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 and at Pure Physiotherapy, our practitioners will be able to rule out joint involvement through physical assessment and accurate diagnosis.
This presentation may be associated with a condition known as gluteal tendinopathy, representing 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. At Pure Physiotherapy, our skilled clinicians will be able to help determine the factors contributing to your pain and discomfort and work with you to develop a personalised and progressive management and exercise plan.
Gluteal tendinopathy refers changes in the physiology of the tendons of the gluteal muscles – Gluteus Medius and Gluteus Minimus, 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 tendon is unable to sufficiently adapt to the loads and frequency it is being exposed to. This is a pattern that our Physiotherapists at Pure 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.
Gluteal tendinopathy onset 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.
The way to address this issue is to continue to load the tendons to keep them strong but allow them 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. This management strategy aims to ensure that the balance between load and adaptation becomes more equal. At Pure Physiotherapy, our therapists will be able to assist you in managing this and finding the right exercises and intensity to control your symptoms and develop strength.
Within this management protocol, we recommend that you try to carry out your usual physical activity on the same day as you perform the strengthening exercises. This allows the most practically explicit ‘on’ and ‘off’ days for the tendons that are affected. Below are two exercises that we recommend:
Alongside this alternate day pattern, 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.