Gluteal Tendinopathy Treatment at Arunalaya Delhi

Expert Gluteal Tendinopathy Treatment in Delhi

What is Gluteal Tendinopathy ?

Gluteal tendinopathy is a common condition characterized by pain and dysfunction of the tendons of the gluteal muscles, primarily the gluteus medius and gluteus minimus. These tendons attach the buttock muscles to the greater trochanter, the bony prominence on the side of your hip. It’s the most common cause of lateral hip pain and is often referred to as Greater Trochanteric Pain Syndrome (GTPS).

Causes of Gluteal Tendinopathy

Tendinopathy refers to a more chronic condition involving degeneration or disorganization of the tendon fibers. It is often due to a mismatch between the load placed on the tendon and its capacity to withstand that load.

Compressive Loading: This is considered a major driver. The gluteal tendons can be compressed against the greater trochanter when the hip is in certain positions, such as:-
- Side-lying: Especially sleeping on the affected side.
- Sitting with legs crossed.
- “Hip hanging” or “lazy standing”: Resting weight on one hip, causing the opposite hip to drop and compressing the gluteal tendons.
- Excessive hip adduction: Movements where the leg crosses the midline.

Overload:-

- Sudden increase in activity: Starting a new exercise program, increasing running mileage, or performing unaccustomed activities like hill climbing.
- Repetitive activities: Long-distance running, walking, climbing stairs, or prolonged standing, especially with poor biomechanics.
- Deconditioning: Weak gluteal muscles may lead to the tendons being unable to handle even normal daily loads.
Muscle Weakness and Imbalance: Weakness in the gluteus medius and minimus, which are crucial for hip abduction and pelvic stability, can lead to increased stress on the tendons. Imbalances with stronger hip flexors or adductors can also alter mechanics.
Biomechanical Factors
- Pelvic instability: Leading to abnormal loading of the hip.
- Gait abnormalities: Altered walking patterns.
- Leg length discrepancy.
- Flat feet or overpronation.
Age and Gender: More common in middle-aged and older individuals, particularly women (up to 4 times more common than in men), likely due to hormonal changes (e.g., menopause affects collagen health) and wider pelvic anatomy.
Other Medical Conditions: Obesity, diabetes, and certain medications can increase the risk of tendinopathy.

Symptoms of Gluteal Tendinopathy

Lateral Hip Pain: A deep, aching pain on the outer aspect of the hip, often localized to the bony prominence (greater trochanter).
Radiation of Pain: The pain can often radiate down the outside of the thigh, sometimes as far as the knee, and occasionally into the buttock or groin.
Pain with Side-Lying: This is a classic symptom, particularly when lying on the affected side at night. Even lying on the unaffected side can be painful if the painful hip adducts (drops down) and causes compression.
Pain with Weight-Bearing Activities: Worsens with activities like:-
- Walking (especially long distances or uphill/downhill)
- Running
- Climbing stairs or going up/down inclines
- Standing for prolonged periods
- Single-leg standing
Pain with Sitting: Especially prolonged sitting or sitting with legs crossed. Pain may be worse with the first few steps after rising from a seated position.
Tenderness to Palpation: Significant tenderness when pressing directly on the greater trochanter.
Weakness: May be subtle weakness in hip abduction (lifting the leg out to the side).
Stiffness: Especially in the morning or after periods of rest.

Advanced Physiotherapy for Gluteal Tendinopathy

Phase 1: Isometric Exercises (Pain Relief)
- Purpose: To reduce pain and maintain muscle activation without tendon movement or excessive compression.
- Examples: Side-lying isometric hip abduction (gently pushing the top leg into a pillow against a wall or a therapist’s hand), standing isometric hip abduction. Holds are typically 30-45 seconds for 3-5 repetitions.
Phase 2: Isotonic Strengthening (Building Strength):
- Purpose: To build strength in the gluteal muscles and improve the tendon’s ability to tolerate load. Focus is on controlled, slow movements.
- Examples:
  - Clamshells: Start with bodyweight, progress to resistance bands.
  - Side-lying leg lifts: Ensure controlled movement, avoid “hip hiking.”
  - Glute bridges (double and single leg): Focus on glute activation, not hamstring or low back.
  - Standing hip abduction: With or without resistance bands.
  - Squats and Lunges: Progress from double-leg to single-leg, focusing on form to prevent hip adduction (knees collapsing inwards).
Phase 3: Energy Storage/Release Exercises (Functional Integration & Return to Activity):
- Purpose: To train the tendon to store and release elastic energy, crucial for activities like running, jumping, and cutting.
- Examples: Hopping, jumping, plyometrics, agility drills, running drills (if applicable). This phase is highly individualized based on patient goals.

Advanced Physiotherapy Techniques:-

Manual Therapy
- Soft Tissue Mobilization/Myofascial Release: To address tightness in surrounding muscles (e.g., TFL, IT band, hamstrings, quadratus lumborum) that might be contributing to altered hip mechanics or compensatory patterns.
- Dry Needling: Highly effective for releasing deeply situated trigger points and reducing muscle hypertonicity in the gluteal muscles (gluteus medius, minimus, piriformis) which can contribute to compression or altered biomechanics. It can significantly reduce pain and allow for better exercise tolerance.
- Joint Mobilizations: To address any stiffness in the hip joint, sacroiliac joint, or lumbar spine that could influence hip mechanics and tendon loading.
Biomechanics and Movement Retraining:
- Gait Analysis: Assessing walking and running patterns to identify and correct faulty mechanics (e.g., excessive hip adduction, “trendelenburg gait” due to glute weakness). Training involves verbal cues, visual feedback (mirror), and tactile cues.
- Postural Correction: Education and exercises to avoid compressive postures like “hip hanging” while standing, prolonged sitting with crossed legs, or sleeping directly on the painful hip.
- Motor Control Exercises: Focusing on precise activation of the gluteal muscles in functional movements, often using biofeedback or real-time ultrasound to ensure correct muscle recruitment.
Kinesiology Taping:-
- Mechanism: Can be used to provide sensory feedback, de-load the tendon, or facilitate gluteal muscle activation. It may reduce pain, allowing for better exercise tolerance.
- Application: Taping techniques can be applied to lift the skin over the greater trochanter to reduce compression, or to provide proprioceptive cues for gluteal engagement.
Shockwave Therapy (Extracorporeal Shockwave Therapy – ESWT):
- Mechanism: Involves delivering high-energy acoustic waves to the affected tendon. It is used to stimulate a healing response, promote collagen remodeling, break down calcifications (if present), and reduce pain by affecting nerve endings.

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