Lateral hip pain is one of the most underdiagnosed and mismanaged musculoskeletal conditions. For decades it was called trochanteric bursitis -- attributed to inflammation of the bursa over the greater trochanter. Research since 2010 has fundamentally changed the understanding: in most cases the bursa is not primarily inflamed; the primary pathology is gluteal tendinopathy -- degeneration and tearing of the gluteus medius and minimus tendons at their insertion onto the greater trochanter. The condition is now called greater trochanteric pain syndrome (GTPS).
How Lateral Hip Pain Affects Walking
GTPS produces pain at the lateral hip that is worst with: crossing the legs, lying on the affected side at night, sitting with hips below knee level (particularly in low chairs), and prolonged walking. During walking, the gluteus medius and minimus control lateral pelvic stability during the stance phase (when the opposite foot is in swing). Tendinopathy at these tendons causes pain at the moment of maximum load -- during single-leg stance on the affected side.
The Adduction Compression Mechanism
GTPS is a compression tendinopathy: the gluteal tendons are compressed against the greater trochanter when the hip is in relative adduction. Activities that bring the leg across the body (leg crossing, walking with narrow stride width) increase this compression. Walking with a wide leg stance (increased stride width) reduces compression; walking with a narrow stride (legs close together, typical antalgic pattern) increases it. This is clinically counterintuitive: the patient naturally reduces stride to reduce pain, but narrow striding worsens the underlying tendon compression.
Cane Use in GTPS: What Helps and What Does Not
| Strategy | Effect on GTPS |
|---|---|
| Cane contralateral to affected hip | Reduces gluteus medius demand during stance on affected side; reduces Trendelenburg sway; BENEFICIAL |
| Cane ipsilateral to affected hip (wrong side) | Does not reduce gluteus medius demand; may worsen Trendelenburg mechanics; NOT RECOMMENDED |
| Increasing stride width with cane | Reduces adduction compression on tendon; provides stability for wider stance; BENEFICIAL |
| Crossing legs on a chair while using cane | Increases tendon compression regardless of cane use; AVOID |
Load Management Principle for GTPS
GTPS responds to load management rather than rest. Complete rest worsens tendinopathy (tendons require some load to maintain structure). Progressive loading -- starting with isometric exercises (no tendon movement), progressing to isotonic loading, then to dynamic loading -- is the rehabilitation path. A cane supports this by enabling continued walking (dynamic loading within a tolerable range) rather than the patient stopping all activity due to pain.
Explore DaiWalk walking canes. Related: Walking Cane for Hip Bursitis and GTPS | Walking Cane for Hip Osteoarthritis.
