Ending the Myths of Hip Pain and Finding Help From Physical Therapy

The hip that hurts when you lie on it

It is a deep ache on the outside of the hip. Stairs bring it on. So does a long walk, or getting out of the car. Then you turn onto that side at night and it is right there waiting.

That pattern often points to gluteal tendinopathy, a problem with the tendons that connect the muscles of the buttock to the hip bone. It is common, and it is routinely misunderstood.

Which is why so many people never get it looked at. Not because they gave up, but because they were told the wrong thing and believed it, sensibly, for years.

The story most people were given

Usually it is inflammation, or bursitis. Rest it, ice it, take something for it. If it drags on, get a shot. If the shot fades, talk about surgery.

A recently published study reviewed the current evidence on this condition and reached a different conclusion. Education and exercise led by a physical therapist, not rest and not injections, are the most effective treatment. Researchers identified nine long-standing myths and explained why each one no longer holds up.

The beliefs worth letting go of

• It only happens to older women. It is more common in post-menopausal women, but men and younger people get it too.
• You need an MRI first. Imaging can help, but it often shows changes in people who have no pain at all. It belongs alongside a physical examination, not instead of one.
• It will clear up on its own. Some people do recover without treatment. Many keep hurting, which is the argument for treating it early rather than waiting it out.
• Stretch the iliotibial band. There is no evidence that a tight IT band causes this, and stretching it may make the pain worse.
• A cortisone shot is the best first move. Injections can help in the short term, but over the long run they are no better than other options. Exercise and education outperform them.
• Clamshells are the exercise for it. That one does not work the hip muscles hard enough and can aggravate the pain. Weight-bearing work, squats among them, is the better bet.
• A tendon tear means surgery. Most tears do not require it. Physical therapy is often effective even when a tear is present.

What treatment actually looks like

Tendons do not want rest. They want the right amount of load, applied in the right order, for long enough to change.

So the plan starts with an evaluation that looks for the cause, then does three things: teaches you which daily positions and habits are keeping the tendon irritated, loads the hip progressively so the tendon builds tolerance, and manages that load week by week so you are always working just inside what it can handle.

It is not fast and it is not dramatic. It is the thing that holds once it works.

When to get it looked at

• Outer hip pain that has lasted more than a few weeks, or that keeps coming back.
• Pain when you lie on that side, or pain that wakes you at night.
• Stairs, hills, or standing on one leg reliably setting it off.
• A limp, or the hip feeling like it might give way.
• Pain that has already changed how far you are willing to walk.

You have spent years fixing things for other people. This is the one you have been putting off. In Louisiana you do not need a physician referral to start, so nothing stands between you and finding out what is going on.

Read how we approach hip and knee pain, see what therapeutic exercise involves, or request an appointment and start one-on-one with a licensed physical therapist.