hip pain when walking

What causes hip pain when walking

What causes hip pain while walking?

Hip bursitis has many names, sometimes called Greater Trochanteric Pain Syndrome, Trochanteric Bursitis and Lateral Hip Pain.

It often refers to a pain felt in the gluteal muscles (the large muscles we sit on) or pain on the outside of the hip and upper leg which can be diffuse and radiate or be very focal. It is most often found on one side.

While this pain is most often attributed to bursitis, the source of the problem is often found in the tendons of the hip, in a problem called Gluteal Tendinopathy.

While the bursitis is often present, it is usually secondary to the initial gluteal tendon problem.

A sore tendon is usually accompanied by changes in how the muscle behaves and as the tissue which passes over the outside of the upper leg is closely related to the behaviour of the gluteal muscles, it can also become irritable and often very painful.

So if a walker has a gluteal tendinopathy, they might find that the longer they walk the more a pain seems to grow in their hip (the gluteal tendon problem) then begin to radiate further down to the outside of their leg, possibly with another more focal sensitive spot forming in the middle of this area (the bursitis).

This pain can become quite significant and often make the walker stop to let it settle, it may also last a few days.

What are the first signs of hip problems?

As the source is often the gluteal tendinopathy, the initial stages may start with pain in the gluteal muscles, or outside of the hip.

However this pain can sometimes refer into the lower back and be misdiagnosed as low back pain, or also refer into the hip at the front and also be misdiagnosed as arthritic pain.

The pain will often come 24 hours after activity so sometimes it is difficult to associate cause and effect. In saying that, it is also possible for it be sore at night or in the middle of strenuous activity.

What does bursitis in the hip feel like?

A bursa is simply a little fluid-filled space which helps to lubricate bands of tissue which must pass over each other, we need them and they are normal.

Bursitis is one which has been irritated and subsequently has become inflamed.

The trochanteric bursa when inflamed often forms a very sharply tender localised spot on the nobbly bit of bone on the outside of the hip.

The surrounding tissue can also be diffusely painful to touch.

Can hip bursitis cause pain down the leg?

It sure can, both trochanteric bursitis and gluteal tendinopathy can refer down the leg, though this referral will most often stop at the knee, helping to differentiate it from sciatica which can often refer further.

What is the fastest way to get rid of hip bursitis?

There are two way to approach this. Short term relief and long term resolution

What cause hip pain when walking? Short Term Relief

Manage your load. 

Grumpy tendons often have a threshold beyond which the will become much more painful. This response is usually the next day.

So a my simple guidelines for load are:

  • There is no such thing as a bad movement, only one which you can’t tolerate
  • So you can do any exercise as long as your pain doesn’t exceed 3 or 4 out of 10. This is to help us avoid a “provocative stimulus”.
  • You should wake up the next day feeling no worse.

These rules help to identify and stop provocations of sore tissue and will help to reduce sensitivity. As sensitivity comes down you will find that pain will settle and become much more manageable and less unpredictable.

Pacing

Pace your long walks. If you know you get pain after 45 minutes of walking, stop at 30 minutes to have a break and rest, then continue. It is easier to stop pain from starting than it is to get rid of it when it does start.

You may find that you can manage two well paced 30 minute walks where one 45 minute walk causes pain.

Sleep

Try to sleep on your back or with the sore side up and a pillow between your knee. If you must sleep on your sore side, try to make the bed as soft as possible using additional pillows or blankets.

Sleep is vital for recovery, so if you can’t sleep, see you pharmacist about advise on NSAIDs (anti-inflammatory medication) which you can take before bed to reduce the inflammation and help you feel better.

Exercise

Sore tendons need load to help them recover, so we have to exercise them.

However at the start their tolerance is often low so I recommend isometric exercises as they are controllable, less likely to irritate and may have some relieving effects.

My favourite is the “Foot Squeeze Exercise” (my name): 

Lie on your front (on your bed is fine) with your knees far apart, put your feet together and push. You should feel you bum contract. Push as hard as you can tolerate (remember 3/10) and hold for 5 to 10 seconds. 3 sets of 5 of these can work wonders for reducing pain and starting recovery.

Example here:
First exercise in video:

What cause hip pain when walking? Long Term Resolution

For the long term resolution, stronger resistive exercises are needed. Things like band walking, or monster walks, side planks and banded leg raises can work well. Example of band walking:

The exercise must follow performed:

  • As hard as you can tolerate – most stalled recoveries are due to insufficient loading
  • Consistently. I.e. 3 or 4 times per week for an extended period.Tendons can be slow healers but they do get there. It is not uncommon for full recovery to take 4 months.

I often say the route the full tendon recovery is time and effort. It can be a challenge, but the reward is bullet proof glutes which will take you on mammoth walks over the biggest hills.

Read more on Lateral Hip Pain

Author Info

Mark McGillian

Lead Physio at Heaton Moor Physiotherapy

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