Experiencing pain and discomfort around the outside region of the buttock which can spread partially down the outside of the thigh is a common cause for concern that the hip joint has been damaged. Although this warrants professional advice, this presentation does not typically represent an issue with the ball and socket joint of the hip but may be associated with a condition known as gluteal tendinopathy.
The development of gluteal tendinopathy is usually gradual and worsens over time dependent on different loads and activities. Sleeping on the affected side is a commonly reported irritable position and ascending/descending stairs may be uncomfortable as a common single-leg, full weight-bearing loading activity.
Gluteal tendinopathy refers changes in the physiology of the tendons of the gluteal muscles – Gluteus Medius (pictured) and Gluteus Minimus (underneath Gluteus Medius), in response the alterations in load/activity, intensity and frequency. Pain can develop when these tendons are unable to adapt to sudden increases load which typically manifests from a change in intensity and frequency of physical activity. This leads to a decreased capacity to tolerate load and may predispose the tendons to injury.
The pain initially experienced is thought to be your bodies’ way of producing a warning that the soft tissue is unable to sufficiently adapt to the loads it is being exposed to. This is a pattern that our Physiotherapists are trained to identify and will work closely with you to address the contributing factors.
Tensile load and compression are the mechanisms in which these tendons are subjected to greater forces. Common examples for when the tendons are exposed to compression are adducted positions – knee being across the midline of the body, such as standing with one hip hitched outwards, sitting with one leg over the top of the other, and, increased single-leg loading with the pelvis tilted laterally. An increase in tensile load can also be attributed to more single-leg loading, sudden increases in resistance training or activity. It could be something as unassuming as you have recently started couch-to-5km or you’ve been going for walks more regularly, which could correspond to a sudden load increase which these tendons cannot adapt to quick enough.
This condition represents a common cause of disability in runners, less active people and 1 in 4 females over 50 years of age. Gluteal tendinopathy considerably impacts quality of life through reducing physical activity levels, pain with weight bearing tasks and disrupts sleep.
By taking a comprehensive history or your symptoms and performing a detailed physical assessment, our skilled clinicians will be able to help determine the factors contributing to your pain and discomfort and rule out joint involvement to produce an accurate diagnosis. With a firm diagnosis in place, your Physio will work with you to develop a personalised and progressive management and exercise plan, based on your goals and needs.
The way to address this issue is to continue to load the tendons to keep them strong but allow more time to adapt. Alternating between days of strengthening followed by a day rest and reduced load is shown to be the most effective way to alleviate symptoms – all of which will be explained in detail by your Physio. This management strategy aims to ensure that the balance between load and adaptation becomes more equal. They will also discuss strategies that may help reduce your symptoms such as changing the way you perform certain activities and postures and positions that avoid aggravating the affected tendon. We strive to ensure that each patient can effectively manage their symptoms and have ongoing support to prevent re-occurrence.
Alongside this alternate day pattern explained above, it is important to monitor the irritability of your symptoms and we recommend doing this with a numerical pain scale. On a 0 – 10 scale – 0 being no pain & 10 being the most excruciating pain, we advise that your discomfort should not exceed 5/10 during the strengthening exercises and 24 hours after loading the tendons on the ‘off’ day in between. Tracking your symptoms with the useful scale will equip you with the skills to keep the tendon loaded to maintain strength whilst simultaneously controlling the irritation and adaptation effectively.
At Pure Physiotherapy, our therapists will help find the right exercises and intensity to control your symptoms and develop the strength of the affected tendon. This will be done by closely monitoring your progress and making adjustments in your strengthening programme so that it elicits an optimal adaptation.
Please find the patient resources section of our website where we have created a series of recommended exercise programmes to strength and stablise the hip. We advise consulting with your Physiotherapist prior to trying any of these exercises.