Lateral hip pain… bursitis or tendinosis?

The femoroacetabular is one of the largest, strongest and most flexible joints in the human body. During gait our hips give us power and stability, and when jumping, these ball-and-socket joints are able to withstand enormous impact. Yet the hips and their supporting structures often take a beating due to aging, overuse, and trauma causing the brain to reactively guard the area with spasm or pain. For decades, lateral hip pain has been blamed on injury to the fluid-filled bursa sacs covering the greater trochanter, thus the name trochanteric bursitis (TB). Yet, today many of us have come to realize that many cases of hip “bursitis” are actually due to wear and tear of the gluteus medius/minimus tendons beneath the bursa and/or IT-band irritation overlying it .

Pain and hip instability do to abductor and IT-band tendinopathies may cause the people to walk or run with poor control, which, in turn, creates friction and irritation of the trochanteric bursa. Researchers Thomas Bunker, et al were the first to compare this condition to “rotator cuff” bursitis, where the subacromial bursa becomes inflamed and irritated secondary to underlying rotator cuff tendinopathy.1 He and others have called the gluteus medius and minimus tendons the “rotator cuff of the hip.” In this newsletter, I will use the term greater trochanteric pain syndrome (GTPS) to describe this condition since it includes three possible injury sites affecting the lateral hip. 

Causes, Symptoms, Assessments

GTPS can result from direct impact to the lateral hip, prolonged single-legged weight bearing, instability due to aging, sports injuries, and IT-band bursa irritation from repetitive movements. Clients usually present with dull lateral hip pain sometimes radiating into the thigh. It’s not uncommon for clients to report that their pain worsens at night and when rising from a chair after having been seated for an extended period of time. During GTPS assessment, the client’s pain may be aggravated by direct palpatory trochanter pressure, single-legged weight bearing (30-seconds), and resisted hip abduction. Yet, I’ve found the hip de-rotation test to be the most effective.

1. Bunker TD, Esler CN, Leach WJ. Rotator-cuff tear of the hip. J Bone Joint Surgery, 1997.