Is Hip Pain the New Frozen Shoulder?

From oprahdaily.com

Just when you thought you were done with physical therapy, a hot new menopause symptom has hit the scene 

There was a time in life—let us call it “youth”—when each time we had a pain, we knew what caused it. Twisted a knee in yoga class. Sprained an elbow playing tennis. Shin splints from dancing all night.

Then comes midlife, when all of a sudden you can’t lift your arm thanks to frozen shoulder. Or you roll over in bed, and searing hip pain jolts you awake.

“I definitely see hip pain in women over 40,” says Jessica Tomazic, MD, a sports and exercise medicine staff physician at Cleveland Clinic. In most cases, it can be treated with medication and physical therapy. But diagnosis can be difficult, since one type of hip pain can masquerade as another. Just ask Joseph Conger (also known as Dr. Joe), a doctor of physical therapy and owner and director of Flying Root Physio in New York City. Shortly after his office reopened post-pandemic, he had a patient come in with pain that seemed like classic sciatica. “She felt the pain in the back part of her hip, and then radiating down the leg—a burning sensation, kind of unrelenting difficulty sitting, walking,” he recalls.

"The pain is kind of unrelenting. It can be like you can’t get comfortable, pain sleeping at night, and without real relief"

He treated her for sciatica, but the pain persisted, so he sent her to an orthopedist, who also diagnosed her with sciatica. One MRI, three months of physical therapy, and two courses of steroids later, she felt no better. So Conger and the orthopedist tapped a third expert, a physiatrist specializing in differential diagnosis, who finally suggested the pain might be gluteal tendinopathy—where the tendon tissue in your hips and butt starts to deteriorate or becomes inflamed. After six weeks of a new physical therapy regimen, the woman’s pain was gone.

That was the first time Conger saw a patient with gluteal tendinopathy. Since then, he’s treated several more women in menopause for it, and recently, patients have started to come in asking about the condition. “Either their friend group is talking, or it’s in their social media algorithms, but they’re hearing it in the fray and asking me to help,” he says.

If you’re wondering if your surly hip pain is the hot new menopause symptom everyone’s talking about, we’ve got the answers.

                                                                          jeffbergen/Getty Images

What’s that pain in my ass?

Dr. Tomazic says she sees three very common types of hip pain in women going through menopause:

• Arthritis is a painful swelling of the joints, which becomes more common with age. (It’s often hereditary—if your mom had it, you might get it too.)
• Sciatica is a pinched nerve (the sciatic nerve being the longest in the body). It can be caused by arthritis in the back, a herniated spinal disc, or narrowing of the spine (spinal stenosis), among other conditions.
• Gluteal tendinopathy is an umbrella term for degenerative changes in the gluteal tendons, which can lead to muscle weakness and pain in those areas.

A number of other, less common issues, like bursitis and hamstring strains, can also cause hip pain.

The kind of pain you feel can clue you in to a potential cause. “With arthritis, people often tell me they have groin pain or posterior pain deep in the hip,” says Dr. Tomazic. “With gluteal tendinopathy, people will feel it in the side of the hip and might notice it’s very painful to walk up stairs.” In the case of sciatica, the pain can radiate all the way down the leg and potentially cause numbness or tingling, she says.

But don’t DIY diagnose based on pain alone, as many symptoms overlap. “The pain is kind of unrelenting,” says Conger. “It can be like you can’t get comfortable, pain sleeping at night, and without real relief.” If the pain has gotten to the point where you’re turning to Google to investigate it, book an appointment with your primary care physician, says Dr. Tomazic. “If it’s severe pain, see somebody right away, because it could be a fracture.”

Conger also cautions against stretching at home for relief, because it might do more harm than good. “In the early stages of gluteal tendinopathy, the glute and the hip may feel sore and achy, and then you work out, and as the hip region gets warm, the soreness and pain might go away,” he says as an example. “People may think, Oh, I feel better when I exercise, but the more we continue to do the exercise and movement, it will only continue to worsen over time.”

The smart thing to do is seek out a diagnosis and follow the prescribed physical therapy program. For example, Conger says he would treat sciatica with self-massage and stretching exercises to release the pinched nerve, but he’d address gluteal tendinopathy with specific exercises designed to strengthen, rehabilitate, and increase blood flow to the weakened tendon.

Once you have a diagnosis, Dr. Tomazic recommends the American Academy of Orthopaedic Surgeons’ public-facing resource site, OrthoInfo, for additional information on exercises or treatments for your particular condition.

Tell me more about this gluteal tendinopathy.

For many people, Grandma had arthritis, and Mom may have had sciatica, but gluteal tendinopathy is likely a new term. “Tendinopathy can be related to overuse and overworking that triggers the tendon to start to break down,” says Conger. “So when the muscle gets overused, the tendon, which attaches the muscle to the bone, starts to get irritated because it can’t handle the amount of work applied to it.” He adds, “In other cases, the muscle is weak, so any effort—like the stress of walking stairs, or any amount of exercise—causes the tendon to overwork and then be inflamed.”

Men can get gluteal tendinopathy, but “I see more women in the clinic,” says Dr. Tomazic. Data suggests that four times as many women suffer from the condition as men. As for the menopause connection, “there may be an association between changes in hormones and tendon health,” she says. Estrogen—which drops in perimenopause and menopause—is believed to help keep tendons healthy. But as with so many menopause-related issues, this connection hasn’t been studied enough yet to prove a definitive link between menopause and gluteal tendinopathy.

How can I avoid hip pain altogether?

Just as physical therapy can help treat gluteal tendinopathy (and other types of hip pain), the right kind of movement can help prevent it too. Dr. Tomazic recommends strength training. “Building muscle is probably the most important thing you can do,” she says, and that includes your core. “A stronger core can help reduce undue stress on other areas of the lower legs or the lower extremities,” she adds. That will help you walk normally to prevent hip strain and pain, while maintaining posture to prevent back pain, she explains.

Mix up your workouts too. “The best preventative advice that I can give is that the body likes variety,” says Conger. “I never like to hear from a patient that all they do is yoga or all they do is pickleball.” Alternate between cardio and strength training as well. Finally, good nutrition is key. Dr. Tomazic advocates a diet high in protein, fruits, and vegetables and low in processed foods. “There’s some thought that collagen supplements can be helpful for soft tissues like tendons,” she says. “The jury’s still out on their total benefit, but they’re pretty low-risk.” In other words, if you’re willing to shell out some extra bucks, a collagen supplement can’t hurt.

Of course, if you’re eating and moving right, you’re setting your body up for success in multiple arenas. It’s a way to put your best foot forward as you age, not just your hip.

https://www.oprahdaily.com/life/health/a64675107/menopause-hip-pain/