Osteopath Eddie Clark discusses this difficult and painful problem.
The Hip Pain Problem
In my job as an Osteopath, I see a large number of women and men aged 35-60 with quite painful and achy hips. I’m writing about this because it seems to be a bit of a silent epidemic. These patients that I see are genuinely suffering and limited by the problem and don’t find much relief at all with the traditional anti-inflamitories and wait-and-see approach. GP’s aren’t able to offer much more apart from a referral for a cortisone injection, which is often not effective or only effective for a short time. If you are going through this problem or know someone who is, Osteopathy can help.
This is a classic symptom a bunch of conditions variously called gluteal tendonitis, trochanteric pain syndrome, lateral hip bursitis, trochanteric bursitis, or hip abductor tendonitis. It is much more common in women- at a 4:1 ratio. This ratio is reflected in my patients too.
One of the most frustrating things for sufferers is that the condition has an insidious onset; i.e. the pain starts off very gradually and cannot be linked to any definitive event like an injury or fall. But once the condition has set in it often dogs the person over months or even years, easing over periods of lower activity and flaring up straight way as they try to get on with their lives.
Now before you go diagnosing yourself from information you read on an article on the Internet, let me just say this: it is not always this problem causing hip pain. If you are suffering and want to find out what’s causing the problem you need to see a professional like an Osteopath to verify you are suffering from one of these conditions. They can rule out other things and will also offer you treatment strategies.
In my experience this can be quite a debilitating condition for the person involved. Because of the slow onset by the time you have realised there is a significant issue you are already having daily pain that’s aggravated by walking, sitting and even lying down!
Discomfort sleeping and ache or stiffness upon rising are the first things I will ask about with a new presentation of hip pain. They are a bit of a cardinal sign of this condition. It hurts to lay on the affected side, but it can even hurt to have it stretched when lying on the good side. A large number of people are affected bilaterally (affects both sides) so it will hurt laying on either side regardless. This, of course, can make sleeping very difficult.
The pain is mostly around the side of the hips but can exist over the buttocks too. It is usually quite dull and aching pain in nature but if someone prods around over the hip you can usually find spots that are exquisitely painful to press. The pain can refer into the groin or down into the side of the leg as far as the knee and sometimes beyond.
About two thirds of people suffering with it will have back pain or hip arthritis as well. These can be seen as probably contributing to increase stress on the hip muscles and tissues.
Walking can be an issue with these hip problems. Usually it is okay at the start but over a predictable amount of time walking – or sometimes a certain distance – the pain grows and becomes nagging. It can lead to limping – either subtly or sometimes quite noticeably.
When you combine this tendency to aggravate the condition doing something as simple as walking with the potential for aggravation from sleeping postures you can see how this condition gets easily entrenched and can be very frustrating.
If you or a loved one suffers from hip pain
Here’s what we can do:
- First: Don’t despair. There are therapies that work well but you need to recognise and accept it’s not a quick-fix condition. It will take effort and education to get better. But you will recover if you make the time to do your therapy and your rehabilitation exercises and be patient.
- Second: Stop Stretching. Yes you read that right. If it’s a true tendonitis issue it might NOT benefit from stretching. This compresses the irritated tendon, which is bad. Current research suggests that this disturbs the blood flow in a negative way for the healing tendons and this can exacerbate symptoms and prolong the conditions.
- Third: Modifying your routing is absolutely essential. You will have to be careful with it. Part of the education process you will go through is learning and accepting that the tissue in your hip is injured and might have been so for some time. It will need a period of not being stirred up and then a deliberate, methodical and planned reintroduction of the activities you love but haven’t been able to do for pain. This is called a graded reintroduction and will form the backbone of your rehabilitation process. Around this plan you can do anything that makes your hip or hips feel better, but must strive to avoid and limit activities that make the pain worse.
- Forth: Get strong… Carefully. What shows up over and over in research into this condition is that careful strengthening programs work. They allow the tendon to heal properly and also increase the muscle and tissue conditioning of all the associated leg muscle groups. This makes the load on the hip more manageable and leads to less chance for relapse. But the difficulty is always in avoiding over-doing it. My advice is that this is where an Osteopath can be very useful. We can help in setting up a do-able exercise routing that can be supervised at first, but quickly progress to self-management once the symptoms show signs of improvement.
My references for this article come from a number of research articles on lateral hip pain syndromes and also from specialist podcasts and conference talks. More information can be gained by contacting the author at Sydney Health Professionals.