In the last blog post, we discussed gluteal tendinopathy: why it happens, whom it affects, aggravating factors, and briefly how to treat it.  Today we will delve further into treatment strategies for gluteal tendinopathy as suggested by the authors: 

Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910-922. 

Ideas to reduce lateral hip pain:

1.     Reduce compression of the gluteus medius and minimus tendons; ie. avoid repetitively adducting the hip (bringing the hip close to the midline of the body) or maintaining it in this position. For example, avoid sitting with the legs crossed or lying on your side without a pillow between your legs. 

2.     Avoid hip stretches into hip adduction while the hip is flexed or extended. So lay off of your pigeon stretch or figure 4 stretch for the time being.

3.     Use dry needling or trigger point release techniques in lieu of stretches to address affected muscles

4.     Avoid aggravating activities for the time being such as excessive stair climbing or running hills during training.

Ideas to rehab: Exercise should be focused on slowly progressing tensile loads in non-aggravating positions.

1.     Start with sustained low intensity isometric contractions into hip abduction to activate the gluteus medius and minimus muscles for pain relief.  Resistance can be progressed as tolerance is improved.  This may be done on your back, standing, or side lying with a pillow between the legs and you can provide your own isometric resistance.

2.     Next, resisted exercises are employed for hypertrophy of the muscle and tendon remodeling.  This should be done 3 times per week and the workload should begin at a moderate level and progress if you are able to tolerate this well.  Weight-bearing exercise is key because it helps activate the gluteus medius better.  A good exercise would be side stepping with a resisted band tied around the legs.

3.     Physical therapists need to assess movement patterns and control of the pelvis during the aggravating task and retrain these motions.

4.     Physical therapists should assess the spine and knee for contributing factors and treat as needed.

Please call GoFit Physical Therapy to help treat your hip pain.  We are here to answer any questions you may have: (443)699-4771