Gluteal tendinopathy: A real pain in the bum!
Gluteal tendinopathy is suggested to be the most common lower limb tendinopathy in the lower limb. So, the glutes, if your not aware is your buttock muscles, there are many, but this problem seems to be focused mainly to two primary sources, the tendons of glute medius and minimus.
http://www.nirschl.com/gluteus-medius-minimus-tendinosis-and-tears.asp
glute exercise video:
https://www.youtube.com/watch?v=9Iy-QrcuGno
It can certainly affect sedentary individuals but is found to be very common in the running population. Woman seems to be more prone to this issue than men, To put some numbers to it Grimaldi et al (2015) suggest that over 23% of woman over 40 years of age develop this problem in comparison to 8% in the men. Part of the problem is to do with hip joint position and the compression and load tolerance of the tendon. Unfortunately the prevelance of this type of tendon injury is increasing over time with the age of the running population increasing in line with the ever increasing age of society.
If you refer back to the achilles tendon article, I highlighted that upsetting the balance of training frequency and duration over time or adding in a different type of load i.e. hill running, can tip it over and because we are, of course, organic, the tendon will either adapt and get stronger or start to break down.
There are other factors that play a part in this problem. Mainly its from excess compression on the glute muscle tendon. The offending and often provocative postures are:
- Sitting for prolonged periods esp if you hip is lower than your knees
- Standing on a single leg – basically hanging on one hip
- Crossing your legs
- Running with a mid line or narrow contact pattern i.e. imagine a line painted on the road, with a narrow pattern both of your feet placement, on each stride, would hit that single line, like running on a tight rope.
So what will you feel and where? Most people will complain of pain over the side of the hip joint, this will can radiate or travel down the outside of the thigh. Typically people will say that it is becoming increasingly painful to lay on the effected side, and may even disturb sleep if the hip is rolled on to. Generally it’s some specific activities of daily living that are painful:
- Standing on one leg to put underwear or trousers/skirt on
- Walking
- Climbing stairs
- Walking or running up hills
Ok, so if you think some of this is resonating with you, what can you do to settle it down and return to your full function. It goes without saying that a full assessment by a physiotherapist will certainly aid in getting the correct diagnosis, but here are a few simple suggestions:
- Reduce the compression: Do the unlady like thing and uncross your legs, reduce the compression on the tendon by stopping the legs coming across the midline.
- Stop hanging off one hip when your standing, try to adopt equal load though both of your legs, be proactive, don’t let pain be the thing that reminds you to not do it!!
- If pain isn’t enough to interrupt your training – attempt to adjust your running pattern, rather than running on a tightrope try to run with your foot placement a little wider.
- Start to strengthen your glute muscles to get the muscle and tendon working well and make the tendon adapt positively.
The glutes are much maligned body part, but in honesty they should be high on the strengthening priority list, they are without doubt the driver of day to day and performance activities. Lots of people think they are loading their stabilising muscles with compound activites like squatting and lunging etc and these exercises are great for strengthening the big gluteus maximus muscle, but these smaller stabilisers of the hip, like glute medius and minimus, that require lower strength endurance type movements to reduce the chances of becoming overloaded and becoming a true pain the bum, so if these symptoms are ringing any bells, try some of these suggestions and if your struggling we are always here if you need us.