A Pain In The Ass
Written by Adrian Choy, Exercise Physiologist at Blacktown. Article from December 2018
A Pain In The Ass
The most prevalent lower limb tendinopathy isn’t located in the knee or ankle, but in fact is in the backside. Gluteal tendinopathy (tendon condition of the bottom muscles) greatly impacts the quality of life as it causes substantial amounts of pain in the lateral aspect of the hips. Women over the age of 40 years are shown to have the highest prevalence of this condition. Although gluteal tendinopathy is evident in sedentary individuals, it is also seen in athletes (particularly runners) (2).
Two of the gluteal muscles, the gluteus medius and gluteus minimus, are currently considered as the main culprits causing the lateral hip pain. The tendons of these muscles, and the associated joint cushion (bursae) can be compressed on the top of the thigh bone (femur) beneath the iliotibial band (ITB) (1,2). This compression is a likely result of excessive and prolonged hip adduction adopted during tasks of dynamic nature and during static postures. Some examples can include sitting with knee together, leaning on one hip whilst standing or excessive lateral pelvic shifting when walking. Another contributor may be when sitting with knees higher than hips on the lounge or in the car as this creates further tension on the ITB and thus further amplifying compression on the underlying tendons and bursae (2).
When it comes to tendons, they love load. If the healthy state of a tendons tissue is abruptly disrupted, this may cause the tendon to induce a catabolic effect (breakdown) which is what may be happening due to compression and lack of loading (stress deprivation) of the gluteal tendons. However, gradual increments in load placed on the tendons with adequate adaptation and recovery time will induce new formation (anabolism). This applies to the gluteus medius and minimus tendons whereby we need to appropriately train the muscles. Exercises such as straight leg raises, squats (plus its variations), hip extensions and abductions (2) are a great place to begin.
- Grimaldi, A. and Fearon, A., 2015. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy, 45(11), pp.910-922.
- Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H. and Vicenzino, B., 2015. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine, 45(8), pp.1107-1119.