Gluteal Tendinopathy: A Pain in the Hip

 

Gluteal tendinopathy is also known as Greater Trochanteric Pain Syndrome (GTPS), Lateral Hip Pain or even Trochanteric bursitis. Individuals with such a condition may experience symptoms such as a constant ache, swelling, tenderness, and pain on the side of the hip which may also extend down the side of the thigh. An increase in the intensity, frequency, or duration of activities such as running, walking, hiking, or even climbing stairs may aggravate the tendon. The prevalence of gluteal tendinopathy has shown to be more common especially in individuals that are working from home with reduced levels of physical activity, but an increase in desire to explore outdoor activities on the weekends. In this article, we explore why gluteal tendinopathy occurs, the risk factors, symptoms, and how physiotherapy can help.

How does Gluteal Tendinopathy happen?

The gluteus region, also known as the hip, consists of 3 main muscles, the gluteus maximus, gluteus medius and gluteus minimus. These muscles attach onto the bony portion of the hip via tendons, giving rise to hip movements that are responsible for maintaining stability during weight-bearing activities. While tendons react well to tensile loads, these structures do not respond well to compressive forces. Here are some examples of activities that increase compressive loads on the tendons:

1. Standing on one leg with the hip sticking out to the side
2. Sitting with legs crossed for prolonged periods of time
3. Laying on the side of the hip to sleep without turning
4. Allowing the hip to fall towards midline without any support (similar to crossing the leg in sitting)

Activities that increase the compressive load on tendons

Crossing your legs or sitting with your knees together

Risk factors causing gluteal tendinopathy

1. Biomechanics

Females have a 2x-4x higher risk of developing gluteal tendinopathy due to having a wider hip angle. This increases the amount of time the tendon has to spend being stretched across the bony portion of the hip, leading to more compressive forces subjected to the tendon.

– Individuals with insufficient gluteal strength have difficulty maintaining hip stability. It is more noticeable during single-leg activities such as stair climbing, walking or running identified with a hip drop. A hip drop occurs when the gluteal muscles are not able to keep the hips level, adding compression and load over the tendon. The tendon is constantly being rubbed against the hip bone, causing it to be further aggravated.

2. Over/Insufficient Loading on the tendon

The health of the tendon is dependent on the load applied to it. A sudden increase in training intensity or underloading it such as a period of inactivity may predispose it to injury. The more times you repeat the aggravating activity, the tendon’s ability to cope gets impaired due to micro stresses. Causing the tendon to not be able to repair itself in time. If not managed appropriately, it may result in persistent pain.

Studies have identified lower back pain and general health conditions such as diabetes, and thyroid function to be factors causing an increased risk of developing gluteal tendinopathy.

What you may experience with Gluteal tendinopathy

• Tenderness, warmth, swelling in the side of the hip in the initial stage due to the presence of inflammation
• Stiffness and pain after a period of inactivity e.g. prolonged sitting. Pain during the night, in the morning upon waking but eases after warming up
• Pain with weight-bearing activities e.g., walking, running, standing on one leg, climbing hills, climbing stairs
• Increased pain/stiffness 24-48hr after activity

Why should I seek help?

Seek help especially if your symptoms are still present during your day-to-day activities even after resting for 1- 2 weeks. This will help to facilitate your recovery and reduce the downtime from your activities.

The cause of gluteal tendinopathy is often due to reduced gluteal muscle strength and hip stability. This drives a vicious cycle of pain and further muscle weakness due to prolonged avoidance of pain-provoking activities. Seeking help in the earlier stages can prevent the symptoms from persisting. Due to an increase in compressive load on the lateral hip especially when completing day-to-day tasks.

Physiotherapy as a treatment option

Many factors can contribute to the development of gluteal tendinopathy. Our physiotherapists will identify and address the root of the problem to ensure that rehabilitation is targeted towards your goals.

The first step would be to manage your initial pain. Treatment methods may include deep tissue massages, manual treatment techniques, gentle exercises for hip pain, and advice on activity modification. Thereafter, we address the contributing factors to prevent recurrence, such as managing exercise frequency and intensity. We will also prescribe an individualized exercise program, based on your lifestyle factors and goals.

If you are experiencing pain and would like to seek physiotherapy help, do contact us to book an appointment with our team of physiotherapists.