A common condition I see with women in menopause is persistent pain in the outer hip area (lateral hip pain). I’m talking about the kind of nagging hip irritation that can hang around for months to years. You may feel it walking, going up stairs, and it can limit your ability to comfortably sleep on your side. What you may be experiencing is a common menopausal condition called gluteal tendinopathy. Strength training with weights that targets the glutes and deep hip rotator muscles can be extremely beneficial for preventing and treating gluteal tendinopathy.
What is gluteal tendinopathy?
Gluteal tendinopathy can cause debilitating pain and fluctuating sensitivity around your lateral or outer hip.
It is sometimes referred to as greater trochanteric pain syndrome (GTPS) and is most common in females ages 40-60.
Inflammation of the gluteal tendons shows up as persistent pain in the outer part of your hip where the tendons of your gluteal muscles attach to your upper thigh bone (the knob called the greater trochanter, hence the name greater trochanteric pain syndrome).
What do those big words mean for YOU?
Some of the things you may be feeling include:
- Pain, sensitivity, feelings of weakness, or snapping/slapping sensations on your outer hip while walking, going up and down stairs or doing activities like yoga or pilates that require big hip motions.
- Outer hip pain while standing for long periods of time, standing on one leg (the painful side), lying down on either side, or sitting with your legs crossed can also be aggravating.
- Aches and sensitivity might also travel down your outer thigh, to your groin, low back, and SIJ or sacroiliac joint region.
Why is gluteal tendinopathy common in menopause?
The menopause transition can be a period of time marked by major changes in daily routines and life responsibilities such as:
- Career changes
- Moving between homes
- Parenting
- Caring for aging parents
Shifts in habits and routines can lead to:
- Increased stress
- Poor quality / fragmented sleep, and reduced overall sleep duration
- Decreased physical activity and exercise
- A more sedentary lifestyle
In addition to lifestyle and activity changes, research suggests that a drop in estrogen levels with perimenopause and postmenopause can contribute to decreased strength and thickness in all of the tissues of the body, namely muscles, tendons, and bones. Most likely due to a combination of lifestyle changes, increased time being sedentary, and hormonal shifts, tendons become thinner and weaker.
Use it or lose it. Without a consistent, progressive program of resistive strength training, physiology outpaces activity. Our tendons, muscles, and bones become smaller, thinner, and weaker.
People tend to lose, on average, 3–8% of muscle mass per decade after age 30. This rate of decline increases in women after menopause if an effort isn’t being made to increase and maintain muscle tissue growth with exercise.
The good news is that anyone (of any age or gender) can increase muscle mass and tendon durability with resistive strength exercise!
Strength training is a great strategy for treating hip pain with menopause
Tendons love load.
Muscle, tendons, and bones all need exposure to robust tension forces on a regular basis to stay healthy and strong. When activity declines and strength decreases, tissues that once handled heavier forces become less tolerant of force and get more easily irritated.
A condition like gluteal tendinopathy can develop into a persistent pain problem that lasts months or years.
Strength training not only helps relieve symptoms of lateral hip pain (and mitigates the risk or future hip pain flare-ups) it can also:
- Build lean muscle mass
- Improve your metabolic health
- Increase your bone density
- Give you a positive mood boost
- Bolster your confidence, comfort, and ease with daily activities
- Improve your sleep quality
- Lower your risk of age related cognitive impairments
A whole-body strength and conditioning program, combined with a few key resistive exercises for your outer hip can do wonders for relieving this common inflammatory hip condition, gluteal tendinopathy.
Do you have old strategies for hip pain relief that aren’t working anymore?
When a patient shows up in my physical therapy clinic with signs and symptoms of gluteal tendinopathy, one of the things I commonly hear is, “I used to do these exercises to make my hip feel better, but the things I was doing aren’t working anymore.” Many of them are long-time yoga or pilates practitioners who are physically active, love to walk for exercise, and have noticed significant changes in the ways their bodies feel after reaching perimenopause.
Things I also hear from patients:
- My body doesn’t feel like my own anymore.
- I feel more easily fatigued and achy with exercise and it’s made me become more sedentary.
- I’m putting on weight in areas of my body I didn’t before.
- It seems like the same exercise I had always done in the past isn’t having the same effects.
- My hips ache when I walk and are sore at night after a yoga class.
