Lateral hip pain is a frequent complaint often misunderstood by patients. Unlike pain felt deep in the groin, which usually signals an issue within the hip joint itself, lateral hip pain occurs specifically on the outer side of the upper thigh. This location of discomfort is distinct from both groin pain and pain that radiates primarily from the lower back. Understanding this difference is key to finding relief from this common musculoskeletal issue.
Defining Lateral Hip Pain
Lateral hip pain is localized to the outer bony knob of the upper thigh bone, known as the greater trochanter. This bony prominence serves as the attachment site for several muscles and tendons. The pain can manifest as a deep, aching sensation, or sharp, intense discomfort during certain movements.
Pain often occurs when lying directly on the affected side at night, which can disrupt sleep. Common triggers include rising from a low chair, climbing stairs, or standing with weight shifted onto the painful hip. The discomfort sometimes spreads down the outside of the thigh, occasionally reaching the knee.
Understanding the Root Causes
The most frequent cause of lateral hip pain is Greater Trochanteric Pain Syndrome (GTPS), an umbrella term for issues in the soft tissues surrounding the greater trochanter. For many years, this pain was attributed to trochanteric bursitis, which is the inflammation of the fluid-filled sacs that cushion the tendons. However, modern imaging and research confirm that the primary issue is typically gluteal tendinopathy.
Gluteal tendinopathy involves degeneration or micro-tears in the tendons of the gluteus medius and gluteus minimus muscles. These tendons attach directly to the greater trochanter and are subjected to load and compression. The breakdown of tendon tissue is most often the result of repetitive compression or overuse, rather than simple inflammation.
The compression of these tendons is a driver of pain, often occurring when the iliotibial band (ITB) presses the tendons against the bone during specific movements. Weakness in the hip abductor muscles can lead to abnormal hip biomechanics, increasing this compressive force. While trochanteric bursitis can occur, it is often a secondary issue accompanying the underlying tendon pathology. GTPS is common in women between 40 and 60 years old.
Diagnosis and Professional Assessment
Assessment of lateral hip pain begins with a thorough physical examination and medical history. This process helps differentiate GTPS from other sources of pain, such as lower back issues or hip joint arthritis. Tenderness when the greater trochanter is gently pressed is a hallmark sign of GTPS.
The examination includes specific movements and muscle strength tests designed to reproduce the pain. For example, pain during a single-leg stance can strongly suggest gluteal tendon involvement. Imaging is often used as a secondary tool to confirm the clinical diagnosis and rule out other conditions.
X-rays are typically the first imaging test to exclude bony problems like fractures or hip osteoarthritis. Ultrasound or Magnetic Resonance Imaging (MRI) can provide a clearer picture of the soft tissues, showing evidence of tendon degeneration or fluid within the bursa. Imaging findings, such as bursal fluid, are sometimes present even in people without pain, so diagnosis must correlate with a person’s symptoms and the physical exam.
Conservative Management Strategies
Initial management of lateral hip pain focuses on conservative strategies aimed at reducing compression and strengthening the surrounding muscles. Activity modification is key, as avoiding positions that compress the tendons can provide immediate relief. This includes not sleeping on the painful side and avoiding crossing the legs while sitting.
If lying on the unaffected side, placing a pillow between the knees can prevent the top leg from dropping. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may offer short-term pain relief, used in consultation with a doctor. Heat packs can also be applied to the area to soothe discomfort.
The most effective long-term strategy involves a program of targeted exercise to strengthen the gluteal muscles. This graduated strengthening helps the tendons become more resilient and improves overall hip stability. Begin this process gently, as excessive stretching or sudden activity can aggravate the irritated tendons.