GLUTEAL TENDINOPATHY
What is it?
Gluteal tendinopathy is a common condition often presenting as a stubborn 'ache' on the side of the hip. Certain positions such as lying on the affected side, crossing the affected leg over to the other side when seated, or climbing stairs can aggravate the pain. Gluteal tendinopathy, like most tendinopathies, occurs after a period of rest followed by an increase in activity (i.e. return to work after holidays, return to gym after months of rest). Fortunately, your Physiotherapist can equip you with the right tools to manage your gluteal tendinopathy safely and effectively.
Anatomy
Firstly, tendons attach muscles to bones to help move the skeleton and appropriately absorb load. When there is overuse or overload of a tendon, it can become aggravated and fail to heal appropriately. In Gluteal Tendinopathy, the tendon between the gluteal muscles - maximus, medius and minimus - and the hip bone becomes irritated.
Risk Factors
Major risk factors include having wide hips, increased body weight and being in your 50s. However, poor control of the hip, reduced strength of the gluteal muscles and tight buttock muscles may also cause gluteal tendinopathy. In addition, loading is an important risk factor. Many people may increase their risk of gluteal tendinopathy by returning to 100% of their capacity at the gym or at the track after a prolonged period of resting/de-loading the tendon. This is usually seen when someone might return to a recreational sport after months of a break or transition from sedentary to active work/lifestyles.
Treatment
Physiotherapy focuses on changing daily activities to optimise the load and compression through the tendon. Strategies such as sleeping with a pillow between the legs, limiting cross-legged positions and limiting time lying on the affected side are often quite helpful for pain relief. Simple planning techniques aimed at gradually building the tendon's capacity when training are also extremely important in Physiotherapy rehabilitation of Gluteal Tendinopathy.
For tight glute muscles, trigger ball release and self-massage have been found to be quite effective. To complete a trigger ball release, simply place a ball (i.e. tennis ball or a trigger ball with spikes) between a wall and the point of pain on the part of the glute muscle that hurts. Apply enough pressure on the spot that is tolerable and hold for 30 - 60 seconds. Repeat up to 3 times, but do not push through pain.
If there is weakness in the glutes, then strength training is your best friend. The golden exercise that can assist with strengthening the entirety of the three glute muscles (maximus, medius and minimus) - is a resistance banded squat. This exercise may be difficult at first, so it is important to slowly build your way up. To perform a banded squat, first ensure you have a resistance band wrapped around your legs just above the knee joint. Then, squat down to a comfortable position while maintaining resistance against the resistance band. Slowly come up back to standing. You may find that repeating this exercise 10 times is fatiguing, so it is important to take rest before doing another set of 10.
In some people, the pain may actually stem from poor hip control. This is often seen as a hip drop or slight limp when walking or difficulty maintaining balance while climbing stairs. The reason for this poor hip control is due to the increased load through the gluteal tendons. When tendons are overloaded, they tell you by inducing pain. Fortunately, there are Physiotherapy treatment techniques to address poor hip control which can address specific muscles involved for each individual.
For most people with gluteal tendinopathy, the results are promising with Physiotherapy. If you have experienced pain on the outside of your hip and want to learn more about how to manage it, book in for an initial assessment. Your Physiotherapist can provide tailored recommendations for you to help achieve your goals and get you back to 100%!
References:
Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy, 45(11), 910-922.