Hip Tendinopathy / Hip Tendonitis
What is Gluteal Tendinopathy?
Gluteal tendinopathy is the most common hip tendonitis (hip tendinopathy). It is a common cause of Greater Trochanteric Pain Syndrome.
Gluteal tendinopathy is an injury to one or all gluteal or buttock tendons in isolation, characterised by the gluteal muscles’ pain and dysfunction to support daily activities. Gluteal tendinopathy can also be associated with trochanteric bursitis.
Your gluteal muscles are a group of three muscles that make up the buttocks: the gluteus maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium and sacrum and insert on the femur. They are responsible for the hip movement and supporting the body in weight-bearing (running and walking).
Gluteal tendinopathy describes its various aliases: gluteus maximus tendinopathy, gluteus medius tendinopathy or gluteus minimus tendinopathy.
What Causes a Gluteal Tendinopathy?
Reduced hip and gluteal muscle strength and control is the most common cause of gluteal tendinopathy. The result is pain and further muscle weakness, resulting in hip-pelvis instability, which further perpetuates the cycle. This weakness and functional instability lead to increased load on the gluteal tendons.
Hip instability can cause you to walk or run with poor control., which may increase the compressive load to your trochanteric (hip) bursa. This bursa pressure raises your risk of developing concomitant trochanteric bursitis.
Who Suffers from Gluteal Tendinopathy?
Gluteal tendinopathy is most common in postmenopausal women, with 20 – 25 % of women suffering from the condition. There is also a 10 – 15 % prevalence in the general population, usually young active individuals, and it is generally associated with running, dancing and skiing.
What are the Symptoms of Gluteal Tendinopathy?
Gluteal tendinopathy usually causes lateral hip pain, muscular stiffness, and loss of strength in the affected area.
- The pain may get worse when you use the tendon, e.g. running or hopping or ascending stairs.
- You may have more pain and stiffness during the night or when you get up in the morning.
- Pain is often worse when you lie on your affected hip.
- The lateral hip may be tender, red, warm, or even swollen if there is inflammation of the bursa.
How is a Gluteal Tendinopathy Diagnosed?
Gluteal tendinopathy can be diagnosed clinically by your PhysioWorks Physiotherapist, based upon presenting signs and symptoms, clinical history, and pain response to loading tests. In most cases, you will not require diagnostic imaging.
Your physiotherapist may suggest ultrasound or MRI that gains further insight into your clinical presentation, given that there is a confluence of multiple pain generating structures in the region. It is important to note that tendon pathology on MRI is a risk factor for developing lateral hip pain. Clinical assessment is required to determine the relevance of imaging findings on your presentation. Your physiotherapist may liaise with your GP to obtain imaging and guide you on what may be specifically required.
What Causes Gluteal Tendinopathy?
The gluteal tendons’ role is to transfer the gluteal muscle forces to the hip and pelvis for everyday movement and activity. Your tendons withstand repetitive loading. However, once the tendon becomes painful, the more times you are required to perform the provoking action, the tendon’s ability to cope decreases. The tendon’s efficiency is impaired and causes micro stresses in the tendon to make the tendon stronger. When this process occurs, the tendon can recover if managed appropriately.
When accumulated tendon loads exceed the repair rate, this process is progressive and causes pain and dysfunction. The result is gluteal tendinopathy.
Risk Factors for Gluteal Tendinopathy
Many factors can contribute to the development of gluteal tendinopathy. Your physiotherapist is the best person to discuss these factors with you. The successful management of gluteal tendinopathy has become highly specialised over recent years. Your physiotherapist will help you to identify all the causes of your gluteal tendinopathy.
Researchers have identified the following factors with increased risk:
- Increased load through increased training loads or new accustomed capacity.
- Weak gluteal musculature
- An altered gait (walking pattern)
- Lumbar spine pain
- General health conditions – diabetes, thyroid function
Gluteal Tendinopathy Treatment
In most cases, conservative management will be able to facilitate your recovery from Gluteal Tendinopathy.
- However, relative rest keeps moving, avoiding positions of compression – such as crossing your legs or propping on one hip.
- Apply ice or cold packs for 20 minutes at a time, as often as two times an hour, for the first 72 hours. Keep using ice as long as it helps with your pain.
- Have your hip joint and muscle function assessed by your hip physiotherapist.
- Undertake Gluteal Tendinopathy Exercises, possibly combined with a Hip Core Stabilisation Program, is vital to prevent a recurrence.
- Visualise and retrain your hip muscle control via real-time ultrasound.
- Modify your return to sport under the advice of your physiotherapist.
Gluteal Tendinopathy Exercises
Persisting tendon injuries are best managed by exercise under the guidance of your physiotherapist. Despite the frequent use of painkillers and anti-inflammatory medications, the cause is related to hip muscle strength and control, so exercise therapy should be a priority as part of your management. Your hip physiotherapist will prescribe the most appropriate gluteal tendinopathy exercises for your rehabilitation phase. They will also customise your gluteal tendinopathy exercises specific to your individual goals and needs. Every sport differs in the demands placed upon your gluteal tendons, so your hip physiotherapist will adapt your exercise to best suit your ultimate needs and requirements.
