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 of the gluteal or buttock tendons in isolation, characterised by pain and dysfunction of the gluteal muscles to support daily activities. Gluteal tendinopathy can also be associated with trochanteric bursitis.
Your gluteal muscles are a group of three muscles which 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, and are responsible for the movement of the hip and supporting the body in weight-bearing (running and walking).
Gluteal tendinopathy may be specifically described as a gluteus maximus tendinopathy, gluteus medius tendinopathy or gluteus minimus tendinopathy.
What Causes a Gluteal Tendinopathy?
The most common onset of gluteal tendinopathy is due to reduced hip and gluteal muscle strength and control that leads to increased load on the gluteal tendons. The result is pain and further weakness of the muscles, resulting in hip-pelvis instability, which further perpetuates the cycle.
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 activities such as 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 the development of lateral hip pain, and 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 which guide on what may be specifically required.
What Causes Gluteal Tendinopathy?
The role of the gluteal tendons 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 ability of the tendon to cope decreases. The efficiency of the tendon is impaired and causes micro stresses in the tendon in an attempt to make the tendon stronger. When this process occurs, the tendon can recover if managed appropriately.
When accumulated tendon loads exceed the rate of repair, this process is progressive and causes pain and dysfunction. The result is gluteal tendinopathy.
Risk Factors for Gluteal Tendinopathy
There are many factors which 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 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.
- Relative Rest – keep moving, however, 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 in combination with a Hip Core Stabilisation Program This 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