Not All Pain in a Spine Clinic Comes from the Spine: Greater Trochanteric Pain Syndrome

I had a series of patients the other day in the office that all complained of pain on the lateral aspect of the hip.  Working in a spine center people are naturally referred to my office for back and neck pain.  Countless individuals, though, have as part of thTrochanteric Bursitiseir symptomatology pain on the lateral aspect of the hip.  My experience is not unique.  One study reported that 20% of all patients referred to spine specialists have “greater trochanteric pain syndrome.”[1]  Other studies report that this condition of lateral hip pain affects between 10% and 25% of the general population.[2]

Many individuals with back pain have a variety of complaints that may include: aching pain on the side of the hip, pain extending down the lateral aspect of the thigh, difficulty sleeping on their side, pain with prolonged standing.  All of these symptoms can be associated with this condition of “greater trochanteric pain syndrome.”

What is Greater Trochanteric Pain Syndrome?

This clinical entity of greater trochanteric pain syndrome includes disorders such as trochanteric bursitis, tears of the gluteus medius and minimus as well as so-called snapping hip syndrome.  On examination, people with this condition have tenderness to deep palpation over the lateral hip, pain on resisted hip abduction or pain at the end-range of hip abduction and extension. [3]

This group of conditions can mimic radiculopathy (or sciatica) and frequently occurs in people who also have arthritis or degenerative changes in the spine. [4] 

So we have established that lateral hip pain is common and it often goes along with back pain symptoms.  What else do we know about greater trochanteric pain syndrome (which I generically usually refer to as trochanteric bursitis)?  It is more common in middle-aged individuals.  Females are affected more commonly than males (4:1).  Finally, studies have reported that this condition is more commonly affecting younger, active patients, especially runners. [5] 

What causes Trochanteric Bursitis?

Lateral hip pain is generally thought to stem from imbalance in muscles around the hips.  We all sit too much.  We often have tightness or a decrease in length of the muscles of the anterior hip.  The muscles on the side and backs of our hips (gluteus medius, minimus and maximus) are often inhibited, weak and tight.  This relative imbalance feeds into a condition where the muscles, tendons and bursae are overloaded.  Biomechanical studies place the root of these issues on “repetitive friction between the greater trochanter and the ITB with hip flexion and extension.” [6]

The Good News about Lateral Hip Pain:

The good thing about these pain conditions is that they are generally very fixable.  Studies have shown that local steroid injections provide effective pain relief in 60% to 100% of patients. [7] 

Hip Abductors and Extensor MusclesNonoperative tools are the mainstay of treatment for greater trochanteric pain syndrome.  For me, exercise interventions make the best, most sustainable fix.  Exercises to strengthen the hip abductors and extensors are critical to the program.  Personally, I like the following exercises for this issue:

1. Cook hip lift
2. Theraband side-stepping and backwards walking

There are a lot of other good exercises that can get at the imbalance at the root of this issue, but I like these as easy, practical exercises.

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[1] The Spine Journal 2(2002) 251-254

[2] Sports Med Arthrosc Rev 18(2) June 2010

[3] Sports Med Arthrosc Rev 18(2) June 2010

[4] Sports Med Arthrosc Rev 18(2) June 2010

[5] Sports Med Arthrosc Rev 18(2) June 2010

[6] Sports Med Arthrosc Rev 18(2) June 2010

[7] Sports Med Arthrosc Rev 18(2) June 2010

Comments

[Jody Rawlings PT]

Thanks for the post. You've given me some new ideas on exercises.