GLUTEAL TENDINOPATHY - OUTER HIP PAIN
Epidemiology
Lateral hip/Gluteal tendinopathy is the most common form of outer hip pain, with the highest prevalence among females over 40 years old, particularly postmenopausal women with a BMI over 27 and higher adipose tissue. However, it can also commonly occur in active runners.
Causes of Gluteal Tendinopathy
Gluteal Tendinopathy is primarily driven by overuse. As we engage in running, each stride subjects our tendons to mechanical stress, a fundamental process that prompts positive adaptations. However, when these stresses surpass the rate the tendon can heal and promote these positive adjustments, it can gradually enter a state of overuse. The speed at which tendinopathy develops hinges on various factors, including the magnitude of stress, your genetic predisposition, and dietary considerations.
Risk Factors for Gluteal Tendinopathy
Risk factors for Gluteal Tendinopathy include:
Females over 40 years old postmenapause (Impacts estrogen, I important hormone for tendon health)
BMI > 27
Recent spike in running load
Recent spike in incline running
Recent spike in gym activity involving: lunges, squats, split squats, bulgarian split squats etc
Insufficient strength training
Clinical Presentation of Gluteal Tendinopathy
Symptoms normally include gradual onset outer hip pain that can radiate down the outer part of the thigh. It can commonly be painful at night, particularly when lying on the affected side. Other aggravating factors can include rising from a chair, climbing hills or stairs, lunging or various single leg movements.
Management Strategies for Gluteal Tendinopathy
Advice and Education:
Individualized advice and education are provided, including an explanation of the condition, prognosis, and guidance on aggravators and easers. An example could include: not crossing your leg when sitting or sleeping with a pillow between your legs
Rehabilitation:
Rehabilitation programs are tailored to individual preferences and needs. Exercises may include various gluteal strengthening exercises and gait re-education while avoiding certain exercises in the early stages.
Corticosteroid Injections:
While corticosteroid injections offer temporary relief, they are not a definitive solution and may impact tendon health, particularly with repeated use. We always recommend 3-6 months of quality rehabilitation before considering this modality
Shockwave Therapy:
Shockwave therapy is considered as an adjunct, but its effectiveness is not conclusively supported by robust evidence.
Hormone Replacement Therapy:
Positive effects of hormone replacement therapy have been observed, particularly in females with low BMI, indicating a potential connection between BMI, adipose tissue, and estrogen levels.