3 Guiding Principles for Effective Lateral Hip Pain Management

Managing lateral hip pain can be tricky, especially when your patient walks in frustrated, sleep-deprived, and unsure of what’s making things worse.

It’s a condition that demands a thoughtful balance of load management, education, and progression – not just exercise prescription. Even then, we can find ourselves constantly adjusting rehab to reduce flare ups, manage setbacks, and ultimately get the best outcome for the patient, which can take time! It can be as frustrating for us as it is for the patient, and it’s in those moments that maintaining our clarity in rehab matters most.

This blog covers three guiding principles I took away from expert hip physio Mehmet Gem’s Practical – principles that can help you bring more structure, confidence and clarity to your approach when managing your next lateral hip pain patient, no matter how tricky!

If you want to know exactly how a top physio manages 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.

#1 – Manage irritability & build confidence

It’s more than likely the patient has come to you when their pain has started to feel out of control – perhaps they’re struggling with load intolerance, increasingly frequent flare ups, or increasingly disruptive night pain.

The first step in management is obviously to calm things down. To do that, you need to understand what the lateral hip structures – commonly the gluteal tendons – are aggravated by (i.e., compressive or contractile loading). Common aggravators include lying on the affected side, or crossing the legs. Reducing the exposure to aggravating factors, at least initially, can make a big difference for the patient’s pain.

This is also where the common misconception regarding stretching can backfire, where the patient has been stretching regularly to try to ‘release’ the muscles, but the position could actually be compressing the tendons and contributing to worsening symptoms, keep an eye out for this!

See Mehmet explain another common pitfall in early gluteal tendinopathy rehab in the below video from his Practical:

#2 – Education is the foundation

Once you’ve identified the aggravating factors, the next step is helping your patient understand them.

Education and reassurance are integral. Patients need to know certain activities may flare their pain, but at the same time, flare ups can be managed. Building understanding around what flare ups mean (i.e., they don’t equal damage or further injury), what a reasonable level of discomfort looks like, and how to adjust activity accordingly are essential for effective self-management. It can be helpful to provide some ‘pain rules’ in this situation, for example:

“If your pain increases by X/10 during an activity, or is X/10 worse 24-hours after completing the activity, you’ve probably done too much, which doesn’t mean you need to stop the activity altogether, simply modify it by doing Y.”

As rehab progresses, make sure your patient knows that a flare up after a new exercise or load increase is normal, it just means things might need a small tweak, not a full step back. Staying calm, explaining this clearly, and having a plan helps patients stay engaged and consistent with their rehab.

#3 – It’s all about progressions

Mehmet’s Practical highlights effective rehab doesn’t require dozens of different, complicated exercises.

Instead, choosing a small number of meaningful, targeted exercises and progressing them thoughtfully can be very effective and help you maintain clarity with your patient. For example, see how Mehmet progresses a patient toward his favourite exercise in the below video from his Practical:

One particularly difficult part of hip rehab is starting to load patients into aggravating positions without flaring them up – see Mehmet demonstrate an example of how he does this in the below clip from his Practical:

Mehmet applies this progression principle consistently throughout his Practical, showing how to clinically reason and progress exercises from the early irritable stage all the way to return to running and impact.

Wrapping up

Effective management of lateral hip pain isn’t about throwing every fancy exercise you know at the problem, it’s about timing, education, and progression done well. Mehmet’s approach shows that by understanding irritability, educating clearly, and progressing purposefully, you can simplify your rehab to achieve the best outcomes for your patients.

If you want to see these principles applied step-by-step, and refine your approach to gluteal tendinopathy, watch Mehmet’s full Practical HERE.