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Lateral Hip Pain

Lateral hip pain, pain at the side of the hip, is a relatively common complain among gym attenders, runners and football players. The lateral area of the hip houses the tendons of the large buttock muscles which control pelvic stability and also contribute to knee stability. Between the tendons and the bone in various places lie lubricating sacs with small amounts of fluid inside, called bursae. When these sacs become inflamed they can cause bursitis and hip bursitis is a common diagnosis of lateral hip pain.

A large number of disorders are capable of causing hip pain and the hip area can refer pain to other parts of the body, with the lumbar spine also capable of referring pain round to the lateral hip, making this part of lower back pain. This means the cause of pain must be carefully assessed to eliminate innocent structures and identify the guilty party.

Although people refer to hip pain as rather vaguely around the greater trochanter area of the femur, it is possible to determine if the pain is in front of this (anterior hip pain), genuinely to the side (lateral hip pain) or behind (posterior hip pain).

Anterior hip pain is more common than the other types and often secondary to osteoarthritis in the hip joint itself. It can also result from a muscle strain or tendonitis of one of the hip flexor muscles or bursitis around the iliopsoas tendon. Early osteoarthritis has been found in many people with anterior hip pain, although hip replacement is only performed for more advanced hip arthritis.

Lateral hip pain is at the side of the hip and is most likely the result of three diagnoses, meralgia paraesthetica, iliotibial band syndrome or greater trochanteric pain syndrome.

Trochanteric bursitis has been the typical diagnosis attributed to lateral hip pain however MRI studies have shown that tendon tears in the tendon of the gluteus medius muscle occurred in 45% of cases and tendonitis in 68% of cases. This raises the question that bursitis is not the diagnosis at all but rather a degenerative condition of the hip tendons. This is now known as greater trochanteric pain syndrome.

The iliotibial band is a wide band of tendinous tissue on the side of the thigh and where it passes over the greater trochanter it can become irritated by repetitive actions. Hip pain running is a common complaint from people who markedly increase their distance running within a short time and overstrain some of their soft tissues.

The third cause of this kind of thigh pain is meralgia paraesthetica, a condition where patients complain of increased sensitivity and pain in the front and side of the thigh, with some having lateral hip pain. The cause is compression of a nerve as it runs from the pelvis to the leg.

Posterior hip pain, felt behind the greater trochanter, is less common and is likely to be caused by problems away from the hip joint such as degenerative changes in the lumbar spine and sacroiliac joint disorders.

Hip pain relief can be achieved by local steroid injection or by physiotherapy using ice, stretches, deep tissue massage, deep frictions and exercises. A physiotherapist can advise on biomechanical alterations to sporting activities to minimise the likelihood of these kind of conditions occurring.

There is a good article on thigh pain with diagnostic criteria here and Emedicine has a detailed page on hip tendonitis and bursitis, typical causes of lateral hip pain.

 


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