For people who suffer from lateral hip pain, or what is more commonly known as Hip Bursitis, it can be a debilitating condition with a long road to recovery. As Pilates teachers we come across this condition quite regularly in the studio and find our role of educating clients on how to manage their condition through a Pilates program makes a huge difference to quality of life.
Interestingly, we currently have some of the best physiotherapists right here in Brisbane who have conducted in depth research into the possible causes of hip bursitis and lateral hip pain, and how people respond to treatments. From this research new protocols have been established within the physiotherapy world. These recommendations are not just limited to treatment strategies given by physiotherapists though, they also provides us as Pilates teachers with a model on how to best help our clients manage this condition, whether exercising or carrying out daily activities of life. In my mind this research is a big step forward. By looking deeper into conditions of the hip we gain a more intimate understanding of how a Pilates program can optimally benefit those struggling with constant, nagging pain in the hip, groin, buttocks and pain that radiates down the leg.
Allison Grimaldi who has been an integral part of this research has 25 years of clinical experience and particular expertise in the management of hip, groin and lumbo-pelvic pain and dysfunction. Alison is the Principal Physiotherapist at Physiotec and an Adjunct Research Fellow at the University of Queensland. Right here in Brisbane!
What has predominantly come out of this research is that tendinopathy of the gluteus medius and gluteus minimus tendons (smaller gluteal muscles responsible for stability when standing on one leg) is the primary source of lateral hip pain, or as we more commonly term it – Hip Bursitis.
What are tendons I hear you ask?
Briefly, and without going into a full anatomy lesson, our bodies are more than just muscle and bone – and of course organs. Most people know that ligaments attach bone to bone and relate to sprains when damage occurs, for example a sprained ankle means the ligaments have been overstretched and damaged. However, we also have tendons that attach the muscle to the bone. Tendons are responsible for absorbing loads through the joint itself. It is this mechanical loading that drives the biological processes within a tendon and then determines its structure and capacity for load bearing activity. This basically means that your tendons can determine how much force you can place on your joints safely. If our tendons are not strong enough to withstand load and external forces (something as simple as running) then our joints are placed under stress and this can result in pain and degeneration over time.
Hip Bursitis is commonly diagnosed in people mid-life and it mostly affects athletes or those who have not exercised regularly. It is more common in women than men and the symptoms are not pleasant for many. Sleep disruption is common due to the pressure of a side lying position, and general weight bearing tasks such as walking, climbing stairs and trying to exercise can also aggravate the condition impact hugely on quality of life.
When diagnosed with this condition a client will no doubt be given options that may or may not involve cortiscosteroid injections, exercise or shock wave therapy. The approach that is recommended by Allison Grimaldi involves exercise that is taught progressively with correct technique. She emphasises the need for education about the underlying biomechanics of the hip joint and how to change or alter some of our postural habits.
Your posture and the position of the hip joint, particularly when you are excessively adducting the leg over the mid-line of the body, such as when sitting with one leg crossed over the other, can be a large contributor in terms of inflammation and pain. An adducted position of the thigh bone can cause compression of the tendon and injury. Take note, do you stand leaning on one leg??
To help prevent the leg crossing the midline and into an adducted position it is important to strengthen the muscles that take your leg out to the side and away from your midline – these are your hip abductor muscles. Through proper exercise management and with an appropriate exercise program you can successfully strengthen these muscles. To have long lasting results it is important to build strength progressively. If you prematurely overload the body it will respond negatively and this in turn has an adverse effect on the injured hip creating further inflammation and degeneration. So if you think this means doing 50 squats per day you may find you make your condition worse as your muscles and tendons are not ready for this repetition and load and additionally you may perform these exercises incorrectly further complicating the issue.
When it comes to these smaller gluteal muscles it may be helpful to visit a physiotherapist, we recommend Physiotec, who can either use ultrasound to help you find the correct muscle or use hands on techniques to assist with correct execution of the movement. A well-trained Pilates teacher can also work with you on posture and help you retrain the muscles correctly whilst performing more functional movements. Most importantly a Pilates teacher can provide a program that looks at your whole body and how you may be compensating for a painful hip. It is not uncommon for people suffering hip pain to complain of back pain and even neck and shoulder pain.
As posture and bad habits play a major role in the health of our joints it is most important to create strategies and give assistance to change these habits. It could be these habits that are contributing to slow recovery or a feeling of no recovery at all.
Some of the recommendations given by Allison Grimaidi and her team are:
• Avoid leaning on one leg.
Standing and chatting – just check – you might find you begin ‘the lean’! Ensure you are placing equal weight through both feet at all times.
• The next one is hard for a woman! Do not sit with one leg crossed over the other.
Again this position creates compression on the hip and tendon and is also not good for the lower back.
• Do you walk a dog?
If you do watch that the dog is not leading you and causing you to lean back and rest in your hip joints whilst trying to control the pull. This positions decreases the need to use your gluteal muscles.
• Sleeping at night.
If you are a side sleeper you need to sleep with a pillow between your knees to take pressure off the side of the hip. It is important not to bend the knee up and then let it drop past the midline – again this is the position of compression. You potentially spend at least 6 – 8 hours in this position so correct set-up is vital to assist with healing.
If you have problems lying on your hip it is recommended trying what they call an eggshell mattress topper. This can alleviate the pain and give better support to the hip.
• Sitting at home or work – try a wedge cushion.
It is important that when you are sitting the knees are not higher than your hips, sitting on a small wedge pillow can greatly help this. You may also wish to look into supportive cushioning for the car.
If you are a gym goer than be careful when squatting and lunging or any balance exercise where you are on one leg, particularly if adding weight to the exercise. If your knee is moving towards the midline as you bend or when you are holding a bent knee position this will create compression and means your abductor muscles are not working as well as they should be. Try reducing range of motion and watch the alignment of knees and ankles at all times.
I hope these small hints help make a difference at home and work. It is always recommended that you visit a physiotherapist, preferably one who specialises in hips, to get a accurate diagnosis and discuss the best treatment options. And of course attending Pilates with an instructor who is qualified to work with these conditions will help improve your posture and strengthen your body as a whole both safely and appropriately whist addressing the specific needs of this condition. You will feel and look great, it just takes time and commitment.
If you would like to find out more about Allison Grimaldi and Physiotec you can find her at https://physiotec.com.au