An Expert’s 3 Practical Tests for Lateral Hip Pain

Lateral hip pain is a common presentation, but it can be tricky to pin down. Several different structures may be at fault, and identifying the true source is integral to getting treatment right.

Greater Trochanteric Pain Syndrome (GTPS) is often the first condition that comes to mind for us physios. Many patients even arrive with the familiar (but not entirely accurate!) label of “bursitis”, yet isolated bursitis accounts for only around 2% of this population. In most cases, GTPS is driven by the gluteus minimus and/or gluteus medius tendons.

While GTPS is relatively common, it’s important not to assume every case of lateral hip pain falls into that category. Other issues can easily masquerade as GTPS, and overlooking them can lead to ineffective management.

In this blog, we’ll share expert hip physio Mehmet Gem’s approach to assessing patients with lateral hip pain, and how he builds diagnostic confidence using a 3-test cluster for GTPS.

If you want to know exactly how a top physio assesses lateral hip pain, watch Mehmet’s full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more HERE.

Background

When faced with lateral hip pain, the first step is to rule out the lumbar spine as a source. This comes through a combination of a thorough subjective assessment and appropriate lumbar screening tests, this is something Mehmet covers in depth in his Practical.

Next, you’ll want to consider whether the pain is extra-articular or intra-articular. A common screen here is the Flexion–Adduction–Internal Rotation (FADIR) provocation test. While not diagnostic on its own, if the test is negative and doesn’t reproduce symptoms, this adds weight to an extra-articular source of pain, helping you to rule the hip joint out.

Every hip assessment should also include Range of Motion (ROM) testing – this may be painful or limited in many conditions, but working out whether it’s limited by true stiffness, by pain, or if there’s even excessive ROM, can help build the clinical picture and differentiate between different conditions such as osteoarthritis, femoroacetabular impingement syndrome and hip dysplasia. It all comes down to spotting patterns!

GTPS test cluster

If your assessment is pointing towards GTPS as the likely source, relying on a single test isn’t enough. Instead, combining these 3 tests can give you a much stronger overall picture:

1 – Single-Leg Stance (SLS)

Ask the patient to stand on the symptomatic leg for up to 30 seconds. A positive result is reproduction of their familiar lateral hip pain within that timeframe. Be sure to look out for subtle compensations like trunk lean or pelvic drop, these give you valuable information about load tolerance and functional deficits. Watch Mehmet explain how he conducts this test in the below video from his Practical:

2 – Palpation

Simple, but still sometimes one of the most powerful tools we’ve got. Direct palpation over the greater trochanter and gluteal tendons can reproduce the patient’s familiar pain. Of course, tenderness can sometimes be incidental, or secondary to another issue, so palpation should never be used in isolation. Watch Mehmet demonstrate his technique in this snippet from his Practical:

3 – Resisted hip abduction

The final piece of the cluster is resisted hip abduction. Pain reproduction here can suggest gluteal tendon involvement. It’s worth noting this is not a reliable measure of strength, but rather a provocation test. Watch Mehmet demonstrate his approach in the below clip from his Practical:

Together, these three tests help you build confidence in your diagnosis of GTPS. But remember, hip conditions often overlap, so keep the bigger picture in mind, monitor symptoms across functional tasks, and continue to reassess your patient regularly to make sure they are truly progressing in the right direction!

Wrapping up

Too often, lateral hip pain gets funnelled into a single diagnosis of “bursitis” without considering contributions from other sources. A thorough subjective assessment helps you spot patterns early and guides the objective testing that follows.

When it comes to hip pain, no single test gives you the answer. It’s the pattern of findings, both subjective and objective, that allows you to make confident clinical decisions and tailor treatment more effectively. And we didn’t even touch on Mehmet’s favourite clinical test for hip pain!

If you want to see exactly how an expert hip physio assesses lateral hip pain, and apply those insights directly to your own practice, watch Mehmet’s full Practical HERE.