Pain on the outside of the hip is a common source of discomfort and can affect one hip and sometimes both. The pain often comes from irritation of the tendon which attaches your buttock muscle on to the side of the hip. The pain can start without any significant injury and is commonly as a result of an increase in a person’s activity levels. It can also occur if you have been significantly less active than what you would normally be.
So why does my hip hurt?
The pain is caused by a combination of two factors;
1. Compression of the soft tissues and tendons of the buttock. – see our compression guide on the next page to reduce this and avoid these positions.
2. Overload, which means putting too much force through these tendons than what they are used to. See the overload guide on page 3 for more information on managing this.
The first step in managing these symptoms is to modify your activities and avoid spending too much time in positions that compress the area. There is a table on the next page to give some advice and tips on how to manage this.
Compression Guide
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Aggravating Factor
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Solution
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Lying on the affected side – This creates direct compression to the soft tissues on the outside of the hip
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Where possible try to lie on your back and if this isn’t possible put a pillow under your affected hip.
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Lying on the opposite side – This causes the top (affected) leg to drop across the line of the body which increases the compression.
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Try placing a pillow between your knees to prevent your leg from dropping down and sleep on your back where possible.
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Crossing your legs
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Avoid crossing your legs.
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Standing on one leg (getting dressed).
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Try to sit down to put shoes and socks on.
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Prolonged Sitting
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If you work at a desk, try to stand up every 30 minutes.
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Sitting in low seats
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Try and sit on a supportive chair. Consider raising the height by sitting on an extra pillow.
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‘Hip hanging’ standing position – Loosely hanging your body weight on one hip increases the pressure on the outside of the hip.
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Try and keep equal weight through each hip with your feet a shoulder width apart.
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Climbing stairs
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Try to lead with the better leg going upstairs. This might mean going one step at a time and try to plan your journeys, so you aren’t making unnecessary trips where possible.
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Excessive walking
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Try to pace your activity levels. It’s important to keep active but don’t push into pain. Keep walks short and frequent.
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Running or exercise
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If you are still able to exercise. Try running on a level surface and not up or down hill. Try and reduce high impact activities that require a lot of jumping and landing
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What does overload Mean and why is it Important?
The muscles and tendons in the body get used to your usual activity levels such as work, exercise and other hobbies. They have the strength to cope with this without becoming sore. If your activity level increases e.g., going from a desk-based job to a more active job, starting a new hobby like the couch to 5k or increasing the amount of exercise you do then these muscles and tendons have to work harder and can become painful. This happens because tendons can’t adapt quickly enough to the amount of work that they are being asked to do. If you slowly build your activity levels up, this allows the tendons time to get stronger and doesn’t result in pain.
This can also happen when we are less active as muscles get weaker which can make returning to your usual activity levels more difficult.
Example
Your usual activity levels include a hill walk twice a week but due to a busy time in your life you haven’t been able to do this for a month. When you do have more time to return to your usual walking, your muscles and tendon may have become weaker causing your normally activities to become painful. You may need to build back up to your usual walking by doing one a week or two shorter walks.
How do I know if my activities are causing a painful reaction?
It is common to get a painful reaction if too much load is put through the hip. If this pain is more than 5/10 (with 10 being the worst pain imaginable) or pain lasts for more than 24 hours check what you have been doing and ease back. Once this has settled you can start to gradually introduce your activities and exercises again. If you have a mild aggravation (pain is less than 5/10) and this settles within 24 hours, keep going with your exercises and gradual return to full activities (see below).
- Pain 0-5 keep going
- Pain 5-10 back off
How does it improve?
The first step is to reduce the compression and overload which is affecting the hip using the guides above. Once the pain has become manageable the next step is to build strength in the tendon to help it to cope with your day to day activities. There are some exercises on the final page to start this process. It’s important not to push through pain with the exercises and follow the same painful reaction rules above. Your physio may then choose to make these exercises more challenging as your symptoms improve.
What about work and hobbies?
We would encourage you to stay active without aggravating your symptoms and work is a part of this. This is different for everybody dependent on the physical demands of each job. We would advise you follow the guidance above on preventing overload but if you have any concerns then discuss this with your manager as there may be ways to modify your duties.
Should I take pain relief?
Pain relief plays an important role in managing your symptoms, allowing you to stay active and start your rehabilitation. Pain relief can also help to prevent developing compensatory movement patterns such as a limp which can lead to pain developing elsewhere. Ice or heat can sometimes be beneficial in reducing the pain but before doing this make sure you have full sensation in the skin on your hip and place a barrier between your skin e.g towel, between your thigh and the heat/ice. Don’t use this for longer than 10-15 minutes.
Can anything else contribute?
There are multiple links within health research to show that the factors listed below can increase the risk of developing problems with tendons and can influence your pain levels and recovery. Therefore, it is important that we help you address these areas as part of your treatment. You can discuss some of these factors with your physiotherapist to help us work together on guiding your long-term management and try to prevent problems recurring.
- Obesity
- Anxiety, depression and stress or other mental health conditions.
- Poor sleep patterns
- Smoking
- Lack of exercise
- Increased Alcohol consumption.
- Other linked conditions that aren’t controlled e.g. Diabetes.
If your symptoms fail to improve within 6 weeks with this regime you should contact your GP for consideration of a physiotherapy referral.
If this is the case remember to bring a pair of shorts to change in to.
What actions can I take to improve my health?
Evidence tells us that making healthy lifestyle choices can have a big impact on influencing problems with your muscles and bones and can play a major role in your overall health. Some of the most effective areas to address are below:
Maintaining a healthy weight:
Link: www.nhs.uk/live-well/healthy-weight/
Increasing levels of physical activity
Link: www.nhs.uk/live-well/exercise/
Avoiding poor sleep patterns
Link: www.nhs.uk/live-well/sleep-and- tiredness/how-to-get-to-sleep/
Reducing alcohol consumption
Link: www.nhs.uk/live-well/alcohol- support/calculating-alcohol-units/
Stopping smoking
Link: www.nhs.uk/live-well/quit-smoking/
Maintaining a healthy mind
Link: www.nhs.uk/conditions/stress-anxiety-depression/
The good news is that you are able to influence lots of these by modifying your lifestyle. Therefore it is important that you consider addressing these areas alongside your current treatment.
You may wish to discuss any of these factors with your treating clinician who will be able to work with you and guide your long term management and support you to improve your wellbeing.
There will be information about the local services that exist within the waiting areas of the physiotherapy department and your treating clinician will be able to help signpost you to appropriate services.
The websites listed below give more information on local services available:
• Blackburn and Darwen - https://refreshbwd.com/
• East Lancashire - http://www.upandactive.co.uk/
