This post was written by Jithmie Jayawickrema, PT, DPT, OCS, physical therapist, Parkview Therapy Services.
Gluteal tendinopathy is pain into the lateral aspect of the hip and/or lateral thigh. The most affected muscles are the gluteus medius and gluteus minimus muscles that insert into the greater trochanter.
Symptoms
Gluteal tendinopathy often brings pain and tenderness, either at the bony prominence on the femur at the lateral aspect of the hip, the greater trochanter or the lateral aspect of the thigh.
Risk factors
Certain groups are at greater risk of gluteal tendinopathy:
- Females are more affected by this condition than males.
- Runners and people who have a sudden increase in activity are also affected.
- Individuals who are inactive are frequently afflicted by gluteal tendinopathy.
Gluteal tendinopathy can be aggravated by:
- Laying on the affected side (usually has pain at night)
- Laying on the opposite side can also cause pain due to the hip going into adduction
- Going up stairs
- Sitting for long periods of time (especially if your legs are crossed)
- Prolonged walking
- Walking after prolonged sitting
- Walking uphill
- Standing on one leg
Treatment
The keys factors in treating gluteal tendinopathy are load management and exercise. Physical therapy can be immensely helpful.
Activity modification strategies include:
- Avoiding sitting with legs crossed
- Avoiding lying on the affected side
- When lying on the unaffected side, putting a pillow in between the knees to prevent excessive hip adduction
- Limiting single leg activities, such as standing on one leg (leaning to affected side when standing), and going up or down stairs
- Reducing walking distance
- Avoiding walking up hills
Physical therapy is individualized and can be adjusted based on the patient’s pain. Progressive loading on the tendon and hip abduction strengthening is important, keeping pain at less than 3/10 when performing exercises.
Here is a basic physical therapy plan for gluteal tendinopathy treatment.
Initial stage
- Focus on load management by modifying aggravating factors.
- Avoid excessive hip adduction stretching that can cause compressive force on the gluteal tendons.
- Non weightbearing hip strengthening, such as bridges, clamshells and isometric hip abduction holds.
Subsequent stages are developed specifically for each patient, but can look like the following:
- Progress to single leg bridges, side-lying hip abduction.
- Add single leg loading such as resisted sidesteps and lateral step downs.
- Assess any gait abnormalities such as excessive hip adduction.
If returning to running:
- Progress to plyometrics such as jumping, hopping, and drop landings.
- Initiate run-walk program.
Smart loading of the tendon is key!
References
Current Concepts of Orthopedic Physical Therapy 5th Edition
