Trochanter pain, which is felt at the lateral aspect of the hip, can result from a number of primary and secondary causes, including repetitive stress, biomechanical imbalances, athletic injuries, structural impingements, and metabolic conditions. In a study published in "Archives of Physical Medicine and Rehabilitation" in August 2007, researchers reported an incidence of 9 percent men and 24 percent women with greater trochanteric pain syndrome. The study also concluded an association between trochanteric, low back, and knee pain.
Trochanteric Bursitis
The trochanteric bursa lies over the greater trochanter of the femur and under the tendons of the gluteus medius muscle and the iliotibial band of the tensor fascia lata muscle. Sandwiched in between these structures, it is vulnerable to impingement from chronic muscle contracture, improper biomechanics, or trauma. Symptoms can occur during rest or during activity. Current evidence via advanced imaging studies shows that inflammation is generally not involved, hence the terminology for this disorder is gradually changing to greater trochanteric pain syndrome, according to the website eMedicine.com
Iliotibilal Band Syndrome
The ilitotibial band is the longest tendon in the body. When problematic, it usually causes pain at the outside of the knee, where it has its lower attachment, but can also manifest as lateral hip pain, where it attaches close to the greater trochanter. This disorder favors long-distance runners, cyclists and tennis players, according to Dr. John M Martinez, medical director of primary care sports medicine at Coastal Sports and Wellness Medical Center. Activity brings on symptoms, particularly unlevel surfaces such as hills or stairs, and a popping sound can often be heard as the tendon passes over the bone.
Meralgia Paresthetica
Meralgia Paresthetica is a nerve entrapment syndrome resulting from compression of the lateral femoral cutaneous nerve where it passes between the crest of the hip and the inguinal ligament. The pain has a burning, tingling, or numb quality and is constant. It can course from the lateral hip area down the front and lateral thigh toward the knee. According to the Mayo Clinic, tight clothing, obesity and pregnancy are common causes, and in these cases it is generally temporary and reversible. Metabolic conditions that affect the nerves, such as diabetes, can also cause this condition, and require long-term management along with the primary disease.
Hip Pointer
This is a traumatic, usually sports-related contusion injury to the anterior iliac crest. Bruising of the hip abductor muscles, i.e. the gluteus medius and tensor fascia lata (the muscle that is associated with the iliotibial band) leads to pain and swelling over the anterior and lateral hip, with restricted range of motion in moving the thigh out to the side of the body. It is normally self resolving with rest, ice and anti-inflammatory medications recommended.
Lumbar Spine Disorders
Disfunction at the lumbar spine can lead to compensatory hip and trochanteric pain by causing an altered gait as the individual attempts to minimize back pain, placing more weight on one side or shifting the direction of forces and resulting in accumulation of stress at the hip.
Treatment for Chronic Conditions
For repetitive stress-related conditions such as greater trochanteric pain syndrome, Iliotibial band syndrome, and lumbar spine disorders, treatment for the acute phase involves rest, ice, shoe orthotics, and retraining of the area via stretching and strengthening exercises. Depending on the severity, steroid injections may be administered if inflammation is present, and ultrasound or, in rare cases, surgery can be indicated. It can take several weeks to resolve the acute phase of these chronic conditions, followed by ongoing monitoring and corrections for several months to prevent relapse.
Treatment for Acute Conditions
Meraligia paresthetica and hip pointers are acute conditions that usually resolve in a time frame of weeks to a few months. Treatment protocols include weight loss, wearing looser clothing and mild analgesics for meralgia paresthetica. Lots of ice is required to ease the sweilling of a hip pointer injury, along with non-blood-thinning analgesics, such as acetaminophen, and gradual resumption of weight-bearing with the use of crutches, according the the Sports Medicine Institute at the University of Minnesota.
