A Patient’s guide to Gluteal Tendinopathy

Lateral hip pain (pain on the side of the hip and thigh) has traditionally been referred to as Trochanteric Bursitis. However, more recent evidence shows that the primary cause of lateral hip pain is due to painful tendons, which attach the muscle to the bone. The tendons that are painful attach the gluteal muscles to the bone on the outside of the hip. This is called Gluteal Tendinopathy.

Gluteal Tendinopathy is the most common tendinopathy affecting the lower limbs. It is thought to affect up to 20% of adults and is more common in females than males, with a ratio of 3–4:1, peaking in the perimenopausal period, 40-60 years. However, this condition may also occur in young athletes, particularly runners or those involved in step training.

The reason for Gluteal Tendinopathy is still being explored, but it is usually associated with weakening of the gluteal muscles and moving in ways that increase the stress on the gluteal tendons. A key factor is thought to be compression of the gluteal tendons linked to certain postural habits and movement patterns.

Other contributing factors for Gluteal Tendinopathy include: high cholesterol, diabetes, increased weight around the stomach area, previous use of fluoroquinolone antibiotics, genetic factors, age, hormones, vascular issues and hip or spinal pathology.

Symptoms usually include:

• Pain lying on the side

• Pain on rising from a chair

• Pain on walking, particularly up hills or stairs

• Tenderness on touching the hip bone

In most cases your doctor or physiotherapist will suspect Gluteal Tendinopathy from your symptoms and also from a number of tests on the physical examination of your hip. Sometimes specific diagnostic tests such as an ultrasound or MRI scan are used.

Recent evidence supports that the best treatment for tendinopathy is physiotherapy. Your therapist will do a detailed assessment of your hip and also assess your postural and movement habits. Treatment then consists of two main parts:

1. Activity modifications over the 24 hour period to reduce the compression of the gluteal tendons
2. An exercise programme, tailored to improve the control, recruitment and capacity of the muscles around the hips and pelvis

Due to the multi-factorial nature of this problem your physiotherapist may also discuss weight management and diet if this is appropriate.

Your physiotherapist will guide you regarding work and leisure activities. If your pain is very severe you may need to reduce or modify these initially.

The most important factor in treating Gluteal Tendinopathy is to decrease the amount of compression to the tendon over the 24 hour period.

Activity Modifications

Sitting

• Minimise the time spent crossing your ankles or legs
• Reduce the time spent sitting on low chairs. When you sit aim to sit with the hips higher than the knees, using a wedge cushion may help this

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Sleeping

• If you prefer to sleep on your side avoid sleeping on the sore hip and put a pillow between your knees
• Another sleeping position that can be helpful is semi prone (halfway between lying on your tummy and your side- to avoid direct compression on the affected hip) again pillows need to be used to support the top leg and in front of the trunk to avoid rolling fully onto your tummy and the underside hip can be straightened
• If both hips are painful, an option is sleeping on your back with pillows under your knees
• An eggshell mattress topper can be helpful as it reduces the amount of compression through the hips

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Functional movements

• When standing, try and keep the weight equal between both feet
• Minimise walking on hills and stairs where possible • When using the stairs hold onto the rail and walk with your feet a little wider

Your physiotherapist will advise you of activity modifications, to reduce the compression on the gluteal tendons, that are specific to your postural and movement habits.

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Each patient with Gluteal Tendinopathy is individual. In order to ensure that your symptoms are appropriately managed, your physiotherapist will tailor an exercise programme specific to your functional ability and to ensure adequate loading to improve the capacity of the muscles around the hips and pelvis.

Gluteal Tendinopathy is a painful condition that with physiotherapy can see a change in symptoms quite quickly but the best outcomes are achieved with several months of exercises. Surgery may be required in some cases.

The Physiotherapy Department: 020 8909 5820