Hi, I'm Ali! I'm one of the physios from sports-injury-physio.com. This is the
fourth in our series on greater trochanteric pain syndrome or lateral hip pain or outside hip pain.
The first three have been talking about what structures can we find on this outside of our
hip – pain that might be causing these problems, what symptoms we might expect with people that
have this problem, and the third one was talking about sitting and standing tips
to try and help reduce some of these symptoms. In this video, we're going to be talking about
tips about sleeping and lying and trying to find positions that might also help these symptoms.
So, if we do a quick recap based on what we've talked about in the other videos,
we're talking about your glute muscles, your big bottom muscles that come all the way around
across your bottom and insert into that outside bony area on your hip. That outside bony area
is called your greater trochanter, and underneath these tendons are a bursa or a sac of fluid,
and that stops those tendons from rubbing where they insert. When we're talking about greater
trochanteric pain syndrome, the theory is that there may be a combination of lots of structures
that are causing those pains, one of which being because of those tendons might have developed
a tendinopathy or that bursa might be irritated and angry, or a combination of the two.
When we're looking at what might irritate us when we're sleeping, quite commonly people report that
they don't like lying on their side. So, they're lying on that painful hip and really can't do that
anymore. Or in addition, they might not like lying on the other side and their leg coming over and
dropping over their body. Now, the reason being is that both of these positions are a bit like
pressing on a bruise. So, we'll come on to what I mean by that. If you imagine that your tendon is
coming around and attaching right onto that bony side – so, really close to that – if you were to
put pressure on that, it's like putting pressure on a bruise. You put enough pressure on it,
that bruise says ‘Ouch! I'm a bit sore!’ You take the pressure off, it calms itself down.
So, the theory behind finding sleep positions that help you is about trying to help it calm
down. Again, this is not a solution, this is just something to make it feel better. And if
you can feel better, then you can go and do your exercise rehab, which has been proven to be the
most effective when treating a tendinopathy. So, this is something to do alongside that.
When you have your leg lying over and dropping over the outside, your body is going into what's
called adduction, so, taking your leg across your midline or dropping your leg in towards the other
side. So, that adduction movement is where we're then stretching those tendons. So, if you're
stretching those tendons, again, they're becoming closer to that bone – that's what we're supposed
to do when we move our leg in that direction – totally normal, but if it's irritated and angry,
you can see again, if you get closer to that bone, it's like pressing on that bruise again.
So, I'm going to give you my favourite three sleeping positions. Now, these aren't things that
you're going to think ‘What a miracle cure! This is great!’ You're probably still going to wake up
in the middle of the night, but it might be now because you're fed up with the cushions being
in that position as opposed to being in pain, and therefore it's easier to get back to sleep again.
Some people like some of these, some people don't like any, and some people have their
own ideas. So, these are my favourite three that I would give a patient.
So, if you want to be lying on your good hip, to stop your leg coming into that adduction – so,
coming down across your body, and if I tilt that down, you should be able to see a bit more. A good
way of trying to stop that from happening is to put pillows between your knees. Now, you want
enough pillows between your knees that your hip is in a nice neutral line. So, I need two because I
have quite wide hips; some people might only need one. But if you can see with me, if I put one in,
I'm still going into that adduction. Some people like to put the pillows the other way around,
and again, you might be able to play around and see what works best for you. So, this is my option
number one, and it's probably one of the most common ones that you've seen on the Internet.
Option number two is to put your leg, your pillows, in front of you, so your top leg then
rests on that and then again, you're trying to have enough pillows under here, but it's
not dropping into that adduction position. And again, that might be quite comfortable to lie in.
An alternative, if you're sick of lying on either side and you find that quite uncomfortable,
is to put a line of pillows down from the top to the bottom of your bed and then you lie
half on those pillows and half off. So, if I'm half on and lie down and half off,
I'm now neither on my side, nor am I on my back, and it can be quite comfortable. And again,
you can just move over and use the other side if you've got the space to do so,
or you can lie on your front and do the same thing half on and half off.
So, thank you for watching these videos so far, and there will be some more coming in
the series where we talk about stretches and why they might not be a great idea,
and also the menopause, and we're going to talk about what exercises are a good idea,
and what other things you can consider. Thanks very much. Goodbye!