Gluteal Tendinopathy – what you need to know

Ladies I’m directing this blog predominantly towards you… it seems we are slightly more pre-disposed to developing this particular problem. Something to do with beautiful child bearing hips and for those with bubs, the changes that your body and pelvis undergo during pregnancy and childbirth. Boys don’t stop reading just yet, you aren’t completely immune to gluteal issues so what’s to follow may still apply.

Gluteal Tendinopathy: the technical name for what you may feel as pain on the outside of your hip. We tend to see it more often in women, in their late 30’s or 40’s, who live an active lifestyle. It’s most common in runners, and even more common in runners who love to run hills and stairs. Yes men can get it, so can younger athletes we just tend to see more of it in the above mentioned patient population.

Like most injuries there are anatomical and bio-mechanical considerations that must be addressed when treating & managing this problem. How wide are your hips? Did you do those post natal core & pelvic floor exercises? Have you never been a runner and now suddenly you’ve decided to train for a marathon? Do you have stiff ankles? Can you activate your glutes?

A whole range of things can lead to that niggle on the side of your hip that’s literally beginning to become a pain in the butt.

First thing’s first. Get your injury diagnosed by your physiotherapist before you take all this information as gospel because it might not be relevant if you are suffering from a completely different issue (and there are many other problems that can cause hip pain)

Positions of high tendon compression

REDUCE TENDON COMPRESSION: Avoid positions of what we call ‘compression’, such positions include sitting cross legged, standing hanging on one leg, sitting on low stools. You should also be aware of your sleeping position, the best position is on your side with a nice big pillow between your legs. Why? When you sleep on your side with no pillow your top leg falls inwards across your body, this is a position of ‘compression’ for the tendons of the hip. If you sleep for 8 hours, that’s 8 hours of load that we can remove simply by placing a pillow between our knees to keep the hips in a more neutral position. If you become aware of how many of these positions you commonly adopt during the day you will easily be able to drastically remove a fair amount of extra load/compression through this area.

STRENGTHENING: Remember the Active RX philosophy – MOVEMENT IS THERAPY.  Remove all forms of stair and hill running / walking from your exercise program, but you may be able to continue with basic forms of exercise such as walking on the flat and some gym based activities. You should be guided pain levels and also the advice of your physio.  You will need to commence targeted strengthening towards specific muscles around the hip to improve your pelvic stability and also to encourage efficient movement & activation patterns. Isometric abduction exercises are a good starting point. These can be progressed to monster walks and crab walks with theraband to fire up the gluteus medius which is one of the most deep pelvic stabilisers.

(Some of these exercises can be found on our Instagram)

STRETCHING. Do not do those figure 4 glute stretches. Please.  Foam rollers are ok if you want to do some release work through your quadriceps and ITB. Trigger balls will work wonders in some nasty spots through the bulk of your glutes, lower back and even around through the front of the hip.

(Kelly Starrett’s website mobilityWOD  has some awesome ideas for release work)

RETURN TO PLAY: This is always case by case & a gradual process. Tendon problems can be a little slow to heal so a little patience will go a long way. To a certain degree you can ‘let pain be your guide’, ease back into exercise and monitor your body’s response. Be aware of pain during, pain directly after and pain 24 hours later as all of these can be indicators that you may be overdoing it.

Tendinopathy can be stubborn and extremely debilitating if not managed correctly. Those bio-mechanical considerations I mentioned before should be addressed as more often than not they will play an integral part of the rehabilitation process especially if you have reached a plateau in your recovery.

My advice? Don’t let that niggle on the outside of your hip linger… and linger… and linger. Make an appointment to see your physio today. Exercise shouldn’t be painful!