Most Common Cause of Side Hip Pain
by Cory Calendine, MD, Orthopaedic Surgeon
Side (or outer/lateral) hip pain is a common complaint I hear from patients and is often caused by Bursitis. Bursitis is inflammation of a bursa – small fluid-filled sacs located within joints. Bursa are positioned between bones and soft tissues (tendons, muscles and ligaments), and function as cushions to help reduce friction. The main bursa in the hip covers the bony protrusion on the outside of the hip bone (femur), called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis, and it can cause significant pain.
An additional bursa, the iliopsoas bursa, is located on the inside (near the groin) of the hip. Inflammation of this bursa is also considered hip bursitis, but the pain is located in the groin area. Iliopsoas bursitis is much less common than trochanteric bursitis, but is treated in a similar manner.
Symptoms of Trochanteric Bursitis
The main symptom of trochanteric bursitis is pain on the outside or lateral surface of the hip. The pain often extends to the outer thigh and upper leg. Initially, hip bursitis pain is often described as sharp and intense - to the point of interrupting sleep or limiting hip movement. Bursitis pain may progressively become more of an ache and spread across a larger area of the hip, buttocks and upper leg.
It is common for bursitis pain to be described as worse at night, especially when lying on the affected side, and worse when standing-up after prolonged sitting. Hip bursitis pain can even get worse with extended walking, stair climbing, and/or squatting.
Differential Diagnosis for Side Hip Pain
Other conditions can cause similar side hip pain symptoms and can even be seen in conjunction with inflammation of the bursa. Other similar and contributing problems include:
Tendonitis: This is an inflammation of the tendons (fibrous bands of tissue) that connect muscles in the hip and buttocks to the hip bones. Tendinitis is triggered by muscle imbalance and more likely with minimal activity, sitting often with crossed-legs, and even prolonged sitting on a wallet.
Overuse injuries: With walking and running, weak hip and pelvis muscles can lead to tightening and irritation of the the iliotibial (IT) band — the long band of connective tissue that runs from the knee to the hip that functions to stabilize the leg and hip joint. Tight hip muscles and IT band increase tension at their attachments in the hip joint and can contribute to outer hip pain.
Spine problems: As I mentioned in the video above, arthritis and disease of the spine can refer pain to the hip region. While “pinched nerves” or arthritis of the spine more often refer pain to the “back pocket” area of the hip, lateral hip pain can also be a symptom of spine problems.
Hip Bursitis Treatment
Nonsurgical Treatment for Hip Bursitis
Initial treatment of hip bursitis does not require surgery. Many people with hip bursitis will experience relief with simple lifestyle changes, including:
Physical therapy: A physical therapist can use a variety of pain treatment modalities (heat, e-stim, ultrasound) and can teach exercises specifically designed to strengthen and stretch the hip. Patients are often also prescribed hip exercises that can be done on their own at home
Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, naproxen, celecoxib, and other medications can help relieve pain and control inflammation. NSAIDs must be used cautiously and only for limited periods of time. Always speak with your healthcare provider before starting a new medicine. NSAIDs and other over-the-counter medications can have adverse side effects especially with certain medical conditions or when taking other medications.
Assistance devices: Use of a walking cane, walker or crutches is sometimes recommended for a short period of time for safety.
Activity modification. While it is always the goal to stay active, avoiding certain aggravating activities may be necessary for a period of time during rehabilitation.
Steroid joint injection: Corticosteroid hip injections (usually combined with a local numbing anesthetic) may be helpful in relieving symptoms of hip bursitis. Hip injections are a simple and effective treatment that can be done in an outpatient office. Injections for trochanteric bursitis typically involve a single injection into the bursa. A steroid injection may provide temporary (4-6 weeks) or permanent relief. We often recommend physical therapy in conjunction with a joint injection to improve the chances of complete symptom relief. If hip pain symptoms returns, patients can receive a repeat injection, but no more than (3) times per year, with sufficient time between injections. More frequent or prolonged corticosteroid use may damage tissues within the joint.
Surgical Treatment for Hip Bursitis
Surgery is rarely a treatment needed for hip bursitis. If the bursa remains chronically inflamed and painful despite conservative, nonsurgical treatments, surgical removal of the bursa is an option. Removal of the bursa does not typically interfere with normal hip function. Newer techniques allow arthroscopic removal of the bursa through a small (1 cm) incision over the lateral hip. With arthroscopic surgery, a small camera and surgical instruments are used to excise the bursa - usually providing a faster recovery with less pain.
If surgery is required, a short rehabilitation period will be involved and may include using a cane or crutches for a few days, taking oral NSAIDs for postoperative pain and progressive movement and strengthening with physical therapy or home exercises.
Prevention of Hip Bursitis
Hip bursitis is not always preventable. But, bursitis is a common condition and the following measures can lower the risk of dealing with hip inflammation and pain:
- Repetitive movement: Stay active, but be mindful of “repetitive activities” that put stress on the hip joint. If you notice hip discomfort starting with a certain activity - don’t stop being active - but consider cross-training with an activity that involves different hip movement and stresses.
- Weight control: Losing weight and maintaining a recommended body mass index (BMI) will lower the risk of hip pain.
- Proper footwear: Get a properly fitting shoe with any needed inserts for leg-length differences, low arch or flat feet.
- Strength training: Include a mix of resistance training in your activity schedule to maintain strength and flexibility of the hip muscles.
Dr. Cory Calendine is a fellowship-trained joint replacement surgeon specializing in the treatment of arthritis and other degenerative joint conditions of the hip and knee. Dr. Calendine and the team at the Bone and Joint Institute of Tennessee offer a full spectrum of joint pain treatment options - from individualized non-surgical plans to advanced robotic-assisted hip and knee replacement. If you are dealing with persistent and/or worsening joint symptoms, CONTACT our office today to schedule a consult with Dr. Calendine.