Have you been diagnosed with bursitis or do you have pain standing on one leg, lying on your side or when increasing your walking?
In this article we discuss Gluteal Tendinopathy and how it can be treated.
Gluteal tendinopathy is a common cause of pain at the side of the hip. Often this condition is diagnosied as ‘trochanteric bursitis’ however research now demonstrates that the primary problem is a reduction in health and load tolerance of the gluteal tendons. No wonder ‘burisitis’ has been traditionally hard to treat!
The pain associated with gluteal tendinopathy is usually centred over the greater trochanter, the large bone that you can feel at the side of the hip, but may extend down the outer thigh towards the knee. It is often worse with walking, particularly at speed, uphill or upstairs and when standing on one leg to dress. It is common to experience pain and stiffness when rising from a chair after prolonged sitting. Pain is often worse in the morning or at night, particularly when lying on your side.
The pain may develop due to rapid increases in training or exercise load, a large force associated with a slip or fall. Sometimes there has been no particular incident but there may have been a gradual weakening of the tendons over time.
What is a tendon and why does it become painful?
Tendons are the structure that connects a muscle onto a bone. As the muscle contracts, it pulls on the tendon which moves the bone.
There are two key factors that aggravate a tendon.
If you picture the tendon as a rope over a pulley. Anything the rope against the pulley or the tendon against the bone underneath will cause compression. This is commonly in the form of avoiding stretching of the gluteals when the leg crosses the midline, lying on the effected side, standing hitched on one leg or sitting with your legs crossed.
This video does a great job of explaining tendon compression.
If the amount of work done by the tendon exceeds the tendon’s ability to recover this can trigger a pain response. In an attempt to recover, the tendon cells become ‘hyperactive’ which causes the tendon to swell and thicken. This is called a REACTIVE TENDINOPATHY.
Over time you can develop a DEGENERATIVE TENDINOAPTHY. In this stage the tendon has undergone permanent changes to it’s structure with vessel ingrowth and break down of the tendon structure. It is important to note that while we cannot fix the damaged portion of the tendon we can definitely strengthen the remainder of the tendon and restore pain free function. “You treat the donut and not the hole.”
What can we do about it?
To help manage your pain we need load your Gluteal Tendon in a way that stimulates healing and pain relief but does not worsen your symptoms.
Isometric Exercise, or long holds, are effective for this in the initial stages. There is significant evidence that exercising your tendon in this manner can be pain relieving and is a good first step in restoring normal tendon function.
Once your tendon pain has begun to settle we need to improve the strength and load tolerance of the tendon. Your strength is then gradually progressed until the tendon can efficiently function as a ‘spring’ again and store and release large amounts of energy to assist with movements such as walking, jumping, running and change of direction.