Resurfacing Lateral Hip Pain

[ztom]

Hello. I got referred to this forum so I’d like to give it a shot!

I’m familiar with psycho-social pain model (to some degree) and a lot of the old school generic rehab stuff (clamshells all day, anyone?).

In any case, I have something like greater trochanteric pain syndrome/bursitis surfacing in both hips, always one at a time luckily. I’ve been training about a decade with no issues, but these last 2-3 years any time I get any momentum it resurfaces in one of my hips. I’m male, 29 years old, 225lbs, around 645/365/675 total. I’ve seen half a dozen physios/chiros for this, most of them just recommending clamshells and the like. I’ve also seen two sports meds which were the most interesting but ultimately not helpful (the second guy said I had some sort of shin sprain on the left and foot sprain on the right and gave me some kind of brace/tape for both—this obviously doesn’t address the either hip part of the issue). Most of them like to point out that my injured hip is less stable as if the pain itself isn’t causing the instability, and my non-symptomatic hip seems fine to them (except it’s liable to injure later)… it feels like a cop out, and working on hip stability hasn’t solved this issue for me.

My standard approach is to cut painful movements and find movements I can do. Generally I can’t train quads at all when it’s at its worst, but I can do hip hinges like SLDLs and I try to do squat core work like front rack holds. In theory I’d like to desensitize and build tolerance, but it generally takes ~6 months before I can tolerate quad loading, and around 8-9 months until I can squat again after it surfaces, so it’s hard to reconcile that.

Usually on the side I do try to do hip work. I find working external/internal rotation mobility helps. I don’t find that training glute med/min helps at all but I try to do that too. I prefer specific stuff like controlled partial single leg squats, increasing ROM over time. Rolling and everything like that seems useless.

At some points I’ve tried ignoring it or working through it, but that’s definitely not viable. By the end I can’t get even get out of my chair with both legs.

But essentially, I have no idea what causes it, and no idea what fixes it, other than a huge amount of time. I try to modify my training, but it’ll take me out between half a year to a year each time and this is my 4th time having it. At this point I just want to hit my last squat goals and quit, but it’s seeming like I can’t get enough momentum to even do that.

You guys seem to have a different perspective than just another round of clamshells. Could I ask for any perspectives/suggestions for the above?

I appreciate the goal of this forum isn’t tailored individual dig-downs, so I’m more wondering what should my goal/approach be here? Removing painful movements and recapturing ROM/load through modest stimulus seems hugely ineffectual and it’ll just resurface once I’m totally recovered, but I’m not getting any effective help from physios.

Thanks!
Tom

[Michael_Ray]

@ztom

Hello. I got referred to this forum so I’d like to give it a shot!

I’m familiar with psycho-social pain model (to some degree) and a lot of the old school generic rehab stuff (clamshells all day, anyone?).

In any case, I have something like greater trochanteric pain syndrome/bursitis surfacing in both hips, always one at a time luckily. I’ve been training about a decade with no issues, but these last 2-3 years any time I get any momentum it resurfaces in one of my hips. I’m male, 29 years old, 225lbs, around 645/365/675 total. I’ve seen half a dozen physios/chiros for this, most of them just recommending clamshells and the like. I’ve also seen two sports meds which were the most interesting but ultimately not helpful (the second guy said I had some sort of shin sprain on the left and foot sprain on the right and gave me some kind of brace/tape for both—this obviously doesn’t address the either hip part of the issue). Most of them like to point out that my injured hip is less stable as if the pain itself isn’t causing the instability, and my non-symptomatic hip seems fine to them (except it’s liable to injure later)… it feels like a cop out, and working on hip stability hasn’t solved this issue for me.

My standard approach is to cut painful movements and find movements I can do. Generally I can’t train quads at all when it’s at its worst, but I can do hip hinges like SLDLs and I try to do squat core work like front rack holds. In theory I’d like to desensitize and build tolerance, but it generally takes ~6 months before I can tolerate quad loading, and around 8-9 months until I can squat again after it surfaces, so it’s hard to reconcile that.

Usually on the side I do try to do hip work. I find working external/internal rotation mobility helps. I don’t find that training glute med/min helps at all but I try to do that too. I prefer specific stuff like controlled partial single leg squats, increasing ROM over time. Rolling and everything like that seems useless.

At some points I’ve tried ignoring it or working through it, but that’s definitely not viable. By the end I can’t get even get out of my chair with both legs.