- I can’t find a comfortable sleep position. I can’t lie on either side because of the pain in my side hip. Read more about sleep position for side hip pain here: Hip Hurts when Sleeping: Is outer hip pain keeping you up at night?
Bodyweight exercises like yoga and walking might no longer be enough to keep pace with menopause related tissue changes. After a few months of beginning a yoga or walking program, your progress will plateau.
You’ll be stuck in maintenance mode. Unfortunately, just maintaining is not sufficient. Heavier resistance training (more than you can do with bodyweight alone) is needed to send a strong enough signal to your muscles, tendons, and bones to adapt.
My story of persistent hip pain with yoga
Back when I was teaching yoga full-time I experienced daily, persistent pain in the outside of my hip. I hadn’t reached perimenopause yet, but was stuck in cycle of under-loading my body. Some days while traversing the SOHO cobblestone on my way to work, it felt like my right femur was falling out of my hip socket. That’s the image I held in my mind anyway. There was clicking and slapping and pain all around my greater trochanter (the knob on the upper, outer portion of the thigh bone). I also had a wonky (that’s a clinical term, ha!) SI joint and all sorts of grippy, tight, sore muscles around my right hip, groin, and low back.
I thought I could use my tools from yoga to stretch and move and align myself back to comfort and optimal function. These were the only tools I had at the time.
I was stuck in a groove of repetitive bodyweight loading, end range practice, and probably a fair bit of hypervigilant movement management.
Taking a broad view, when the body complains with persistent unpleasant sensations, it usually just wants different stimuli. Simple. A bit less of the stuff it’s already getting in excess and more of something else.
I decided it was time to switch it up.
After teaching at the yoga studio, I headed over to the fighting gym down the street and promptly learned how to pick up and swing heavy kettlebells. I got out of my well worn movement grooves, got outta my head, and began using my body in completely new ways in a new environment.
Guess what happened next.
Yep! My hip pain went away within a couple months. It’s not magic. It was most likely due to the brilliance of physiological adaptation.
The bells spoke to my cells!
Anyway, this is all to say that pain does not mean broken. There is a way forward. And you probably won’t be able to more-of-the-same your way to recovery. It doesn’t have to be kettlebells. For me, they were a gateway into heavier strength training. And that heavy strength training has served me and the folks I treat in my physical therapy practice very, very well over the years.
Ready to do something about your lateral hip pain? Start here
The side sitting hip mobility sequence demoed in the video below is a great on-ramp for introducing a bit of novel force stimulus into your painful outer hip area. It includes active hip abduction, internal and external rotation, and side lying hip circles. This set of hip exercises can help calm down feelings of tenderness and irritation, and set the stage for more robust resistive exercises down the road.
This video is included for your education and experiential movement practice. It does not replace clinical examination and individualized recommendations from a physical therapist or other health care provider.
Next step: Gradually progress to loading your outer hip with more resistance!
Still need help with your hip pain? Here are three ways I can help:
Hey, I’m Caitlin. I’m a Doctor of Physical Therapy who loves helping women in middle age get strong AF.
I want to help you alleviate common musculoskeletal aches and pains in menopause. Even more, I strive to arm you with tools for self-treatment and help you build a habit of strength training now so that you can enjoy independence and sustainable robust activity 20-30 years from now.
1. Physical Therapy
If you are local to New York City, come see me for physical therapy. I’ll conduct a thorough clinical examination that covers whole-system health factors as they relate to common musculoskeletal complaints in menopause, a movement screen and physical exam, as well as advice for implementing a strength training program to prevent and treat osteoporosis. Practice Human proudly accepts Medicare and works out-of-network with most insurance plans.
2. Small Group In-Person Strength Classes for Older Adults
For those local to New York City, Durability for Life is Practice Human’s signature small group strength training course. Designed for women ages 65+ who want to feel more confident and capable in daily life and with more demanding physical activity. Appropriate for people with osteopenia, osteoporosis, knee and hip arthritis, and persistent low back pain. Led by physical therapist and strength & conditioning coach Caitlin Casella.
3. Online Strength & Conditioning for Women Ages 40+
The Slow Cooker is a comprehensive 15-week online small group strength & aerobic conditioning program designed for women ages 40+. Appropriate if you are perimenopausal or postmenopausal, training with knee or hip arthritis, have osteopenia or osteoporosis, or working with persistent pain. Led by physical therapist and strength & conditioning coach Caitlin Casella.
Next on your reading list: Menopausal Joint Pain: Strong at Every Stage
