Gluteal tendinopathies are a condition resulting in lateral hip pain. The word tendinopathy is used to describe a pathological change to the tendon which consists of microtears, degeneration of collagen fibres with replacement by scar tissue and premature death of tendon cells (tenocyte apoptosis). Tendinopathies develop as a failed healing response due chronic overload.
The general action of the gluteal muscles is to extend, abduct and laterally rotate our hip. They also play a pivotal role in hip, trunk and pelvic stability in all activities where load is placed through our legs.
Gluteal tendinopathies develop when the load they are placed under is greater than what the tendon can withstand and adapt to. While the pain may feel as if it had a sudden onset, tendinopathic changes occur over a sustained time of high training loads. Hence most tendinopathies may develop several weeks after increasing training volume or taking up a new activity.
Gluteal tendinopathies are not just limited to athletes. Tendinopathic changes are often observed in the older population which is part of the normal aging process. However, on the background of these changes, the threshold for how much load the tendon can withstand is lower, particularly if the individual lives a sedentary lifestyle. Hence what seems like a small amount of increased activity may be enough to irritate the tendon. Gluteal tendinopathies are commonly seen in middle aged to elderly women due in part to their age and their wider hips, as this places greater tension through the tendon.
The most common sign of gluteal tendinopathy is lateral hip pain and stiffness, particularly over the bony prominence on the outside of our hip where the tendon inserts (greater trochanter).
Typically, pain is exacerbated with single leg loading activities such as walking or climbing stairs. Pain and stiffness may be more prominent at the beginning of exercise, ease off slightly once warmed up, and increase again at the conclusion of the activity.
In a similar pattern, pain and stiffness may be more prominent first thing in the morning and before going to bed at night.
Sleeping on the affected side or stretching the leg across the body’s midline may exacerbate symptoms due to the compression of the tendons.
Due to the important stabilisation role the gluteal muscles have, poor hip strength/stability are often observed.
The initial phase of treatment aims to reduce the irritability of the tendon. This may involve a combination of:
Once the tendon becomes less irritable, the most effect way to heal tendons is to progressively load them with resistance-based exercises. Tendons love exercise! With the write type and dosage from your Physiotherapist, we can promote healing and advantageous adaptations to strengthen tendons tissues.
Your Physiotherapist will also undertake a thorough biomechanical assessment with you to find causes specific to you which may have placed you at greater risk of developing a tendinopathy in the first place. Examples of this include: