Gluteal tendinopathy/greater trochanteric pain syndrome
A common complaint amongst female peri/post menopausal women is an onset of pain over the outside of the hip. Researchers in this area believe that this issue is most common for this demographic population due to the width of the female pelvis, hormonal changes that occur affecting the homeostasis of the tendon, weight gain which is common during this stage and overload to the tendons around the outer hip due to activity changes and poor biomechanics.
Generally, the pain begins when there is a mechanism causing a repetitive compressive load to the tendons. These tendons are known as gluteus minimus and gluteus medius and are responsible for helping aid hip control and stability. We often see this when someone begins or increases their levels of exercise. Without good hip strength and biomechanics this can gradually lead to repetitive compression and strain on the outer hip (gluteal) tendons causing pain and tendon injury.
Symptoms include pain over the outer (lateral) aspect of the hip in an area known as the greater trochanter (bony bump on the side of the hip). Pain can sometimes travel to the outer thigh, buttock and lower back. Pain at night is very typical of this condition with discomfort lying sideways both on the affected side or on the opposite side with the affected side hanging down. Stair climbing and walking can begin to be painful as well as prolonged sitting.
Some simple changes in daily activities can have a dramatic impact on reducing the compression forces around the tendons and reducing pain. This may be as simple as not sitting cross legged, sleeping with a pillow between your knees, using an eggshell overlay and not standing or ‘hanging’ off one hip (like holding a baby on your side).
Assessment is very important to rule out any other hip pathology and take a thorough history in order to ascertain which activities are overloading and causing compression on the tendons and address any underlying biomechanical problems or weakness around the hip and trunk. Exercises will be prescribed in order to strengthen the hip and improve the gluteal tendons’ capacity to tolerate activity and maintain fitness without completely stopping your current fitness program. You may also find that soft tissue therapy by our physiotherapists will be beneficial in order to promote pain relief and improve muscle function whist rehabilitating.
Shay McLeod practices from Advance Healthcare Hoppers Crossing. He was a treating practitioner in the LEAP study, a randomised controlled trial comparing the results of ‘’wait and see, corticosteroid injection, and education and exercise’’ in the management of lateral hip pain. Results favoured education and exercise at 8 weeks and 52 weeks follow up when comparing pain and the proportion of people reporting they were at least moderately better.