In the first part of our blog (https://www.upnadamptphysio.com/post/struggling-with-hip-pain-uncover-the-causes-and-risk-factors-of-greater-trochanteric-pain), we discussed how greater trochanteric pain is often linked to gluteal tendinopathy, a condition that involves the tendons around your hip. Now, let's dive into how this pain develops, what contributes to it, and how to manage the condition effectively.
How does the pain develop?
When gluteal tendinopathy occurs, the tendons that connect your gluteus medius and minimus muscles to the greater trochanter (of your femur bone) become damaged or irritated. This can happen suddenly after a high-stress activity or over time as the tendons wear due to repeated 'suboptimal' use. The tendons may start to thicken and change their overall structure (https://www.upnadamptphysio.com/post/why-can-we-get-tendon-pain-running), leading to pain that worsens during movement.
One major factor contributing to this condition is mechanical stress. For example, hip adduction (when your leg moves toward the centre of your body) can increase the compressive load on the tendons and bursae, causing more irritation. When the hip is in this position for extended periods or with high intensity, the tendons and bursae are under pressure, which can exacerbate pain.
The role of the Iliotibial Band (ITB)
The iliotibial band (ITB) is a thick band of tissue that runs along the outside of your leg, from the hip to the knee. Some very powerful muscles attach to the ITB such as Gluteus Maximus. It helps stabilize your hip during movement, but when there’s excessive adduction or load, it can become irritated. This condition is called ITB fasciopathy, and it can contribute to the pain in the lateral hip area, leg & knee.
If you’re experiencing gluteal tendinopathy, the ITB may also be under increased strain, leading to additional discomfort. This makes it even more important to address the health of both the tendons and the ITB to reduce pain and improve mobility.
How the muscles and gait are affected
As the tendons weaken (i.e. reduce their tensile load capabilities), the muscles around the hip become less efficient at controlling optimal movement, often leading to altered movement patterns. People with gluteal tendinopathy may recruit more muscle fibres than usual to compensate for the loss of strength, which can result in abnormal movement strategies. For instance, people often activate their hip muscles more than normal when walking (trying to guard against the pain), leading to overuse and even more strain on the tendons.
One key clinical finding is that people with gluteal tendinopathy tend to experience greater loads on their hip abductors during movement. This means that during walking, the muscles around the hip are under increased strain, which can worsen the condition.
What can be done to help?
The good news is that gluteal tendinopathy can be managed and treated. The main approach involves improving activation patterns of key muscles & strengthening the hip muscles. This can help restore normal movement patterns, reduce the strain on the tendons, and ease the pain.
Working with a physiotherapist at Up N Adam Performance Training & Physiotherapy can be extremely helpful. They can guide you through specific exercises designed to strengthen your hip muscles, improve your gait, and help prevent further damage. You may also need to modify certain activities or postures that place excessive strain on your hip.
Final Thoughts
Greater trochanteric pain (Lateral Hip Pain) and gluteal tendinopathy are common conditions, but with the right approach, you can manage and even reverse the symptoms. If you’re struggling with hip pain, it’s important to address the underlying causes and work on strengthening the muscles around your hip to improve your mobility and reduce pain.
Remember, healing takes time, but with patience and proper care, you can get back to living a more comfortable and active life.
This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!
You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com
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