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Struggling with Hip Pain? Uncover the Causes and Risk Factors of Greater Trochanteric Pain (Part 1)

Updated: Feb 5




In part 3 on tendons, let's quickly recap on these unsung heroes of our musculoskeletal system. Remember, tendons play a critical role in transmitting forces from muscles to bones, enabling movement, and supporting athletic performance. However, they are also a common source of pain and injury for runners, hikers, cyclists, and athletes in sports like CrossFit and hockey. To stay active and pain-free, it’s essential to understand how tendons work, what disrupts their balance, and how to keep them healthy.


Tendons are made up of three key components: tenocytes (tendon cells), collagen fibers (which provide strength), and proteoglycans (which help organize collagen and absorb compressive forces). These structures work together to handle the high forces generated during movement, but they require a delicate balance of load and rest to stay strong and functional (Blog 1: https://www.upnadamptphysio.com/post/why-can-we-get-tendon-pain-running ).


Too much or too little load can disrupt this balance, leading to tendon breakdown, pain, and dysfunction. Common issues like gluteal tendinopathy, proximal hamstring tendinopathy, groin tendinopathy, achilles tendinopathy, or patellar tendinopathy often arise from overuse, poor mechanics, or inadequate recovery. The good news? Tendons can heal and adapt with the right approach, including proper loading, strength training, and rest (Blog 2: https://www.upnadamptphysio.com/post/exercise-rest-go-hand-in-hand-to-help-avoid-injury ).


In the remaining blogs on tendons, we’ll start exploring specific areas of tendon pain, why they get injured, and how you can help yourself get back to doing what you love—pain-free. Remember, rest is just as important as exercise when it comes to tendon health. Let’s dive in!


Understanding Greater Trochanteric Pain (Lateral Hip Pain): Causes and Risk Factors

If you’ve been experiencing persistent pain on the outside of your hip (lateral hip pain), you might be dealing with a condition known as Greater Trochanteric Pain. This pain can seriously disrupt your daily life, making it harder to perform everyday tasks like walking, climbing stairs, or even lying on your side. But what exactly is this condition, and why does it happen?


Greater Trochanteric Pain is most often caused by gluteal tendinopathy, a painful condition that affects the tendons around your hip. These tendons are responsible for stabilizing your pelvis and controlling leg movement, but when they become irritated or damaged, they can cause significant discomfort.


Who is at risk?

This condition is most common in peri- and post-menopausal women, with studies showing it affects about 23% of women and 8% of men aged 50 to 79. However, it’s not just older adults who suffer from this issue. Younger individuals, especially active runners or those who regularly engage in activities like lunging, stepping up, or squatting, can also develop gluteal tendinopathy.


The pain is typically localized around the greater trochanter, which is the bony part of your hip on the outside of your leg. But it can also spread down the outer thigh and sometimes even below the knee. This pain tends to worsen when you lie on your side, stand on one leg, or do weight-bearing activities such as walking uphill or running.


What causes the pain?

Gluteal tendinopathy occurs when the tendons that connect your gluteus medius and minimus muscles to the greater trochanter become overstressed. This can happen suddenly, for example, after an intense workout, or more gradually over time as the tendons ‘weaken’ due to repetitive stress (i.e. the delicate balance between load and rest has been disrupted).


Certain factors can make you more prone to developing this condition, including hormonal changes (like those that occur during menopause), previous injuries, and even medications like statins or corticosteroids.


The role of muscles and bursae

Our hip muscles work in harmony to stabilize the hip and enable smooth movement. There are two main groups of muscles involved in this process:

  1. ITB tensioners (like the TFL and gluteus maximus) help stabilize the pelvis when standing on one leg.

  2. Trochanteric abductors, which support the hip and work together to keep your pelvis steady.


Three bursae (fluid-filled sacs) in the hip act as cushions, protecting these tendons as they move. However, these bursae can become irritated, leading to a condition called trochanteric bursitis. While bursitis was once thought to be the primary cause of lateral hip pain, it is now recognised as a secondary condition often linked to gluteal tendinopathy.


Next Steps

If you’ve been experiencing pain in the hip, it’s important to understand what could be causing it. While greater trochanteric pain (lateral hip pain) and gluteal tendinopathy are common, they are also treatable with the right care. In the next blog, we’ll talk about how this condition progresses, the potential role of the iliotibial band (ITB), and how it affects your movements.


This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!


You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com


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