What a pain in the butt?! Or is it the hip?!
Dana Brackley, Physiotherapist
Are you female? Are you perimenopausal or menopausal? Have you recently started walking more than your usual amounts? Do you have pain at the side of your hip and find it’s really uncomfortable at night especially if you try to lay on your side?
If you have answered yes to any of these it may be a case of Gluteal Tendinopathy…………
Gluteal tendinopathy is an extremely common type of tendon disorder in your hips and buttocks area (gluteal region), particularly if you are in the category of women who answered yes to any of the questions above.
Your tendons are strong, flexible tissues that connect your muscles to your bones and allow the muscles to pull on the bones to create movement.
Gluteal tendinopathy in particular affects the tendons that connect to your buttock’s muscles. These include the gluteus maximus, medius and minimus. These muscles run from your hipbone (pelvis) to your greater trochanter.
The greater trochanter is the bony part at the top of your thighbone (femur). This area is where you will often ache and try to stretch out your hip in attempt to find relief, especially at night. The soreness may even spread down the outer thigh.
According to studies, gluteal tendinopathy is more frequent in females than in men and is most common in middle age, particularly when hormonal changes occur in the body. Hormonal changes may have an impact on tendon quality and load tolerance.
The good news is that a diagnosis may be acquired via physiotherapy and, if necessary, verified with ultrasound or MRI scans. A comprehensive physiotherapy evaluation ensures that all relevant elements are addressed to help you manage and recover from gluteal tendinopathy.
To keep things simple for the purpose of this blog and to avoid boring you with science, the two major tactics for controlling and repairing Gluteal Tendinopathy are reducing the load or stress on the tendon and engaging in a corrective exercise programme. (Load refers to the pressure placed on the tendon as a result of exercise, certain motions, or hip positions).
Activities that cause lateral hip discomfort are often caused by compressivestresses on the tendon when the hip is adducted (when the hip and leg cross the midline). Sleeping on the side, going upstairs, sitting with crossed legs, and standing with a hitched hip are all activities and postures that may cause hip adduction. Being aware of and changing how you stand, sleep, and sit throughout the day may help to minimise the intensity and length of symptoms.
Also, recognising that unexpected or abrupt increases in load on the gluteal tendon may also cause gluteal tendinopathy, such as when you begin walking excessively (or begin any new exercise excessively), or when you increase the amount of sitting/driving or repeated bending that is beyond your regular activity level.
Here are some Posture Tips to help improve YOUR SYMPTOMS AND RECOVERY
standing “hanging on one hip” or standing with legs crossed
sitting with legs crossed
sitting in low chairs especially in long car travel
sleeping on your painful side
if sleeping on non-painful side avoid letting top painful hip drop across the body unless a couple of pillows are placed under knee and thigh.
stretches that bring the knee across the body, “Glute/Piriformis stretches”.
Night-time pain is a good barometer of how the hip is tolerating daytime loads. If night-time pain increases the activities of the day or last couple of days may have been too high and should be reviewed.
Corrective Exercises involves focusing on retraining hip postures and alignment while walking, climbing stairs and other functional movements and specific exercises to strengthen the gluteal muscles which also off loads the hip from compression during movement. Without adequate gluteal strength the hip will fall into an adducted position, causing increased gluteal tendon load and compression.
A specifically graded exercise programme designed by your Physiotherapist is necessary to increase the quality of the tendon fibres and enable tendon healing and load tolerance.