Gluteal tendinopathy is a common complaint that we see among middle aged women and men. More often than not people come to see us after having had niggling pain on and off for months if not years. Because it is easier to treat in its early stages and is quite common, let’s talk a bit more about what it is and how you can identify it. Remember that this isn’t the only injury that causes hip pain so it is important to speak to a health professional for specific advice.
The pain is typically on the side of the hip and can travel down the thigh when it worsens. Things that make it hurt include; pressure on the bony part of the hip, lying on that side at night, standing on one leg, getting out of a car (or in), getting up from a chair or climbing stairs. It might feel quite stiff first thing in the morning and can have good and bad days.
Things that might make it feel better temporarily include; massage, rest, anti-inflammatory medications or ice. These treatments usually aren’t the cure for it, especially if there is a long history of pain already. Doctors sometimes refer this presentation for an ultrasound and cotricosteroid injection which can help but might provide only temporary relief. Chiropractors might tell you that your hips and pelvis are ‘out’ and need to be realigned, but they usually revert quickly after an adjustment.
So, what is it?
We have three gluteal muscles that attach through strong tendons to the greater trochanter. This is the bony prominence you can feel on the side of your hip and is usually the site of pain. Underneath these tendons is a fluid filled sack called a Bursa which reduces friction between the tendons and bone. The gradual effect of posture, changes in hormones or suddenly increasing or stopping activities like walking/running can contribute to weakening or degeneration of the tendons. The bursa can also become inflamed when the above changes compress it more than normal.
What can you do about it?
The evidence is pointing to exercise therapy as the best way to manage the injury. It is all about managing the amount of load on the tendon and gradually increasing it at a rate where the tendon can remodel and heal. This is a tricky balance to find. Our Physiotherapists work closely with our clients to build a program of specific exercises and teach them how to find that balance. It is also important to look at what caused the tendinopathy and remove as many contributing factors as possible. This might be posture, biomechanics (the way you move) or patterns in level and type of exercise you do. Depending on the severity of the tendinopathy and how long it has been symptomatic, it can take months to treat but it is generally manageable. There is no one size fits all treatment or exercise, it needs an individual approach.
If you are experiencing this type of pain it is good to see a Physiotherapist sooner rather than later so you can start the appropriate rehab. It might be helpful to know that an ultrasound is not necessary for diagnosis and a corticosteroid injection is not recommended for tendinopathy without first trying exercise therapy. In the meantime there are some simple things that might help reduce the pain. Avoid things like crossing your legs and standing with one hip stuck out to the side as these movements compress the tendon and bursa. If you are having difficulty sleeping, try sleeping on the opposite side with a pillow between your knees. As always, speak to your doctor or our staff if you would like more information.