How to Return to Sport after Gluteal Tendinopathy
Your physiotherapist will gradually progress your rehabilitation program. Based on your current level of function and desired goals, they will prescribe an initial batch of gluteal tendinopathy exercises and then monitor your progress with the following:
- Pain levels
- Strength Testing
- Functional activities related to your goals
- Outcome Measures – specifically VISA – G Score
It is common for gluteal tendinopathy rehabilitation to take a minimum of 6 – 12 weeks. Tendinopathy is one condition where the longer you have suffered the injury, the longer it takes typically to reverse the tendinopathy symptoms and resume your function. Be patient and proactive. Stick with your treatment and the advice of your tendinopathy physiotherapist. If you start using the injured tendon too soon, it can lead to more damage and further time delays.
If you have any concerns, please seek the advice of your PhysioWorks physiotherapist.
Common Causes of Hip & Groin Pain
Hip Joint Pain
- Hip Arthritis - Hip Osteoarthritis
- Hip Labral Tear
- Hip Pointer
- Femoroacetabular Impingement - FAI
- Perthes Disease
- Slipped Femoral Capital Epiphysis
- Stress Fracture
- Avascular Necrosis of the Femoral Head
Lateral Hip Pain
Adductor-related Groin Pain
Pubic-related Groin Pain
Inguinal-related Groin Pain
- Inguinal hernia
- Sportsman's hernia
Iliopsoas-related Groin Pain
- Hip Flexor Strain
Other Muscle-related Pain
- Piriformis Syndrome
- Muscle Pain -Muscle Strain
- Poor Hip Core
- DOMS -Delayed Onset Muscle Soreness
- Core Stability Deficiency
Hip Pain TreatmentA thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain. Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence, or improve your athletic performance. The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise. However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control. You should consult a healthcare practitioner who has a particular interest in hip pain and injury management, to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all have an impact, especially at the high athletic performance end. A quality practitioner will specifically educate you regarding your condition and combine with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints. Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible. For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapist experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.
Hip Pain Treatment OptionsYour hip physiotherapist may consider an extensive range of treatment options including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and joint control exercises as they deem appropriate for your specific functional and sporting needs. Please click the links below for more information about some of the conventional hip treatments that your physiotherapist may recommend or utilise for your hip pain.
- Early Injury Treatment
- Avoid the HARM Factors
- What to do after a Muscle Strain or Ligament Sprain?
- Acupuncture and Dry Needling
- Sub-Acute Soft Tissue Injury Treatment
- Closed Kinetic Chain Exercises
- Gait Analysis
- Biomechanical Analysis
- Balance Enhancement Exercises
- Proprioception & Balance Exercises
- Agility & Sport-Specific Exercises
- Soft Tissue Massage
- Dry Needling
- Electrotherapy & Local Modalities
- Heat Packs
- Joint Mobilisation Techniques
- Kinesiology Tape
- Running Analysis
- Strength Exercises
- Stretching Exercises
- Supportive Taping & Strapping
- Video Analysis
Experience the PhysioWorks Difference?
You'll be impressed with the experienced physiotherapists, massage therapists, allied health team and reception staff representing PhysioWorks.
If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level.
To ensure that we remain highly qualified, PhysioWorks is committed to continuing education to provide optimal care. We also currently offer physiotherapy and massage services for numerous sports clubs, state and national representative teams and athletes. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment.
How You'll Benefit from the PhysioWorks Difference?
At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment. With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.
What are Some of the BIG Differences?
We aim to get you better quicker in a friendly and caring environment conducive to successful healing. Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc. Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that, in reality, only last for a short time. We attempt to treat the cause, not just the symptoms.
PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge. Our staff care about you! We are always willing to go that 'extra mile' to guarantee that we cater to our client's unique needs. All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.
Article by John Miller
Common Youth Leg Injuries
Why are Children's Injuries Different to Adults?
Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas of the bones from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.
Common Adolescent Leg Injuries
In the adolescent leg, common injuries include:
Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.
More info: Osgood Schlatter's Disease
Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.
More info: Sinding Larsen Johansson Syndrome
Anterior Knee Pain
Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.
More info: Patellofemoral Pain Syndrome
The cartilage between the leg bones have a better blood supply and are more elastic in adolescents than in adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.
More info: Knee Ligament Injuries
ACL (anterior cruciate ligament) injuries
This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.
More info: ACL Injury
Your meniscus is crescent-shaped cartilage between the thigh bone (femur) and lower leg bone (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.
Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive volume of training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.
More info: Sever's Disease
An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. An ankle sprain usually improves in 2-6 weeks with the correct treatment. Your ankle physiotherapist should check even simple ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.
More info: Sprained Ankle
Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.
More info: Patella Dislocation
The separation of a piece of bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.
Growth Plate Fractures
A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.
Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children
An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow and ankle are the most common locations for lower limb avulsion fractures in the young sportsperson.
Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.
An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.
For more information regarding your youth sports injury, please consult your physiotherapist or doctor.
Common Youth Leg Injuries
Pelvis & Hip
- Osgood Schlatter's Disease
- Sinding Larsen Johannson Disease
- Patellofemoral Pain Syndrome
- Patella Dislocation
- Meniscus Tear
- Discoid Meniscus
- Juvenile Osteochondritis Dissecans
Heel & Ankle
Common Youth & Teenager Sports Injuries
Common Stress Fracture Related Conditions
Spinal Stress Fractures
- Spondylolysis (Back Stress Fracture)
- Lumbar Stress Fractures (Cricket Fast Bowlers)
- Rib Stress Fracture