Gluteal Tendinopathy
Gluteal tendinopathy’s occur when the tendon is overloaded due to an increase in intensity or duration of training with an insufficient recovery period. The IT band produces significant compressive forces onto the gluteal tendons, especially as the hip adducts (leg moves in towards midline of body from neutral position). Standing with one hip adducted, sitting with legs crossed, excessive pelvic shift during single seg tasks and running with a midline or cross-midline gait are all positions that may aggravate the condition. It affects athletes, in particular runners, as well as non-athletic populations and is most commonly seen in females.
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1. Lateral hip pain which begins without any specific trauma to the area2. Pain gradually worsens with time and depending on what tasks are being done
3. Painful to lie on at night resulting in disturbed sleep
4. Pain during walking, stairs and sit to stand
Treatments
It is important to address load management of the tendon and lifestyle factors that may be aggravating the condition [1][2]. Avoiding prolonged sitting, low chairs, sitting cross legged and standing with your hips pushed out to one side is advisable. Additionally adjusting sleeping position to use pillows as supports and sleeping on your back where possible [1][2].Sporting activities will likely need to be adjusted and reduced in the short term to manage the load [3].
Static strengthening exercises are beneficial at controlling pain in the initial stages, exercises can then be progressed to concentric – eccentric exercises focusing on strengthening the gluteals as well as the TFL, quads, adductors and core [1][2]. Exercises will be performed on both single and double leg. Sport specific exercises can be reintegrated as strength improves, for example a progressive running programme involving tempo runs, uphill runs and sprints may be introduced to challenge the tendon.
Massage and dry needling can be effective at reducing pain in the short term [1][2] however stretching is not recommended as it increases the compressive forces on the tendon [3].
Corticosteroid injections have shown to be effective at reducing pain in the short term however reoccurrence rates can be high if load is not controlled after the injection with a controlled strengthening programme [2][3].
References
1.https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1043-6 Mellor, R., Grimaldi, A., Wajswelner, H., Hodges, P., Abbott, J.H., Bennell, K. and Vicenzino, B., 2016. Exercise and load modification versus corticosteroid injection versus ‘wait and see’for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC musculoskeletal disorders, 17(1), p.196.2. https://www.sciencedirect.com/science/article/pii/S0031940619300719
3. https://link.springer.com/article/10.1007/s40279-015-0336-5 Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H. and Vicenzino, B., 2015. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine, 45(8), pp.1107-1119.
4. https://bjsm.bmj.com/content/49/19/1277.short E. Rio, D. Kidgell, C. Purdam, J. Gaida, G.L. Moseley, A.J. Pearce, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med, 49 (2015), pp. 1277-1283