Lateral Hip and Buttock Pain

Contemporary Diagnostic and Management Strategies

Lateral Hip and Buttock Pain

This course concists of an online learning component of 4-6 hours and a practical workshop of 1 day. The workshop is hosted as a two day combo course with the 'Anterior Hip and Groin Pain" workshop.

Lateral hip and particularly buttock pain can often present a diagnostic dilemma. The lumbar spine and sacroiliac joints may refer into these regions; intra-articular hip pathologies may be accompanied by lateral hip &/or buttock pain; local soft tissues & neural structures may be primary sources of nociception. The first step is determining the most likely contributors to the patient’s pain presentation. Developing an optimal management program with positive effects past the short term, will also require an evaluation of physical & psychological drivers. Intrinsic & extrinsic factors should be considered within the overall context of workload. While non-modifiable factors (e.g. bony morphology) are by nature unable to be modified, awareness of these factors can be integral to providing advice and interventions (active or passive) that ‘do no harm’ and development of strategies that allow maximal function with minimisation of adverse effects.

LATERAL HIP & BUTTOCK PAIN Practical Workshop (1 Day)

The practical workshop will guide participants through diagnostic tests and management strategies for lateral hip and buttock pain. There is now high-quality evidence for assessment and management of gluteal tendinopathy from the ‘LEAP’ lateral hip pain randomised clinical trial, of which Alison was a key investigator. Participants will receive first-hand instruction on techniques, advice regarding how best to apply this approach in clinical practice and valuable troubleshooting for slow or non-responders. The workshop with then delve into the other lesser-known problems associated with buttock pain that may present diagnostic and management challenges – posterior joint instability, bony impingements, peripheral nerve entrapments and musculotendinous overload, particularly of the proximal hamstring tendon and deep hip external rotators. Understanding the impact of bony morphology, soft tissue interfaces and postural and movement patterns is critical to optimal management of these conditions.

Learning Objectives: This practical workshop will teach skills that allow participants to

  • Perform pain provocation tests for gluteal tendinopathy & associated soft tissue pathologies, and reason through the differential diagnosis for lateral hip pain

  • Provide evidence-based load management and exercise strategies for lateral hip pain

  • Assess and develop management strategies for posterior hip joint instability

  • Recognise occurrence of and potential drivers for extra-articular impingements such as ischiofemoral

    and posterior greater trochanteric impingement

  • Develop management strategies for these extra-articular bony impingements

  • Differentially diagnose ischial pain, including diagnostic tests for proximal hamstring tendinopathy

  • Apply neurodynamic assessment and mobilisation techniques relevant to the lateral hip and buttock,

    and consider the impact of soft tissue interfaces

  • Recognise the important anatomical relationships and functional roles of the deep external rotators

Online Learning Component (4-6 hours) Understanding definitions, pathology & mechanisms

Learning Objectives: The online component aims to

  • Clarify definitions and diagnoses of lateral hip and buttock pain

  • Explore factors which may influence loads and integrity of the posterior capsuloligamentous

    structures.

  • Explore factors which may influence extra-articular loads in the lateral hip and buttock region – a.

    morphological variants (e.g. bony structure, soft tissue - neural relationships), b. adverse soft tissue loading associated with kinematics and neuromotor function (focus on hip abductors and short external rotators).

  • Provide an overview of key load management and therapeutic exercise strategies for lateral hip and buttock pain, particular to the patient presentation and associated difficulties with mechanical load transfer.

  • Provide an update on scientific evidence for underlying diagnostic and management approaches

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