A New Perspective on Lateral Hip Pain

A-New-Perspective-on-Lateral-Hip-Pain

Persistent lateral hip pain is a common complaint of women over age 50, with 23.5% reporting either unilateral or bilateral hip pain. Lateral hip pain occurs in women four times more often than in men. An inflamed trochanter bursa is often invoked as the underlying source of pain, and treatment usually centers on anti-inflammatory medication. However, recent research does not support Trochanteric Bursitis as the primary cause of lateral hip pain.

Potential Causes of Lateral Hip Pain

The hip is a complex joint, located in the midst of numerous neuromuscular and anatomical structures, including the lumbar spine and sacroiliac joint, any of which can evoke lateral hip pain. Yet the greater trochateric bursa has been historically blamed, and patients are often misdiagnosed with greater trochanteric bursitis when their pain stems from another source.

The following studies suggest alternative causes of lateral hip pain:

  • In a controlled, blinded study, Silva et al. (2007) looked at patients undergoing total hip arthroplasty on the involved hip. They compared patients diagnosed with greater trochanteric bursitis versus asymptomatic control subjects. Bursa samples were taken from each of the subjects and blindly examined by two independent surgical pathologists. They found no evidence of acute or chronic inflammation of the bursa, either in the control group or in the greater trochanteric bursitis group.
  • A 2014 study conducted by Board et al. used an even larger subject pool consisting of 50 patients with greater trochanteric pain and 50 without pain. They found no evidence of inflammation in the greater trochanteric region of any of the patients, although 20% of the pain group was found to have a thinning gluteus medius tendon.
  • A third study by Long et al. (2013) reviewed the sonograms of 877 patients with lateral hip pain, and 79.8 percent showed no evidence of trochanteric bursitis. Of the 800 subjects, 28.5 percent showed a thickening of the IT band and 49.9 percent had gluteal tendinosis.

Why the Source of Lateral Hip Pain Matters

When lateral hip pain is universally assumed to be caused by greater trochanteric bursitis, all cases are then subjected to a similar course of treatment, geared to reducing inflammation. Pain and inflammation are first managed with NSAIDs, followed by cortisone injections, and then on to surgical interventions. Yet physical therapy is rarely considered as treatment for lateral hip pain, even though evidence suggests that bursitis is rarely the primary cause.

Diagnosis is Key to Proper Treatment and Recovery

The sports medicine professionals at NYDNRehab understand human movement science and how mechanical deficiencies can lead to structural pain. They will conduct a comprehensive physical exam, ultrasound imaging and testing for motor deficiencies to get to the bottom of your lateral hip pain. NYDNRehab is committed to not just treating your pain, but to resolving it by getting to the source. Our advanced treatment strategies are cutting edge, geared to getting you back on your feet and physically active again. Call NYDNRehab today, and find out why we are the leading specialists for lateral hip pain in NYC.

Sources:

Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. American Journal of Roentgenology. 2013; 201(5): 1083-1086. doi:10.2214/AJR.12.10038.

Board TN, Hughes SJ, Freemont AJ. Trochanteric bursitis: the last great misnomer. Hip Int. 2014; 24(6): 610-615. doi:10.5301/hipint.5000154.

Silva F, Adams T, Feinstein J, Arroyo RA. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. 2008; 14(2): 82-86. doi:10.1097/RHU.0b013e31816b4471.

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