Hip Pain in Older Women with Iyad Salloum

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, British Columbia. We're talking about hip pain today. This is probably even more common than I would think with older folks. Is that right? 

Iyad: Yeah, so the specific thing we wanna talk about is you know, specifically outer hip pain. When people tell you, you know, the outside of my hip feels a bit sore and it kinda tends to be quite limiting and very painful in certain cases. You'll see it favouring, let's say an older population and it tends to affect even women more than men, quite a bit more, unfortunately. 

You know, there are several causes for this that that could maybe predispose women more than men. We've actually been seeing a couple more of these, we had a really sunny October, so people were out and about moving around a lot more. And we saw this in a few hikers, you know, so we had a couple of seniors coming in actually just happened to come in the same week, same exact presentation, just went on a big hiking trip, and then suddenly started developing soreness in their outer hip.

And, you know, it feels a bit tight, feels a bit stiff, so they start stretching and then it starts to get progressively worse. To the point where they just tell you that they can't lie on it, they can't really sleep well. It kind of gets really, really bothered. 

He could walk a flat line, but that's about it. Like any kind of incline or stairs gets to really, really become bothersome. And I think the reason it's a tough one to kind of almost get at is because it could present also like an arthritic hip. So when you have arthritis in your hip, it can also give you pain in the outer hip and, you know, on excessive exertion.

But the thing we're talking about specifically affects the actual tendon of your glute muscle, your glute med muscle where it in inserts to the outer hip. Though that tendon can get affected like any other tendon, like our Achilles or our patella tendon. And it tends to get really aggravated with changes in your, let's say, loading patterns.

So if you, you know, haven't really been active that much, and you start doing a whole bunch of incline walking and stairs, well that'll do it. And then, when it flares up, it tends to get really aggravated with stretching , even though you might not be harming it just really, really gets irritated and triggered with repeated stretching. And then unfortunately it feels, you know, tight and uncomfortable, so people have the instinct to try to stretch more sometimes. 

Mark: Other than just an increase in load, are there any other causes that manifest this? 

Iyad: We do see it with impact. So if you fall flat on your outer hip, and if you're you know, if we're lucky enough not to have any like bony injuries or anything like that you can get that.

Because your glute tendon, especially glute med tendon is quite exposed on that outer hip. So we have like a big bony prominence, just the beginning of our thigh, just below the pelvis, and that's where those insert. And that really plays a huge role, that muscle, it prevents us waddling when we walk when it works, you know, normally. And so that could be a reason. And then when most people kind of end up Googling it, they find something called trochanteric bursitis, which is the most commonly viewed thing where it's classified as the inflammation of something called the bursa, which helps kind of almost like lubricate the surface between the tendon and the bone.

However, what we're finding is that bursa seems to be a victim of just the tendon at large. So if the tendon sore, the bursa could get sore. It's hard to get the bursa kind of happening on its own. You'd have to have some very specific mechanism or somebody rubbing that specific part only to get it. And it's really rare that you just get it out of the blue. 

So when we see, a lot of the times our first thing to do is actually try to identify are we actually dealing with that versus let's say an arthritic hip. And the management's really, almost a bit surprising to a lot of people cuz we will exercise it a lot. But we would just start off with also avoiding certain things like a stretch for the first week or so, just to give it a break. 

Mark: And what is the typical course of treatment? 

Iyad: So, again, you wanna identify triggers. So it's a lot of, let's say, not necessarily avoidance, I would just say, let's call it controlling the triggers. So if you can do a little less of that, that would be really good. We wanna keep people active, obviously, as much as possible. So like if somebody's used to walking a lot and we wanna keep them walking, ideally we would find a distance they're comfortable with. We would probably change them from walking big hills to more like a flat surface, a flat road, even on the treadmill, if they could tolerate that.

So that's number one. It's really important not to let people kind of decondition, you know, cause they tend to have taken quite a significant rest when they come and see us already. And it doesn't seem to kind of go away. They're like, oh, it only feels good now when I'm not doing anything.

So the second they get back to activity, it flares up. And then we will try to give specific exercises that, let's say are tolerated by that affected tendon, but also let's call it like comfortably uncomfortable, so that it kind of tends to work well without flaring them up for too long. 

And and then obviously it depends on your goals and where you want to go. So if you are trying to just get comfortable walking 30 minutes a day, obviously your treatment isn't gonna be the same as somebody who's trying to get back into running or doing some pretty intense hill work and hiking and stuff like that. So that's where you'll see a big difference between different people. And it depends a lot on their goals and where they're at already. So some people tend to be very, very affected and some people are less so. So it's not like a, a one size fits all because of the spectrum of presentation and also goals that people wanna get to. 

Mark: So is this a thing that if you just quit and didn't do anything for a year, it would go away?

Iyad: It only seems to get better at rest. That's the thing. So rest makes it better at rest. That's what we're finding with actually almost all the tendons in our body. And I mean, it makes sense, you know, we constantly think of muscles as atrophying, but tendons actually really get affected structurally when we don't put like the right amount of, let's say, stress through them. 

So yeah, like it'll probably feel better when you're not doing much. But then the second maybe you return to any form of exertion on that area, it can flare up and people think, oh my God, I thought I got rid of this. And we see it a lot. We see it with shoulders, we see it with everything. We see it with Achilles tendons, we see it with even some cases of knee pain where you know, we think rest is the way to go. But really the key thing for us tends to be about finding an activity that anybody with this can tolerate and kind of progressing them from there. And they do really well, exercise programs tend to be quite effective here. And we're having a lot more studies show that compared to other, let's say even pharmacological interventions, which is quite good. 

Mark: If you're having some hip pain get in to see the folks. Sooner is better. Always. Your recovery will probably happen quicker. The sooner you get in there, rather than you waiting around. It ain't gonna get better by itself. Go see the folks at Insync Physio in North Burnaby. You can book online at insyncphysio.com or you can call the office to book. Burnaby's office number (604) 298-4878. They also have a location in Vancouver and you can book online there as well. Thanks Iyad. 

Iyad: Thank you.