Gluteal tendinopathy

So what is a Gluteal Tedninopathy (GT)?

• GT typically presents as pain over the greater trochanter (the bony lump felt at the side of your hip) Up until recently hip bursitis was diagnosed as the main cause of lateral hip pain (pain on the outside of the hip) but recent studies suggest that an irritation of the gluteus muscle tendon is the likeliest cause.
• The tendon attaches onto a bony prominence and it is here that the tendon is subject to compressive forces leading to irritation. This can result in pain over the lateral hip which can refer down the outside of the thigh and into the knee. 

How common is it:

• Gluteal tendinopathy is relatively common affecting 10-25% of the population.
•  It is 3 times more prevalent in women than men and is most common in women between the ages of 40 and 60.
•  One of the reasons for this is women tend to have a greater angle at their hip joint increasing compressive forces on the tendon.

 
 Signs and Symptoms:

• Pain on the outside of your hip, can refer down outside of the thigh to the knee
• Worse when going up and/or down stairs
• Worse lying on affected side (and sometimes on the other side)
• Worse when crossing legs

 
Top tips for managing  GT pain:

•  Avoid crossing your legs in sitting or standing as these positions increase friction of the tendon, can cause pain and slow the healing process.
• It is also important to modify your activity. Avoid or reduce things that flare up your pain, this could be climbing stairs or hills or  longer walks/runs. By 'pacing' these activities the tendon is able to recover and gradually the swelling and pain will reduce
• A gluteal tendinopathy responds best to Non-Steroidal Anti-Inflammatories such as Ibuprofen which can be obtained without prescription. Follow recommended doses and always discuss with your GP or Pharmacist if you are unsure.
• If conservative management is unsuccessful a corticosteroid injection may be considered to settle down the inflammation, but this should be done in conjunction with your strengthening programme

 
Exercise therapy:

• Your Physiotherapist at Physioimpulse can help you manage your pain with hands on physiotherapy techniques and tailored exercises to help with your gluteal tendinopathy. Exercises that strengthen around this structure will help with pain and inflammation. Here are some easy exercises you can do at home:

1.  Place two pillows between legs, bad leg on top. Raise leg off pillow keeping shin level. Hold position for up to 45s. Repeat 5 times.

2.    Lie on your side with your knees bent. Tighten your pelvic floor muscles and gently pull your lower stomach in.
Lift your top knee as far as you can, without letting your pelvis rotate forward or back. Keep your feet together during the exercise.

New evidence: Hot off the press!
 

• The British Medical Journal published on May 2nd a study by Meollor et al. (2018) that compared education and exercise with corticosteroid injection and a ‘wait and see approach group’ with patients with Gluteal Tendonopathy.
• The education plus exercise group had 14 physiotherapy sessions over an 8 week period with a progressive rehab programme to improve the load capacity of the gluteal musculotendinous unit and education that centered around avoiding painful compressive movements (such as hip adduction, sleeping and sitting positions).
• Education and exercise performed better than steroid injection and the wait and see approach for gluteal tendinopathy. At the 8 week time point education and exercise achieved an impressive 77.3% success rate on the global rating of change which was superior to both the CSI (58.5%) and wait and see groups (29.4%). Hip pain intensity was also significantly better in the education and exercise group at 8 weeks which would question the common assumption that CSI is superior for pain relief in the short term.

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