Gluteal Tendinopathy - The #1 cause of lateral Hip Pain

Gluteal Tendinopathy - The #1 cause of lateral Hip Pain

Gluteal Tendinopathy

Gluteal Tendinopathy is the most common cause of lateral hip pain.

The condition has been traditionally referred to as “Trochantic Bursitis” however imaging studies have confirmed this condition is largely due to changes in the Gluteus Medius and Gluteus Minimus tendons – with only a smaller portion of patients (20%) showing thickening/inflammation of the bursa (Long et al. 2013). The bursa is a little fluid filled sack which help to reduce friction between our tendons and bones. 

There are several risk factors for tendinopathy but will generally occur when load placed through the tendon exceeds the capacity of the tendon. This can occur from doing too much (e.g. increasing your running speed/kms) or not doing enough (tendons will weaken with rest).

Risk Factors for Gluteal Tendinopathy Include:

• Being female and over 40 years of age; as we get older our body produces less collagen – which primarily make up the structure of the tendon. Females are more at risk due to anatomy of the female pelvis and hip bones predisposing to greater compressive loading of the gluteal tendons.
• Presence of low back pain.
• Compression of the Gluteal Tendon by the Iliotibial band (ITB).
  • Running with a cross over or Trendelenburg style gait pattern increases hip adduction and leads to compression of the gluteal tendons.

What are the symptoms:

• Lateral hip pain that may radiate down the lateral thigh.
• Gradual onset of pain, which may worsen over time.
• Pain may be worse at nighttime – those with gluteal tendinopathy have difficult sleeping on the affected hip.
• Difficulty with single leg loading tasks; standing on one leg, running, stairs, hills.
• Pain may be worse at the at the start of activity, and improve with a warm up.

Management Strategies

Load management:

• Reduce longer distance and high speed running
• Reduce hopping/bounding/plyometric work in training
• Modification of running technique
  • Increase running cadence by 10% (Bramah et al. 2019)
  • Placing tape on a treadmill to encourage a wider steps (Brindle et al. 2014)
• Avoid stretching – e.g. gluteal and ITB stretches (note; the ITB cannot be physically stretched) as this compresses the gluteal tendon.
• Avoid Hanging on one hip in standing, sitting with your knees together crossed.
• Sleep with a pillow in between your knees.

Medical:

• Cortisone has been shown to reduce pain however can negatively affect the integrity of the tendon.
• Cortisone is an anti-inflammatory medication. Gluteal tendinopathy is not an inflammatory condition so the injection does not address the underlying pathology.

Exercise Therapy:

• A strength program progressively targeting the hip abductors (Gluteus Medius and Minimus) is the best way to overcome Gluteal Tendinopathy.
• This reduces pain and improves the tendons load bearing capacity.
• The longer you’ve had a tendinopathy the longer it will take to resolve. At a minimum most tendon rehabilitation programs are 8-12 weeks.

Prevention Is key. Ensure you’re complimenting your running with S&C exercises.