Lateral hip pain refers to discomfort felt on the outer side of the hip joint and is a highly common musculoskeletal complaint, particularly among adults. This pain is distinct from groin pain, which typically signals an issue with the hip joint itself. It affects a significant portion of the population, with estimates suggesting that up to 10% of the general public may experience it chronically. The prevalence is noticeably higher in women between the ages of 40 and 60.
Understanding the Location and Structures Involved
The pain described as lateral hip pain is centered around the outside of the upper thigh, specifically over a bony knob known as the Greater Trochanter. This prominent landmark is the attachment point for several muscles and tendons that control hip movement and stability. It is an anatomical site where soft tissues are subjected to considerable friction and compression forces during daily activities.
The primary soft tissues in this region are the tendons of the gluteal muscles, mainly the gluteus medius and gluteus minimus, which function as the hip abductors. These tendons stabilize the pelvis during walking and lift the leg out to the side. Nestled around these tendons and the bony surface are small, fluid-filled sacs called bursae, which serve to cushion the area and reduce friction between the moving parts.
The Primary Conditions Causing Lateral Hip Pain
The source of lateral hip discomfort is now broadly classified under the umbrella term Greater Trochanteric Pain Syndrome (GTPS). While GTPS encompasses various issues, the two most common components are tendinopathy and bursitis.
Gluteal Tendinopathy is considered the most frequent underlying cause of GTPS and involves irritation or degenerative changes within the gluteus medius and minimus tendons. Unlike inflammation, which is a short-term response, tendinopathy represents a failed healing response within the tendon structure, often due to chronic overloading or repetitive stress. This degenerative process can lead to disorganization of the tendon’s collagen fibers, reducing its capacity to handle normal loads.
Trochanteric Bursitis, the traditional diagnosis for lateral hip pain, involves inflammation of the bursa located over the greater trochanter. However, recent imaging and surgical studies have shown that true, isolated inflammation of the bursa is present in a minority of GTPS cases, sometimes as low as 2% to 8%. When bursitis does occur, it is often a secondary issue, arising from the underlying irritation and compression caused by the primary tendon pathology.
A less common, though sometimes relevant, contributor to lateral hip pain is the friction caused by the dense band of connective tissue known as the Iliotibial (IT) band. This thick band runs along the side of the thigh. It can rub over the greater trochanter and underlying structures, contributing to the overall syndrome.
Key Symptoms and Pain Presentation
The presentation of lateral hip pain is typically localized and highly predictable, making it distinct from other types of hip or low back pain. A defining symptom is tenderness experienced directly over the greater trochanter bone when pressure is applied. The pain is often described as a persistent ache that can sometimes radiate down the outside of the thigh toward the knee.
A classic sign of this condition is a significant increase in pain when lying on the affected side, which frequently disrupts sleep. Direct mechanical compression of the irritated tissues against the mattress exacerbates the discomfort, often forcing individuals to wake and change positions.
The pain may also worsen with activities that load the gluteal tendons. Prolonged standing, walking for extended periods, or climbing stairs can all aggravate the condition. Patients often report pain when standing up from a seated position, especially a low chair, or when standing with their weight shifted onto the affected leg.
Diagnostic Steps and General Treatment Approaches
Diagnosis of lateral hip pain begins with a comprehensive physical examination and patient history. A healthcare provider will typically palpate directly over the greater trochanter to check for localized tenderness, a hallmark sign of GTPS. Specific movements and strength tests, such as resisted hip abduction, are used to stress the gluteal tendons and reproduce the pain.
Imaging is often utilized as a second step to confirm the diagnosis and rule out other conditions. Ultrasound or Magnetic Resonance Imaging (MRI) can provide visual evidence of tendon changes, such as thickening or degeneration, and can help distinguish between gluteal tendinopathy and a true bursitis. However, imaging findings must always be correlated with the patient’s symptoms, as abnormalities can sometimes be seen in people without pain.
General management strategies focus on reducing the mechanical load on the affected tissues and restoring strength. Initial treatment often involves activity modification to avoid aggravating positions, such as sleeping on the painful side or standing with weight shifted onto one hip. Physical therapy is widely considered the most effective long-term approach, centering on progressive strengthening of the gluteal muscles to improve hip stability and tendon capacity. Anti-inflammatory medications may be used temporarily to manage pain, but the cornerstone of long-term recovery involves a structured, targeted exercise program.