The top 5 ways you are making your hip pain (gluteal tendinopathy) worse:
Lateral or outer hip pain is a common complaint that we treat at Mountain Health & Performance. There are many structures around the hip that can cause pain. The lower back can also refer pain into the hip, which makes things even more complex! This is why a detailed history and physical examination is an important part of getting to the root cause of your hip pain. At Mountain Health & Performance our chiropractors spend between 45 minutes to an hour with our patients on their first visit in order to correctly diagnose and provide a detailed treatment plan for your hip pain.
Outer hip pain (or lateral hip pain) is a common location that people experience pain. Once the lower back has been ruled out as a cause of lateral hip pain, our chiropractors will focus on determining which tissues may be causing pain. The most common tissues involved in outer hip pain are the gluteus medius and minimus tendons. When these tendons cause dysfunction and pain it is classified as a gluteus medius tendinopathy or a gluteal tendinopathy In the past this condition has been labelled as hip tendonitis or hip bursitis but more recent research has revealed that painful tendons rarely involve inflammation and that the bursa is less commonly involved. Tendinitis (or Tendonitis) means “inflammation of the tendon,” but many doctors may still use the term tendinitis out of habit. For the purpose of this article we will refer to hip tendonitis/bursitis as a gluteal tendinopathy.
The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. Therefore tendinopathies do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.
Click the link below to learn more about gluteus medius tendinopathy:
You can also watch the video below to learn more
The glutues medius muscle help provide side-to-side stability to our pelvis and allow us to move our hips in various ways. The tendon of the gluteus medius muscle inserts onto the greater trochanter, which is a bony prominence on the outside of the thigh (femur). The IT band also crosses the greater trochanter and can place compression on the gluteus medius tendons when the hip is weak and or placed in certain positions. Over time increased compression on these tendons can lead to weakening and changes in structure of the tendons. Gluteal tendinopathy is a compressive issue therefore, anything that increases compression on the tendon is going to aggravate or worsen the condition. Unfortunately there are various things that patients do to help their outer hip pain, which actually hurts them in the long run. This is why a proper history and diagnosis is really important to treating any painful muscle, joint or nerve condition. Let’s look at the top 5 ways people make their hip pain worse and exacerbate a gluteal tendinopathy.
1. Stretching the piriformis muscle and IT band:
There is a common misconception that stretching is a long-term solution to muscle or joint pain. When we are in pain it is almost second nature to want to “stretch it out”. You may even feel better during or shortly after a stretch because of something called “stretch induced analgesia”. This is a complex neurological phenomenon but simply put you’re replacing pain signals with stretch signals and creating a distraction from pain for a short moment.
A gluteal tendinopathy may also cause the muscles around the hip to feel tense. Piriformis and IT band stretches are commonly prescribed by practitioners for various lower back, hip and knee conditions. It’s easy to understand why patients believe that stretching these muscles will be beneficial however it’s actually one of the worst things you can do if you have a gluteal tendinopathy. These external rotation and adduction stretches will place compression on an already compressed and irritated tendon which will make things much worse in the long run. Take a look at some of the common piriformis and ITB stretches below and cut those out of your routine if you are currently doing them.
Figure 4 stretch:
Standing ITB stretch:
Rotational hip stretches :
2. Clam Shells:
Clam shells are also a commonly prescribed exercise for low back, hip and knee pain. It’s an easy exercise that patients default to if the hips feel painful and weak. Strengthening the hip is an important part of treating a gluteal tendinopathy however, the muscles must be strengthened in a very specific way to ensure that there is no added compression on the tendons. As we discussed above any stretches or exercises that place the hip in external rotation (figure 4) or adduction (hip dropping down) will compress the gluteus medius tendon. The clam exercise places the hip into external rotation repeatedly so it’s an important exercise to scrap when healing from this condition. There are various other gluteus medius exercises that can be done to strengthen the hip in a way that will not place compression in the tendon. These will be specifically prescribed by the chiropractors at Mountain Health once a diagnosis of a gluteal tendinopathy has been made.
3. Foam Rolling:
Foam rolling is a great way to loosen up muscles and warm the body up for exercise. Typically foam rolling muscles that feel tense or sore is fine but for compression injuries like a gluteal tendinopathy, foam rolling right over the compressed tendons will…. add more compression. While trying to loosen things up you are irritating a gluteal tendinopathy. If you really want to foam roll just make sure not to roll directly over the side of the hips. Roll out your lower back, quads and hamstrings all day just avoid the sides of the hips and thighs for now!
Please don’t do this:
4. Improper sitting postures:
A lot of us sit for a living, or spend a lot of time at home sitting on a computer or watching TV. Because of the amount of time spent sitting it’s important to avoid placing the gluteal tendons in compression for long periods of time. If we sit with the legs crossed (one foot on the knee or ankles crossed) we add compression and irritate a gluteal tendinopathy. Low chairs will also create more compression on the tendons. Try to sit with the hips, knees and ankles straight (feet flat) and if you have a low chair try adding a cushion wedge to decrease the angle between the hip and torso.
5. Improper standing postures: standing while hanging off your hip
Remember that IT band stretch that you should avoid? Well a lot of us actually stand in a similar position. Hanging off the hip or standing with one hip dropping out to the side is a common pattern a lot of us revert to. It is less work for the muscles on the sides of the hips (including gluteus medius) when we stand with the hip dropped down to the side. You can see in the picture below how the woman is standing in a position where the hip hangs to the side. Every time you let your hip hang you are putting that hip under compression and irritating a gluteal tendinopathy.
This posture may be a pattern that is easy to fix but may also be due to lack of endurance in the muscles and or weakness in the hips. It could also be due to anatomical variants like a leg length inequality. Try your hardest to avoid this posture but it’s also important to start training these muscles in various ways to help support you in a neutral posture. A leg length inequality can also be investigated and diagnosed by the chiropractors at Mountain Health and Performance.
Posture Below: It feels easier and like less work to stand in this position but long term it is irritating a gluteal tendinopathy.