Gluteal Tendinopathy also known as Greater Trochanter Pain Syndrome (GTPS) is considered to be the main cause of pain located at the outer/lateral aspect of the hip and is the most common tendinopathy in the lower limb, (1,3) experienced mostly by sedentary individuals but can also occur in athletes. In this condition, a breakdown/alteration in normal tendon structure occurs. This condition affects the tendons of the gluteal muscles i.e. gluteus medius and minimus muscles, which arise at the pelvis and attach at the femur/thigh bone.
What causes gluteal tendinopathy? (6,7)
• Overuse.
• Overload of the tendon.
• Incomplete healing post-injury.
• Weak gluteal muscles.
• Errors in training techniques.Symptoms (1,4,5)
• Pain when lying on the affected side.
• Pain on pressure application close to the tendon.
• Increased pain when walking, running or climbing stairs.
• Sitting crossed legs.Risk Factors (2,3)
• Females over the age of 40.
• Angulation of thigh bone.
• Leg length discrepancy.
• BMI.
• Waist and hip girth.
• Strength of lower limb musculature.
• Flexibility of lower limb musculature.Assessment (2,3)
In order to make an accurate diagnosis, we at Floyd Lebatie Physiotherapy are passionate about conducting an extensive evaluation which will include the following:
• A thorough subjective assessment in order to determine the most likely cause of your symptoms.
• Postural evaluation.
• Gait assessment.
• Single leg balance.
• Strength assessment of the gluteal muscles.
• Mobility of the lumbar spine, pelvis and hips.
• Flexibility of hip musculature.
• Various special tests which place the hip joint under stress, to rule out other diagnoses.
Management (2,3,6)
To reduce symptoms, it is imperative to manage the load placed through the tendon. This can be done by avoiding certain postures or positions whilst sitting and lying down. It may also be necessary to alter the mattress type to provide additional relief. To further provide symptomatic relief, dry-needling and/or soft tissue massage can be conducted. This will assist in relieving tight musculature which could be placing additional tension on the affected tendon. For athletes, it may be required that certain activities in terms of training type, frequency, intensity and duration are adapted. Progressive loading and strengthening exercises are key in the management of gluteal tendinopathies. Additionally, those risk factors which can be addressed should be managed accordingly.
At Floyd Lebatie Physiotherapy, we are committed to holistic management and would love to help you get back to what you enjoy doing, free of pain!
References
1.Fearon, A., & Grimaldi, A. (2015). Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. JOSPT, 45(11), 910-924.
2.Grimaldi, A., & Fearon, A. (2015). Gluteal Tendinopathy: Pathomechanics and Implications for Assessment and Management. Journal of Orthopaedic and Sports Physical Therapy, 45(11), 1-41.
3.Grimaldi, A., Mellor, R., Hodges, P., & Bennell, K. (2015). Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports medicine, 45(8).
4.Klauser, A., Martinoli, C., Bellmann-Weiler, R., Feuchtner, G., Wick, M., & Jaschke, W. (2013). Greater Trochanteric Pain Syndrome. Seminars in Musculoskeletal Radiology, 17(1), 43-48.
5.Lin, C., & Fredericson, M. (2015). Greater Trochanteric Pain Syndrome: An Update on Diagnosis and Management. Curr Phys Med Rehabil Rep, 3(1), 60-66.
6.Mellor, R., Grimaldi, A., Wajswelner, H., Hodges, P., Abbott, J., Bennell, K., & Vicenzino, B. (2016). Exercise and load modification versus corticosteroid injection versus ‘wait and see’ for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskeletal Disorders.
7..Reid, D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop, 15-28.
