Gluteal Tendinopathy (Lateral hip pain) Explained
July 29, 2021
Our gluteal muscles, or “glutes” are some of the largest and strongest muscles in the body. They are a group of 3 muscles that make up your buttocks:
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
All 3 of these muscles run from the pelvis, specifically the ilium and sacral bones, to the outside of the femur (thigh bone). They play a crucial role in providing balance, strength and stability to our hip and pelvis during weight bearing activities. The muscle is able to do this by contracting and relaxing, or lengthening and shortening.
The way a muscle attaches to a bone is via a tendon, so imagine the structure goes like this:
Tendons are dense, fibrous tissue that are made up of collagen fibres meaning they have far less elasticity or stretch than a muscle. This means that can transmit the strong contraction of a muscle directly onto the bone, and therefore a joint, without risk of tear to the muscle or tendon itself.
Despite this strong structure, tendons can often become overloaded, inflamed and irritable. This can occur at any age, and can occur due to a wide variety of causes. When a tendon becomes irritated or inflamed, or annoyed, we refer to it as a tendinopathy. Microscopically, this occurs when a tendon has increased water content and the fibres go from nice smooth parallel lines to a jumbled mess.
The biggest cause for a tendinopathy is a change in loading, or exercise, that means the tendon is working overtime to try and keep up with the new demands placed on it by the muscle. This causes mini tears of the collagen fibres and the fibres break down. There is then an imbalance between damage and repair and disorganisation of the tendon occurs.
When we begin to think specifically about the tendons of the hip, gluteal tendinopathy is the degeneration of any of the three gluteal muscles. Most commonly, we see this at the gluteus medius muscle due to its role in stabilising the hip as we walk, run and change direction.
Pain is often felt at the side of the hip, very close to the bony bump on our outermost hip. The pain is typically worse first thing in the morning or at the start of a run or a walk but can improve throughout the day or with more exercise. Other classic gluteal tendinopathy symptoms are:
- Pain on the outside of the hip
- Pain during sitting or lying on the affected side
- Sitting cross legged
- Reaching to put shoes and socks on
- Climbing stairs or steep hills
- Pain down the outside of the leg, and even into the knee
Outside of increasing exercise suddenly, some causes of this pain are:
- Weak gluteal muscles
- Changed walking pattern due to another injury or surgery
- Sustained compression (long periods of sitting on a hard surface)
What we know now better than ever in treating tendinopathies is that rest is NOT the option. A rested tendon is the same tendon and therefore we need to find the most appropriate amount of exercise for it, couples with good strengthening work. The more a tendon is rested, the more it will break down and weaken further.
When exercising an irritated tendon, we often say pain is a good guide. We will accept a 3-4 out of 10 pain score and take particular note of how sore the tendon is the day AFTER any given exercise We want to gradually build the resilience of the tendon whilst not inflaming it further.
If this sounds like something you are experiencing, a great first step is commencing static, or isometric) exercises. The purpose of these exercises is to flood the tendon with fresh blood, and in the process temporarily flushing out the inflammatory gunk. These can be used as a warm up or just as a pain reducing option for you. Below are a couple of ideas as to how you might commence a strengthening program for a gluteal tendinopathy.
Side-lying hip abduction hover isometric – Start lying on your side, with your body and your legs in a straight line. Squeeze the muscles in your bottom to lift your top foot up and hold your heels 2-3cm apart. Hold this position for 45 seconds then lower back down.
Resisted hip abduction – Lying on your back with your knees at 90 degrees, put a theraband or resistance band around your knees. Tighten your bottom muscles and push your knees out into the band. Hold the tension on the band then slowly release back to the starting position.
Single leg stance- This one is easy! Simply stand on one leg, and try to focus on keeping both your hips in a straight line, not letting one side sag down. To make this one more challenging, stand on a step and let your non-stance leg hover off the edge without dropping below the level of the step.
For all of these exercises, we want to complete for 4-5 reps of 45 seconds on each leg. If you feel an increase in pain during or after these exercises, you should stop. However, the typical outcome is a reduction in tendon related pain, and therefore an increase in hip strength and control.
If you feel like you are experiencing hip pain, and these exercises or Pilates haven’t managed to take the edge off your pain, touch base with us today and one of our physios can complete a thorough assessment. Our team at Instinct Health can then determine how we can help fix your hip pain for good.
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