I’m a physical therapist who loves helping women in middle age get strong AF. I want to help you build a habit of strength training now so that you can enjoy independence and sustainable robust activity 20-30 years from now. A common barrier I see with women during and after menopause is persistent pain in the outer hip area. I’m talking about the kind of nagging hip irritation that can hang around for months to years.
Hip pain with menopause can be a literal pain in the butt!
The good news is that 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 general, 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.
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 over age 40.
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?
A drop in estrogen levels with perimenopause and postmenopause decreases strength and thickness of muscles, tendons, and bones. Collagen production also decreases with menopause and tendons become thinner. We lose, on average, 3–8% of our muscle mass per decade after age 30. The rate of decline increases in women after menopause.
This means that without a consistent, long-term program of heavy strength training, physiology outpaces activity. Our tendons, muscles, and bones become smaller, thinner, and weaker with age.
Why strength training is a great strategy for treating hip pain with menopause
Tendons love load and need to experience stimulus from tension forces to stay healthy. 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 last months or years.
Do you need physical therapy before starting a strength program?
A common misconception I see with physical therapy is people thinking that they need to complete a course of PT first before beginning a strength training program. As a physical therapist who treats primarily with movement and exercise I say WHY WAIT? When scaled and progressed at an appropriate pace, a strength training program is the answer for resolving your persistent hip pain.
Besides, there’s no time to waste when it comes to building up your strength, muscle mass, tendon health, bone density, and all of the other health benefits listed above.
Do you have old strategies for 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 that most of them say 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.
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 body weight 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 hip pain? Start here
The “pull the ground apart” exercise demoed in this video is a great on-ramp for introducing a bit of novel force stimulus into your painful outer hip area. This should help calm down feelings of tenderness and irritation and set the stage for more robust resistive exercises down the road.
Does hip pain keep you up at night?
Most people who experience hip pain with menopause have a hard time getting comfortable sleeping on either side. Sleeping on the painful side hurts because of pressure on the area, and sleeping on the non-painful side can hurt as well because of stretching forces being applied to the tendons of the top hip for a prolonged period of time.
Try sleeping on your non-painful side with one or two (or four?!) pillows between your legs. Not just between your knees. Use the pillows to support your top thigh all the way up to your groin. Since your hips are wider than your knees, raising your top knee and thigh up to at least hip height will decrease pulling forces on your tendons on the outer thigh bone throughout the night.
You’ll be using more props than a Broadway show but hey, if it makes the difference between a night of side hip agony and a sound restorative sleep that will bolster healing on every level… I say, prop it up!
Next step: Gradually progress to loading your outer hip with more resistance!
My two part workshop, Calming Down Lateral Hip Pain, is now permanently available as part of my online membership library.
You’ll get…
- Self-treatment strategies for calming down acute pain
- A series of strength exercises that can be gradually progressed over 3-6 months
- Improve hip strength and load tolerance for better walking and balance
- This will probably help your knees too!
- I offer plenty of options to find the appropriate level of intensity to meet you where you (and your hip symptoms) are today
The Feel Good, Move More Membership is a $30/month recurring subscription that includes monthly classes/workshops on a theme plus a library of replay videos.
