172: Lateral Hip Pain: Stop Blaming the Bursa (with Whitney Lowe & Til Luchau)

Well, we said we're gonna have some discussions on lateral hip pain today, of, uh, looking at some of the things.

There's been some pretty radical and significant shifts in the scientific literature in the recent years about what really causes a lot of lateral hip pain problems, and this has some very relevant, uh, ramifications for us as soft tissue manual therapists.

So we're gonna take a little deep dive into looking at greater trochanteric pain syndrome today.

Do you wanna start there? How, how has our understanding of lateral hip pain shifted, and how does this change our approach?

Yeah, this is one of the most significant factors, um, is a move away from what's for many years been referred to as trochanteric bursitis.

Um-

Mm-hmm

... you know, there's just not a lot out there in the l- very lateral hip region to be sort of the culprit for a lot of the lateral hip pain that people were experiencing.

And so consequently, I think a lot of the, uh, pain was blamed on the bursa that sits just underneath the skin, underneath the iliotibial band, over the top of the greater trochanter there, as the inflammatory culprit, um, as, uh, the culprit of, of the pain problems that people were feeling.

But, um, some, uh, a, a good bit of sort of recent, um, biomedical research looking into tissue f- uh, functions, tissue pathology, and the quality of what's happening in these different pain conditions has really dramatically changed that picture.

Um, and we're finding that, um, uh, one of the studies that I was reading was saying close to, uh, the, the number of people who actually have, um, trochanteric bursitis or inflammation of that greater trochanter bursa is only about 8% of these people with [clears throat] the lateral hip pain problems.

And more commonly, this is really a problem of tendinopathy with our gluteus medius and gluteus minimus tendons, and we'll explore here a little bit more about the, the why and the, the, the what and why around that as well.

Wow.

Wow, you just laid out the problem and gave the punchline all in one.

You told us, like, uh, how we used to think about it, what it was, and what we're finding and where to focus.

Yeah.

Now, before we dig in, I'm wondering if we should describe a little bit what we mean by lateral hip pain.

What would clients complain about, or how would that be recognized really clearly-

Yeah

... or simply?

Let's sort of dig into a little bit more of the, just in reviewing the sort of structural, um, uh, landscape, so to speak, in that area.

So the greater trochanter is, of course, that bony prominence on the lateral aspect of your hip that most everybody can feel pretty easily when you palpate the lateral hip region.

And, uh, we have two pretty strong muscles that are pulling on the iliotibial band that lie directly over the greater trochanter.

We have the tensor fasciae latae coming in from sort of the front side, and then the gluteus maximus coming in from the, the back side and fanning together into their attachment sites on the iliotibial band.

[clears throat] Excuse me.