Diagnosis: Gluteal Tendinopathy
How Gluteal Tendinopathy Presents
- Do you get pain on the outside of your hip? At the side of your hip, you should feel a prominent bony bump. This is your “greater trochanter”. Do you feel pain around this area when applying a little pressure?
- Do you get this pain when you stand up after sitting for a while, especially if you sit with your knees crossed?
- Do you get this pain when you run, walk up and down stairs, or balance on one leg?
- Do you have trouble finding a comfortable sleeping position because of this pain?
If you’re experiencing these symptoms, you may have Gluteal Tendinopathy. The pain can range from moderate discomfort, to severe and disabling.
You may also experience some associated lower back pain and/or pain that radiates down the side of your thigh, but most of the pain should be over the greater trochanter when it is aggravated.
How Gluteal Tendinopathy is Diagnosed
Gluteal Tendinopathy can be confused with trochanteric bursitis and hip osteoarthritis as both present with similar symptoms. However, it is the most common source of lateral (i.e. side) hip pain.Gluteal Tendinopathy can be confused with trochanteric bursitis and hip osteoarthritis. #performbetter @pogophysio Click To Tweet
Your physiotherapist may perform a combination of the following diagnostic tests:
- Palpation (applying pressure to the greater trochanter)
- Ober’s Test
- Resisted External Rotation
- FABER Test
- Sustained single leg stance
Magnetic Resonance Imaging (MRI) or ultrasound can be used to confirm the diagnosis of Gluteal Tendinopathy.
Causes of Gluteal Tendinopathy
Gluteal Tendinopathy a degenerative disease of the tendons of the Gluteus Medius and/or Gluteus Minimus muscles, which insert onto the greater trochanter (hence pain in this region).
The gluteal muscles (source: www.nirschl.com
There is often no specific event that causes the pain, but a subtle onset that progressively worsens over time as tendon health declines.
It can occur due to not enough activity, or too much activity!
In case of the former, tendons need to be loaded through routine exercise to remain healthy. Otherwise, they weaken and lose their ability to withstand tensile forces generated by muscles. For the latter, activities like running causes microtears to tendons which spontaneously repair and strengthen with rest. However, if there is not enough rest, then the rate of damage exceeds the rate of repair, leading to disease.
It commonly affects athletes and sedentary people over 40, women more than men. Certain postures may also increase risk, as it is highly associated with people who sit with their knees crossed, or stand “hip hanging”. Those who run with a hip drop, or land their foot across their midline are also more at risk.
Treatment of Gluteal Tendinopathy
Other than in severe cases, where the body’s own healing processes are no longer able to repair the damaged tendon, the prognosis for non-surgical treatment of Gluteal Tendinopathy is generally good.
Your physiotherapist will advise you on the appropriate level of exercise to manage tendon load, correct postures and running technique. They will also provide you with a tailored eccentric exercise program that aims to encourage tendon healing, and may include therapeutic ultrasound or Shock Wave Therapy as part of their treatment.
Corticosteroid injections may be effective in reducing the symptoms of pain in the early stages, however, since tendinopathies are not inflammatory conditions, the long term outcomes are less favourable, with high rates of recurrence. They should be used with caution.
Goom, T. (2013, May 06, 2013). Gluteal Tendinopathy Retrieved December 07, 2016, from http://www.running-physio.com/gluteal-tendinopathy/
Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med, 45(8), 1107-1119. doi: 10.1007/s40279-015-0336-5
Thomas, E. (n.d.). Greater Trochanteric Pain Syndrome Retrieved December 07, 2016, from http://www.physio-pedia.com/Greater_Trochanteric_Pain_Syndrome