Member Case Study: Burning Hips

I have burning hips. They start to hurt about 20 miles into a bike ride and then they hurt as I try to sleep all night long. Stretching and massage don't seem to make much difference.

Member Question from gcirongirl
I have burning hips. They start to hurt about 20 miles into a bike ride and then they hurt as I try to sleep all night long. The pain is on the outside (TFL?) almost as if someone has drilled a pole into my hips from one side to the other right at the pivot point. NSAIDS help. Stretching and massage don't seem to make much difference. I can handle the pain while riding, but I sure would like to sleep sometime.

Answer

The most likely source of your pain is the iliotibial band (ITB); a large, thick band of tissue that starts on the outside of the hip at the iliac crest and runs all the way past the knee to insert on the tibia. This structure passes over a prominence of the femur called the greater trochanter, and there is a bursa (a fluid-filled sac) between those two structures that can often become inflamed creating a condition called trochanteric bursitis. Trochanteric bursitis often goes hand in hand with ITB syndrome.

Cyclists and runners very commonly suffer from ITB pain.  To address the problem, you should reduce your training volume both for running and biking slightly. Calming the inflammation with ice and gentle massage with a device such as a foam roller can help as well. When some of the pain subsides you should target your gluteal muscles and ITB with a series of stretching and strengthening exercises since weak hip abductors often contribute to this syndrome. Other core exercises which focus on the abdominal, back, and pelvic muscles can also help. See below for a few simple exercises which you can incorporate into your daily training plan.

While running, avoid especially hilly routes; a slightly faster pace on flat ground is better for the ITB.  Have someone check your bike fit as a seat that is positioned too high can create increased stress on the ITB. Other ways to adjust your bike include raising the handlebars and/or moving the seat forward just a little to create a more upright position and reduce stress at your hip.

For quick relief from severe pain you could try getting a corticosteroid injection into the trochanteric bursa from a sports medicine physician. This option might allow you to rest at night, but in order for you to avoid a recurrence you should target the underlying biomechanical cause of the problem. Consider asking about a referral for formal physical therapy if a program of home exercises is not effective.

Side Lying Leg Lift: Lie on your side, and bend your bottom leg at the knee. While keeping your hips in alignment raise the top leg up and slightly back to an angle of about 45°. Hold for 1-2 seconds before lowering. Perform 15 repetitions on each leg.

 

Hip Abduction with Theraband:Attach one end of an elastic band to a stationary object (table leg, etc.) and tie the other end around the ankle that is farthest away from the object. Cross your leg slightly in front of the other foot then raise it out to the side. Perform 15 repetitions on each side in a steady, controlled manner.

 

 

 

ITB Stretch: Stand a few feet from a wall with the outer aspect of the right hip facing the wall, and cross the right leg behind you. Lean towards the wall feeling a stretch along the right hip. Hold for 1 minute. Repeat on the other side. Perform the stretch 2-3 times daily on each side.