your painful side towards it. Bend the knee on that side and press the outer side of the knee against the wall. Do not let the knee of the leg you are standing on turn inwards.
Hold for 10 seconds, 10 repetitionsLie on your back with your knees bent. Tighten your tummy and buttock muscles; lift your pelvis slowly and lower it with control. Do not let your lower back arch.
10 repsStand with your feet hip-width apart. Bend your knees and hips as if you were going to sit on a chair; keep your knees in line with your toes. Then push back up.
10 repsPut an elastic band around your knees. Take a step out to the side, a little wider than hip width; then bring your other foot in to hip width, without bringing your ankles together. Keep the band under tension all the time.
10 steps in each directionHold lightly onto a worktop and stand on your painful leg. Do not let your pelvis drop to one side or your hip slide outwards; you can check in a mirror. If the pain increases, shorten the time.
10 seconds, 5 repetitionsFlare-ups can happen; on those days reduce the repetitions, or rest for a few days and start again. If your pain is severe, stop the exercises and talk to your physiotherapist.
Video
From the YouTube channels of Somerset NHS Foundation Trust in England and UC San Diego Health in the USA.
An information video prepared by the hospital’s physiotherapy team.
A video showing home exercises for trochanteric bursitis.
Most of the time it is not bursitis alone. The source of the pain is usually overload of the tendons that attach to the bony point on the side of the hip (tendinopathy); sometimes the small sac there (the bursa) is inflamed too. That is why the name “greater trochanteric pain syndrome” is used today.
In the LEAP trial of 204 people, the injection did better than waiting at eight weeks, but worse than education and exercise. After one year there was no significant difference left between those who had the injection and those who waited. The injection is therefore not regarded as a first choice; it may be considered for short-term relief if the pain is severe enough to prevent exercise.
It takes patience: recovery often takes 6–12 months. Even so, in the LEAP trial about three quarters of those who had education and exercise reported marked improvement at eight weeks. If you have a flare-up, reduce the repetitions, or rest for a few days and start again.
Do not lie on the painful side. You can lie on your back with a pillow under your knees, or on your good side with a pillow between your knees; this stops the top leg dropping forwards and stretching the side of the hip.
See a doctor without delay if you have any of the following:
Sources
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