But essentially, I have no idea what causes it, and no idea what fixes it, other than a huge amount of time. I try to modify my training, but it’ll take me out between half a year to a year each time and this is my 4th time having it. At this point I just want to hit my last squat goals and quit, but it’s seeming like I can’t get enough momentum to even do that.

You guys seem to have a different perspective than just another round of clamshells. Could I ask for any perspectives/suggestions for the above?

I appreciate the goal of this forum isn’t tailored individual dig-downs, so I’m more wondering what should my goal/approach be here? Removing painful movements and recapturing ROM/load through modest stimulus seems hugely ineffectual and it’ll just resurface once I’m totally recovered, but I’m not getting any effective help from physios.

Thanks!
Tom

Hey ztom - thanks for the questions and sorry to hear about the recurring hip issues. Based on the information you’ve supplied thus far, the main point I’d say is, in this context, we do not typically advocate for removing movements in hopes of being “pain free” but rather finding tolerable activity levels (loading) for movements you want to do. Check out this article HERE on tendinopathy for a detailed discussion on this topic and our rehab approach for situations like yours. You’d also like this article HERE for general recommendations on managing symptoms by altering programming variables. If you are interested, we’d be happy to consult with you to give individual advice. You can complete our intake paperwork HERE.

[ztom]

@Michael_Ray

Hey ztom - thanks for the questions and sorry to hear about he recurring hip issues. Based on the information you’ve supplied thus far, the main point I’d say is, in this context, we do not typically advocate for removing movements in hopes of being “pain free” but rather finding tolerable activity levels (loading) for movements you want to do. Check out this article HERE on tendinopathy for a detailed discussion on this topic and our rehab approach for situations like yours. You’d also like this article HERE for general recommendations on managing symptoms by altering programming variables. If you are interested, we’d be happy to consult with you to give individual advice. You can complete our intake paperwork HERE.

Thanks Michael.

I’ve rehabbed each specific instance so far to the point where that hip might feel perfect and I can train it beyond previous strength—interestingly enough the injured sides tend to alternate, so I might go a year or more post-recovery without problems.

I might’ve misunderstood, but the article seems tailored towards rehabbing a particular instance of tendinopathy. Is the implication that I never successfully rehabbed a particular instance?

Likewise, would the individual consult be tailored towards preventing a reoccurrence vs. rehabbing this particular instance, beyond something like advising load management?

I’m familiar with the general principles of rehabbing a tendon via sufficient stimulus (when I say I can’t tolerate quad loading, I mean my symptoms will get drastically worse the following days even if I try something like step ups to a couple of stacked plates), and assumed my many months’ timeline for each instance was fairly reasonable given the nature of the injury (which the article seems to say as well)… my bigger concern is ideally not having to rehab tendinopathy, assuming it’s something like glute med/min tendinopathy, again.

[Michael_Ray]

@ztom

Thanks Michael.

I’ve rehabbed each specific instance so far to the point where that hip might feel perfect and I can train it beyond previous strength—interestingly enough the injured sides tend to alternate, so I might go a year or more post-recovery without problems.

I might’ve misunderstood, but the article seems tailored towards rehabbing a particular instance of tendinopathy. Is the implication that I never successfully rehabbed a particular instance?

Likewise, would the individual consult be tailored towards preventing a reoccurrence vs. rehabbing this particular instance, beyond something like advising load management?

I’m familiar with the general principles of rehabbing a tendon via sufficient stimulus (when I say I can’t tolerate quad loading, I mean my symptoms will get drastically worse the following days even if I try something like step ups to a couple of stacked plates), and assumed my many months’ timeline for each instance was fairly reasonable given the nature of the injury (which the article seems to say as well)… my bigger concern is ideally not having to rehab tendinopathy, assuming it’s something like glute med/min tendinopathy, again.

The article is meant to provide self-management tools to work through instances in which someone is dealing with tendinopathy. It’s rare we set expectations such as “If you rehab now then you will never have to deal with symptoms in that region again.” Instead, we take the approach of hopefully providing strategies to work through more symptomatic time periods in life to gain control over the situation give these experiences are a part of being human.

Step-ups, if you are noticing significant increase in symptoms post exercise, then I’d say the stimulus was too much for that particular session and changes in dosage of loading need to be made (i.e. lower step-up, or even in place split squats).