Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Med. 2015;45(8):1107-1119.
Today’s blog post highlights gluteal tendinopathy and it’s relationship to physical therapy. Tendinopathy is defined as a disorder of a tendon, which is the tissue connecting the muscle to bone. This post summarizes some key points directly from the article listed above.
Previously most lateral hip pain (pain on the outside portion of the hip) had been over diagnosed as trochanteric bursitis. Now, it has been established that oftentimes lateral hip pain is not coming from the bursa, but instead from gluteus medius and minimus tendinopathy. These muscles are two of the three gluteal muscles and these two sit on the outer portion of the hip. It is thought that the gluteal tendinopathy arises because of altered compression and tension to the tendons. When the tendon is not provided with the correct amount of loading, whether it be too much or too little, the tendon begins to break down. The gluteal muscles are then unable to function as they would normally, potentially leading to pain.
It is proposed that the positioning of the hip can lead to increased compression of the gluteal muscles. If the hip is constantly in an adducted position (with the leg coming into a position closer to midline of the body), the gluteus medius and minimus tendons are continually compressed and placed on tension causing atrophy. Additionally in this position, the gluteus medius and minimus muscles do not have a mechanical advantage to activate when needed, so other muscles take over.
Who typically suffers from this condition? Women > men, ages 40-80 years old
Aggravating factors: Crossing the legs when sitting, side-sleeping, walking, going up and down stairs, moving from sit to stand
How to treat it: Control the load placed on the gluteus medius and minimus tendons. Specifically avoid activities with high tensile and compressive loads, and work to modify movement patterns (ie. train the body to avoid adducted positioning of the hip). This can be done in physical therapy. In fact, physical therapy has been shown to be more effective at improving this condition long term than corticosteroid injections.