Whats that Grumbling Pain at the Side of your Hip??

Pain at the side of your hip.. or 'Lateral hip pain'? Slowly worsening? Doesn't get better with rest? Sudden spike in running volume or  bootcamp classes? Suddenly started a weight loss regime? Disturbing your sleep? Worse while on your feet during the day?

 

You may have a condition called gluteal tendinopathy.  For years this complaint was often grossly mislabelled as hip bursitis.

 

Here at East Coast Physiotherapy and Sports Injury clinic, we see this very common hip complaint, typically from middle aged 'weekend warriors', elite athletes and even those who do not regularly exercise. Females tend to be afflicted more than males, typically aged 35-60. Global prevalence is estimated at 1 in 4 women over 50, prevalent in postmenopausal women, and can have a considerably large knock on affect on quality of life.

 

Thanks to a research surge over the last 10 years, our knowledge is constantly evolving about tendons - those tough fibrous connective tissue that links muscle to the their boney attachment and transmits mechanical force between such structures. How does pathology develop in them? What drives pain in conditions associated with them, and do we best manage them in rehabilitation?

 

The why? (For all the glute geeks)

Tendinopathy is a clinical syndrome, characterized by peristant, localized pain and loss of function, commonly from overuse, repetitive patterns. Mechanical force of tendons beyond their loading capacity is typically at fault. Gluteal tendinopathy is the most prevalent lower limb tendinopathy. In the case of gluteal tendinopathy, when under excessive compressive and tensile load, these tendons of both gluteal medius and minimus will start to grumble as the pathological process kicks in!

 

 

While we don't have all the answers (yet!), we are confident that specific exercise-based physiotherapy, load modification and education has long lasting positive effects, reducing the often disabling impact of this condition on your activities of daily living and sporting endeavours.

A fantastic study called the LEAP trial published in 2018 showed Improvements in pain, pain frequency, and quality of life with education and targeted exercise as first choice intervention strategies, over steroid injections or a "wait and see" approach.

 

 *** So, Top tips to get better. *** 

Some Do’s and Don’ts

1. (as always) Get a thorough assessment from your Chartered Physiotherapist - other structures could be at fault and must be clinically ruled out.

2. Education from your physio - take on board to understand your triggers, be it:

  • cross legged sitting
  • standing with a hip shift
  • lying position in bed
  • big spikes in activity
  • movement control, strength deficits, or other maybe sport specific biomechanical inefficiences.
  • High BMI


Start to give those tendons some good TENDON CARE, and avoid winding up and causing further irritation to the structures around the hip.

 

3. Gradually build back your tendon capacity through progressive loading with specific therapeutic exercises, as guided by your physiotherapist. We will always pitch these corrective exercises to you given what we individually assess in clinic, there is NO ONE RECIPE, no one size fits all programme with this.

 

4. Monitor your response to exercises with pain levels day - to - day, both during AND after exercises, up to 24 hours after. A question we will always ask is, how do you feel the next morning? General rule when it comes to how much pain is too much during an exercise, keep pain between 0-3 on a scale out of 10 during the exercise or activity, watching that no pain lingers the next day.

 

5. Be patient - while there is no overnight fix, we see good results across pain rating scales typically in a 8 week window of rehabilitation. 

 

6. STAY ACTIVE. Tendons love loading., so keep moving. Degenerative tendons usually get worse with rest, so keep exercising 'smartly'.

 

Book in online www.eastcoastphysio.ie or call into the clinic to talk to any of the team here at East Coast Physiotherapy and how we can help you today.

 

Thanks for reading, have a fun and fit day, from all the East Coast Physiotherapy Team.

 

References

1. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015 Aug 1;45(8):1107-19.

2. Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H. and Vicenzino, B., 2018. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. bmj, 361, p.k1662.

Being an avid fitness enthusiast for some time, I have been fairly lucky in avoiding injuries. However, over the past 12 months on two separate occasions I have picked up minor (but painful) injuries.

On both occasions I attended East Coast Physio where the problems were diagnosed and quickly resolved via single sessions coupled with some excellent advice on how to manage the problems further myself. East Coast Physio provide a very friendly, professional service which I highly recommend.

Roger Bateman
Ashford, Wicklow