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Monday, February 4, 2019

Gluteal tendinopathy- a real pain in the butt by Mike Blackwell

What is the condition?

The gluteus medius & gluteus minimus muscles are located around the side of the hip and pelvis. Irritation of these tendons is now named gluteal tendinopathy.

Glute med takes its attachment from the iliac crest (wing part of the pelvic bone) and then attaches via a thick tendon onto the greater trochanter (big bone on side of hip). The Glute Min is deep to the Glute Med and originates from lower down the wing bone of the pelvis (ilium) and also attaches into the greater trochanter.

Glute med’s main action is to abduct the hip (bring the leg out to the side) and internally rotate the hip (turn the whole leg in from the hip). Glute Medius also assists the pelvis to stay level and controlled during the stance phase of walking and running.

 

Symptoms around Glute Med/ Min tendinopathy include:

  • Pain on the outside of the hip sometimes extending down the outisde of the thigh and into the knee. Particularly when running, walking, lying on the affected side, crossing legs, sitting in low chairs, standing on one leg or going up stairs or hills. Pain can also be worse during the night or first thing in the morning when getting out of bed
  • Weakness of these muscles
  • Reduced hip range of movement particularly into internal rotation

 

How do I get the condition?

Gluteal tendinopathy is more common in women, in particular post menopausal women. This is thought to be due to the increased Q Angle (angle of the thigh bone from hip to the knee) as a result of women generally having wider hip bones for child birth. There are also some hormonal factors that may predispose women to this injury.

The most common cause of this injury is poor load management in that these muscles do not have the capacity to cope with the amount of load being placed upon them on a daily basis. This can be a sudden onset of symptoms due to doing too much too soon when for example they start a new sporting activity, in particular running. Alternatively, it can be a gradual onset when they have progressively put on weight or if they have gradually become weaker in these muscles or a combination of these 2 factors.

Finally, foot posture and control can also be a factor in this injury. If you have poor foot control, each time you take a step during walking or running the likelihood is that your foot will roll in towards midline and this often has the knock on effect that both the knee and hip will follow suit. This can be enough to put excess load on the gluteal tendons and therefore cause pain.

 

How long will it take to Fix?

This is too hard to answer as a generalised rule as it all depends on how long you have had the injury (the longer you’ve had the injury, the longer it usually takes to recover), how severe your injury is and what your preexisting base line fitness is (strength, mobility and cardiovascular fitness). As a general rule though, we know that strengthening of the muscles around your trunk, pelvis and hips is the correct approach to assisting gluteal tendinopathy recovery. Starting to strengthen any muscle groups takes at least 8 weeks and so positive changes in the injury usually start between 2-3 months of consistent work with your physio.

What do I do to Fix it?

There are several strategies that need to be introduced to assist recovery of gluteal tendinopathy:
Looking at your load management- are you doing too much too soon and if so, modify your activities appropriately. Your Physio can certainly advise you on this.
– Initially hands on treatment by your physiotherapist such as massage and joint mobilisation to release any of the tight structures around the hip, lower back and pelvis that may be causing additional load to be placed on the gluteal muscles. It is important to mention that research has shown that massage of the affected or tender area is not advisable even though it feels like that is what is necessary.
– Anti inflammatory medication such as ibuprofen has been shown to be helpful to ease symptoms of gluteal tendinopathy. You must check with your doctor before taking and you must make sure you have eaten just prior to taking the medication. Also, taking the recommended daily dose consistently for 4-5 days in a row has been show to be far more effective than just taking it when you are in pain.
– A specific strengthening program of the muscles around the lower back, hip and pelvis in particular, the core stabilisers and gluteal muscles (Max, Med & Min):

i. Black theraband bridge

 

ii. Side plank with up & down- hold- hip Abd

 

iii. Pelvic drop exercises

 

iv. Fire hydrants

 

v. Dead lifts- single leg

 

Long hold stretches (at least 40-60 seconds) of tight structures such as hip flexors, quads and quadratus lumborum that may be impacting the biomechanics of the pelvis. Again, research has shown that we should not stretch the gluteal tendinopathy.

Occassionally it is appropriate to consider orthotics (custom made in soles for shoes) as well as advice on particular foot wear to assist with the control of the foot and therefore offload the gluteals around the hip.

If you have any further questions on Gluteal tendinopathy then please email us at reception@fixphysio.com.au or come and see us at Fix Physio Sydney in Sydney CBD www.fixphysio.com.au/booking

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