Author: Emma Freemantle
Introduction
Gluteal tendinopathy is typically described as a constant ache or bruise sensation on the side of the hip. This pain can be aggravated by compression (e.g. lying on the affected side) or loading (e.g. climbing stairs). It is also common to have accompanying pain into the side of the thigh or lower back. This pain can significantly impact your mobility in day to day life – but the good news is that physiotherapy led management of gluteal tendinopathy has been shown to have over a 90% success rate.
Essential Anatomy
Before we get into the management of gluteal tendinopathy, what exactly is it?
A tendon is the part of your body where the muscle attaches to a bone so that you are able to use your muscles to move your skeleton. In cases of overuse or overload, sometimes tendons become irritated and don’t heal in the way they should – this is what we call a ‘tendinopathy’. Gluteal tendinopathy is the disrepair of the tendons of the buttock muscles – gluteus maximus, gluteus medium, and gluteal minimus.
Causes of Gluteal Tendinopathy
There are some physical risk factors that may predispose someone to gluteal tendinopathy – including having wider hips, being middle-aged, or having increased body weight. However, we also know that having tight gluteal muscles, poor hip control, or weak gluteal muscles are local causative factors that increase the load through the tendon.
Physiotherapy Treatment of Gluteal Tendinopathy
As previously mentioned, physiotherapy-led management of gluteal tendinopathy is the gold standard – with over 90% success rate. Activity modification is an important initial strategy in order to reduce the compression and load through the tendon. Depending on the individual’s aggravating factors, some simple modifications such as sleeping with a pillow in between the legs or reducing the amount of time spent sitting with the legs crossed can make a significant impact.
Tight gluteal muscles can be addressed by either getting a massage or applying a self-massage technique. In order to apply a self-massage to the gluteals, start by gently sitting on a massage ball or a cricket ball, taking some of your body weight through your hands and feet. You can gently roll around the bulk of the gluteal muscles until you find tight areas – once you find these tight areas, try to apply slightly more pressure or roll over the spot a few times until the tension dissipates. Check our Instagram post on gluteal tendinopathy for video instructions (Gluteal massage)
Poor hip control often presents in either what we call ‘hip drop’ (where, as the name suggests, the hip on the opposite side drops) or ‘lower limb valgus’ (where the knee falls inwards). Both of these positions put more tension through the gluteal tendons on the outside of your hip. Various control exercises can be prescribed as a way to retrain your brain to hold yourself in the most optimal positions to prevent overload through the tendon. An example of these control exercises is called the hip hitch, where you work on correcting the hip drop. Depending on the severity of your condition, your physiotherapist can help guide the parameters of these control exercises to optimise the level of ‘good’ load for your tendon. (Hip hitch)
To address weak gluteal muscles, doing some strength exercises is key. A great one for gluteal tendinopathy is a theraband squat. This involves putting a theraband around your legs above your knees, and pushing the knees out against the band as you squat down and up. This not only aims to strengthen all gluteal muscles and therefore increase their capacity for load, but reinforces good hip control. However, be careful with this one. It may not be appropriate to perform day one of your rehab and may take some time to build up to. If you are unsure, speak to your physiotherapist. (Banded squat)
If these exercises still aren’t enough to completely resolve your hip pain, at Back in Motion Hawthorn, we are very lucky to have the latest technology called ‘Extracorporeal Shockwave Therapy’, or ‘Shockwave Therapy’. This therapy has been shown to promote healing for stubborn tendons and can be used as an adjunct with the previously mentioned management strategies. To read more about Shockwave therapy, check out this article on our Services Page – SHOCKWAVE
Summary
Gluteal tendinopathy can be a very frustrating type of hip pain that gets in the way of everyday life. The great news is that there are many successful management strategies that can be implemented to not only reduce pain, but increase the hip’s capacity for load in the future.
If you have pain on the outside of your hip and would like an assessment and tailored management plan, Book Now, for a free initial assessment. For more on the exercises we have mentioned above, head to our Instagram page for video tutorials.
References
- Reid, D. (2016). The management of greater trochanteric pain syndrome: a systematic literature review. Journal of orthopaedics, 13(1), 15-28.
- Del Buono, A., Papalia, R., Khanduja, V., Denaro, V., & Maffulli, N. (2012). Management of the greater trochanteric pain syndrome: a systematic review. British medical bulletin, 102(1).
- 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.