The term “saddlebags” commonly describes the lateral, or outer, area of the hip and upper thigh where pain often develops. This discomfort is frequently reported, particularly in women, and usually points to a musculoskeletal problem involving the structures surrounding the hip joint. Pain in this region can significantly interfere with daily activities, making walking, standing, and even sleeping difficult. This article explores the most common medical and mechanical reasons for pain in the outer hip area.
Inflammation and Soft Tissue Damage
The most frequent source of outer hip pain involves the inflammation or breakdown of soft tissues, a condition often grouped under the umbrella of Greater Trochanteric Pain Syndrome. Two primary culprits are trochanteric bursitis and gluteal tendinopathy, which often occur together.
Trochanteric Bursitis
Trochanteric bursitis involves the trochanteric bursa, a small, fluid-filled sac over the greater trochanter, the large bony prominence on the side of the thigh bone. The bursa acts as a cushion, reducing friction between the bone and the overlying tendons. When this sac becomes irritated and inflamed, it causes a sharp, localized pain that is tender to the touch directly over the bony point. This pain often worsens after periods of rest, such as when getting up from a chair, or when lying on the affected side at night due to direct compression.
Gluteal Tendinopathy
Gluteal tendinopathy is now recognized as the more frequent underlying issue, often preceding or co-occurring with bursitis. This condition affects the tendons of the gluteus medius and gluteus minimus muscles, which attach to the greater trochanter and stabilize the hip during movement. Tendinopathy involves a breakdown or degeneration of the tendon structure due to excessive load, presenting as a deep, aching pain. This discomfort is aggravated by activities that strain the muscle, such as walking, climbing stairs, or standing on one leg.
Nerve Compression and Referred Pain
Pain in the lateral hip and thigh can also originate from the nervous system, which presents with distinct symptoms compared to soft tissue injury.
Meralgia Paresthetica
One common nerve-related cause is Meralgia Paresthetica, a condition resulting from the compression of the lateral femoral cutaneous nerve (LFCN). This nerve is purely sensory, providing sensation to the skin of the outer thigh. When compressed, the LFCN produces symptoms including burning, tingling, numbness, or a heightened sensitivity to light touch on the outer thigh. The compression often occurs where the nerve passes through the groin, frequently caused by external pressure from tight clothing, heavy tool belts, or conditions that increase abdominal pressure, such as weight gain or pregnancy. Unlike bursitis, this pain is typically superficial and does not involve deep muscle or joint ache.
Referred Pain
A separate category is referred pain, which originates in the lower back but is felt in the hip or thigh. Issues like a herniated disc or nerve root irritation in the lumbar spine, particularly at the L4 or L5 level, can cause pain to radiate down the path of the affected nerve. This referred pain can sometimes mimic local hip injury, but it is often accompanied by other symptoms like lower back discomfort, or tingling and numbness that follow a specific nerve pathway down the leg. Recognizing these radiating symptoms helps differentiate referred pain from a problem located directly in the hip structures.
Common Mechanical Stressors
Many lateral hip problems are initiated or worsened by daily habits that place undue mechanical stress on the hip structures. The body’s soft tissues can be repeatedly compressed or overloaded by specific postures and routines.
Posture and Gait
Poor posture and an uneven gait are significant contributors to lateral hip pain. Standing with weight shifted onto one leg, often called “hip-hanging,” places excessive compressive load and strain on the gluteal tendons and bursa on the weight-bearing side. This uneven distribution of body weight can create an imbalance that the stabilizing gluteal muscles are unable to manage over time. Similarly, a gait pattern where the hips move excessively side-to-side can chronically overload the tendons with every step.
Sleep Habits
Sleep habits frequently exacerbate outer hip pain by subjecting the tissues to prolonged compression. Side sleepers who lie directly on the painful hip or who sleep with their top leg dropping forward can compress the bursa and tendons against the greater trochanter. This mechanical pressure is a common reason for waking up at night with sharp, intense pain in the outer hip area.
Activity Changes
Sudden or significant changes in physical activity also act as mechanical stressors that can trigger symptoms. An abrupt increase in exercise intensity, such as starting a new running routine or significantly increasing hill walking or stair climbing, can overload the hip tendons beyond their capacity. Conversely, prolonged inactivity followed by a sudden return to demanding movement can also cause injury.
Next Steps and When to See a Doctor
For new or mild outer hip pain, initial self-care steps can often provide relief by managing inflammation and reducing mechanical irritation. Resting the hip by temporarily avoiding aggravating activities, such as prolonged standing or excessive stair use, is a simple first measure. Applying ice to the outer hip for 15 to 20 minutes several times a day can help reduce local pain and tenderness. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may also be used to manage discomfort in the short term.
Changing sleep posture is a highly effective self-management strategy. Avoid sleeping directly on the painful side, or use a pillow between the knees and ankles to keep the hips properly aligned. If hip pain is severe, prevents you from walking normally, or is accompanied by other concerning symptoms, professional consultation is warranted.
You should seek medical attention if the pain:
- Persists despite two weeks of self-care.
- Is associated with a fever or chills.
- Involves sudden, unexplained weakness in the leg.