- Do you have hip pain or pain travelling down the side of your leg?
- Does your hip pain get worse with exercise, lying on your side, crossing your leg’s or walking up a hill?
- Is your hip pain achy, spreading or deep?
You could have Gluteal Tendinopathy with or without Trochanteric bursitis.
Gluteal tendinopathy is where the gluteal muscles (the buttocks muscles) become overused. This may be due to:
- overtraining, or
- starting a new training program, especially with actions of squatting, lunges, up hill or stair running,
- incorrect warm up or
- altered biomechanics (a term we used to describe ineffective movement patterns, like if one wheel of a car is misalignment, the whole car with not drive correctly),
- weak adductor muscles,
- a leg length discrepancy or
- an underlying condition such as hip osteoarthrtitis
This condition starts with minor tissue damage, which then weakens the muscle, placing pressure on the tendon, resulting in tendon inflammation. This process also applies pressure to the bursae. Keep reading to find out more about bursae. It is common to experience both gutted tendinopathy and trochanteric bursitis, due to one leading to the other.
Our clinical experience shows that the most common reason for these conditions to occur is poor hip and pelvic muscle control, which leads to an increase of stress over the Gluteal tendons, creating pain and instability.
A simple test to see if you have good pelvic stability is to stand on one leg. Poor pelvic stability may be seen if you shake, hitch your opposite hip, rotate your pelvis or reach out to put your hand on something for balance or support.
Recent research shows that bursitis in the hip, known as trochanteric bursitis does not occur without the presence of a gluteal tendinopathy. But what is a bursae?
We have 160 bursae in the human body, situated in areas of the elbow, shoulder, knee, heel and the hip. These fluid filled sacs act as a cushion between bones and soft tissue to reduce friction. If there is too much pressure applied to these sacs, the bursae will get inflamed and the inflammation causes pain, known as bursitis. The most common bursae to be inflamed, is the Trochanteric bursae, located on the outer side of the hip. The thigh bone, known as the femur, has a boney prominence known as the greater trochanter, this is where the gluteal muscles, which form our buttocks attach to. The bursae located here are designed to reduce friction between the gluteal muscles and the pelvis when we walk.
So, how is gluteal tendinopathy and/or trochanteric bursitis managed?
A full patient history and assessment will need to be undertaken by your osteopath or Chiropractor to determine why the hip pain is occurring and to rule out any back problems or underlying pathologies.
Once diagnosed, advice on how to stop the pain from re-occurring will be given, depending on contributing factors such as posture, training habits and sleep patterns.
Sleeping position will be assessed. Pain may get worse with sleeping on either side suggesting incorrect sleeping posture. A small pillow between your knees whilst sidelying may limit the pressure on the hip area at night.
Posture – regular breaks from prolonged sitting as well as postural education on how to limit the impact on the body in a sitting position
Changing habits such as sitting with legs crossed or standing with weight to one side
Footwear – advice on appropriate footwear
Pain relief may be suggested to help the pain initially, to allow you to start a rehabilitation program. Always discuss new medication with your GP or pharmacist as NSAID’s have a list of side effects and are contraindicated in some cases
Ice to reduce swelling and to help with tissue damage. Ice may be applied 2-3 times per day for 10-20minutes.
Rest in the early stages to allow for tissue healing.
Treatment to address biomechanical imbalances, reduce the inflammation and tightness in the gluteal muscles and strengthen the gluteal and hamstring muscles.
Home exercise program including strengthening, stretching and use of self massage balls. The strengthening program is vital to prevent a re-occurrence by improving hip and pelvic stabilisation.
Kinesiology tape may be applied to help initially or with the start of an exercise program.
Supervised exercise program for some people with this condition may be appropriate.
This condition generally has a good prognosis with the correct management.
If pain lingers or does not improve then an injection of cortisone may be prescribed by your GP, however it is still important to address the biomechanics influences that caused the inflamed bursa initially.
If you think you might be suffering from gluteal tendinopathy or any other hip condition or pain, then contact us at Body of Life Health Centre on 02 9453 3046.
Article written by Dr Alex Kleydish (Osteopath)