Gluteal tendinopathy primarily affects the gluteus medius and minimus tendons, causing pain on the outside of the hip.
Diagnosing gluteal tendinopathy involves a combination of patient interviews and physical assessments, considering differential diagnoses to accurately diagnose the condition.
Managing gluteal tendinopathy requires a multi-faceted approach including isometric and functional loading exercises, load management, and proper load distribution.
Deep dives
Overview of Gluteal Tendonopathy
Gluteal tendonopathy is a musculoskeletal condition that causes pain on the outside of the hip, specifically on the greater tricana. The primary pathology associated with this condition is persistent tendon pain and loss of function due to mechanical loading. Gluteal tendonopathy primarily affects the gluteus medius and minimus tendons, but there may also be involvement of bursi and the iliotibial band. Common symptoms include pain on the lateral aspect of the hip, tenderness over the greater tricana, pain when lying on the affected side, pain with standing on one leg, and pain during activities such as walking, stair climbing, and running. Gluteal tendonopathy is most prevalent in postmenopausal women, but it can also affect younger individuals, particularly those who have recently given birth or engage in activities like trail running. It is important to differentiate gluteal tendonopathy from other conditions such as hip joint-related pain and lower back referral, as treatment approaches may vary.
Diagnosis and Assessment of Gluteal Tendonopathy
Diagnosing gluteal tendonopathy involves a combination of patient interviews and physical assessments. Important diagnostic tests include a sustained single-leg stand, where pain on the greater tricana is observed, and tenderness over the bone is noted when lying on the affected side. Clinical severity can vary, and patients may experience pain during sitting, particularly when in a low chair or with crossed knees. The diagnostic process also involves considering differential diagnoses such as hip joint-related pain and lower back referral, which may coexist with gluteal tendonopathy. A thorough assessment is crucial to accurately diagnose and understand patient-specific factors that may contribute to the condition.
Management and Exercise Therapy for Gluteal Tendonopathy
Managing gluteal tendonopathy involves a multi-faceted approach that includes both isometric and functional loading exercises. Isometric exercises specifically target gluteus medius and minimus while down-regulating the activity of the tensor fascia latae (TFL). This can be done using low-load isometrics in positions such as supine with a belt around the lower thighs or standing with feet slightly wider than hip-width apart. Functional loading exercises aim to improve load capacity and may include activities such as bridges, squats, step-ups, and balance exercises. Progressive frontal plane and dynamic exercises can also be incorporated based on the individual's needs and goals. It's important to monitor the patient's response to exercise and ensure they are working at a moderate to high intensity level. Additionally, load management and proper load distribution during activities like sleeping, sitting, and stair climbing are key for effective management of gluteal tendonopathy.
Diagnostic Tests for Gluteal Tendinopathy
The podcast discusses several diagnostic tests for gluteal tendinopathy. One such test is the fader test, where the hip is flexed to 90 degrees and the hip is adducted and externally rotated, compressing the iliotibial band against the greater trochanter. Another test is the faber test, which involves flexion, abduction, and external rotation of the hip. Additionally, the podcast mentions the modified Obers test in the side-lying position, where the hip is lowered into adduction to assess pain reproduction. Palpation of the greater trochanter is also highlighted as an important part of the assessment.
Treatment Strategies for Gluteal Tendinopathy
The podcast emphasizes that education and structured exercise programs are key components of effective treatment for gluteal tendinopathy. The education aspect involves helping patients understand their condition, reducing fear, and empowering them to manage their pain. Specific modifications while performing daily tasks, such as walking and stair climbing, are suggested to reduce pain. The importance of exercise fidelity, proper exercise technique, and gradual progression of exercises is highlighted. The podcast also addresses the use of corticosteroids, cautioning against their routine use, as they can be toxic to tendon cells and may lead to reliance on passive interventions rather than active management.
Dr Alison Grimaldi, Principal Physiotherapist at PhysioTec in Brisbane, Australia, adjunct Senior Research Fellow at the University of Queensland with over 30 years of professional clinical experience joins us to explore diagnosis assessment and management of the tricky musculoskeletal condition that can affect many endurance athletes, gluteal tendinopathy. Gluteal tendinopathy is pain on the outside and lateral aspect of the hip.
Dr Grimaldi is one of the world's preeminent experts when it comes to the rehabilitation of hip related injuries.
Show Sponsor:
POGO Physio Telehealth Consultations believe that everyone deserves access to complete and remarkable physiotherapy services.
Our goal is to get you back to your Physical Best. Find out more about telehealth consultations and book online.
