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Lateral Hip Pain And Gluteal Tendinopathy – Is Your Training the Cause?

hippain physicaltherapy running Nov 19, 2020

We all know experiencing pain when running is never welcome.  As a runner if you’re experiencing hip pain it robs you of the enjoyment of the run, the benefits of stress relief and reduces the overall running experience as a whole.  We can place lateral hip pain (pain at the side of the hip) into two categories of types of pain runners experience and what we commonly see in the runners coming to our clinic.

Typically when someone experiences symptoms at the side of their hip they tend to believe its inflammation of a bursa (a fluid-filled sac or saclike cavity) located near the hip at the top of the thigh bone (femur) and think it’s bursitis of the hip. The other common cause is gluteal tendinopathy and this is often seen in conjunction with trochanteric/hip bursitis. When we determine the difference between the two it comes down to when the symptoms occur and how long they can last. This blog will be focusing on gluteal tendinopathy.  Most commonly symptoms occur during or after prolonged activity or unaccustomed activity leading to more 

Runners are some of the best athletes to follow a training program to achieve their goals and push their limits. But what if your training program is setting you up for performance sabotage?  Did you know 70-80% of running injuries are training errors. We believe at Inside Out there are a lot more that plays a role in reasons for injuries but strongly believe with intelligent programming and strategic training you can allow for a higher threshold to perform. Let’s take a closer look at the different factors that may contribute to developing lateral hip pain in runners.  There are intrinsic (internal factors) and extrinsic (external factors). The main intrinsic factors include:

  • Age - as we age our tendons may become stiff or less pliable if we haven’t been taking long term care of them with recovery, nutrition and activity levels and natural tendon health change that can occur over time.
  • Hormone factors - considerations for women perimenopausal due to lower levels of the hormone estrogen. This may be a reason why Gluteal tendinopathy has a 4:1 ratio of occurrence in women compared to men.
  • History of previous injury on the same side of the body - this can lead to incomplete mechanics, improper movement patterns and compensations leading to a higher likelihood of overuse injury.
  • Poor trunk stability (Check out the Top 5 Home Bodyweight Core Strengthening Exercises and see share with us how you do!)

The main extrinsic training errors to cause lateral hip pain and gluteal tendinopathy include:

  • Too much, Too soon 
  • Too much speed work  
  • Increase in volume 
  • Rapid changes - from location, duration, experience and apparel to lifestyle changes like nutrition, sleep or stress levels.

As you can see developing an injury and pain can be multifactorial. The intrinsic and extrinsic factors all work together in a system to help you train and perform. The common trigger is in training errors which we tend to see is injury that arises at the area of the weakest link. If you’re still having symptoms and no improvement after 6 weeks, seek a health care provider to address the root cause and work on developing a training plan that supports you - not brings you down.

During the painful stage, which can be 1-3 months for pain to resolve and up to 3-5 months for full recovery. If you’re experiencing pain, it’s time to take action. Below we wanted to share with you some recommendations to help reduce the pain level today.

  • Avoid rolling over the greater trochanter (side of the thigh bone closest to the hip), as much as you feel like it may help. During the painful stage rolling over this area can increase irritation as there are other structures around the area such as the bursa sac which can continue to remain irritated with the specific friction and pressure placed on it. 
  • Avoid over stretching and rubbing over the sight of symptoms, similar to the above bullet point, it may give temporary relief but long term setbacks in your recovery. 
  • HIIT training/ plyometrics - we all love burpees, bootcamps and interval training, but when you’re experiencing pain in your hip, there’s a time for modifications or choosing a different form of exercise to reduce pain rather than increase pain. 
  • On a scale of 0 to 10, try to keep pain levels at or below 4-5 out of 10 initially in this phase. The goal is to resolve pain.  A bit of pain is okay with tendons as they rehab, but they shouldn’t flare up 24hrs after activity. That’s a sign the activity was beyond the appropriate threshold at that given time.
  • Avoid running hills and speed work right away or it may cause symptoms to flare up
  • Reduce frequency and duration of runs. If you can’t walk for 20-30minutes without pain, you might have to stop running temporarily and build up your foundation to become more resilient. Eventually you can consider returning with a walk/run program for 6-8 weeks to build up volume.

Ready to take some action? Try these 5 exercises for lateral hip pain relief:

Banded Hip Abduction Isometrics (laying on back)

Side Lying Hip Abduction

Single Leg Bridge Isometric Hold

Split Squat with DB Contralateral Loading 

Side Plank

Whether you’re new to running, weekend jogger or an experienced road race runner the opportunity of working with a performance physical therapist is more than the exercises given. Their expertise comes in with taking all the factors, intrinsic, extrinsic and customizing it best for you, your goals and meeting you wherever you may be at. As Strength Docs, our goal is to intelligently create a program with you to reduce pain, address underlying causes and raise the tendons capacity to work up the load to withstand your training and running performance. 

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You shouldn’t have to waste your time and money on options that don’t work. We understand how frustrating it is to try different things without getting the results you had hoped for. Click here to fill out a contact form to request an appointment or phone call to help develop a clear and specific plan to reach your goals.  We help active adults in our local Southern California practice and throughout the country through our remote services.

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