The gluteus medius is a muscle in the upper portion of your bottom muscles. The Gluteus medius attaches to the bony part on the side of your hip. Gluteus medius tendinopathy can cause problems for athletes and the general population. Athletic performance can be affected due to decreased speed changing directions or suffering pain when running. General populations are most effected when using the hip or when it is positioned awkwardly.
Symptoms of gluteus medius tendinopathy include:
Pain at the side of your hip with:
- Walking and sitting
- Laying on your side or pressing on your hip bone
- Pain standing for long periods
What is a tendinopathy?
A tendinopathy is essentially a problem with a tendon which is usually caused by an unaccustomed amount or type of activity. Things that can make you more likely to get a tendinopathy include: increases in compressive loading, age, genetics, hormones, and some medications.
Another problem related with gluteus medius tendinopathy is trochanteric bursitis. The bursa is a fluid filled sack which helps to reduce friction around the bone. Bursas often become inflamed when there is a tendon issue or loading problem or if there is a direct impact.
Stages of Tendinopathy:
There are different stages of tendinopathy which will determine how long it takes to improve.
- The reactive stage is the first stage and can be managed well with anti-inflammatories, rest, and gradual increase in loading above and beyond your requirements.
- The disrepair stage is when the tendon tries to heal itself but does a poor job, resulting in changes within the tendon which reduce the strength and potentially make it more painful
- The degenerative stage is where some cells within the tendon begin to die, the structure of the tendon becomes less orderly and less tolerant to load.
What do I do if I have a gluteus medius tendinopathy?
With treatment, gluteus medius tendinopathy can be managed in a way where you can get stronger, move better and be more comfortable. This is where physiotherapy can help. The main aim of treatment is to modify the amount and type of activity you do with the tendon. This is done by customising a program based on your current ability, lifestyle and goals. There are 3 stages to a successful rehabilitation program for gluteus medius tendinopathy:
- Rehab initially focuses on reducing pain through education regarding provocative activities and improving strength of the tendon. Often, we start with holding exercises to reduce the pain and begin the strengthening process.
- The next stage is to progress into slow repetitions through range with increasing loads.
- Your program then progresses into activities that you would like to do, developing strength and speed as required for what you need to do.
Passive treatments such as injections, medications and dry needling may offer some relief but do not help the tendon adapt in the long term. In contrast, active approaches that involve progressive loading such as the program mentioned above have good long term outcomes, especially if rehab is continued after your pain subsides and you can perform the tasks required.
Check out the pictures of Courtney, our Massage Therapist and Strength and Conditioning guru, performing some typical exercises for gluteus medius tendinopathy rehabilitation
If you have any of the symptoms mentioned above, come in to get a customised program to get your hip and glutes feeling great again.Authors: Tylana Woodward, Mark Davis and Mitchell Shorten.
Pain was once thought to be a very basic sense; something damaged you and you would feel pain. We now know that pain is a very complicated response to things that happen in your body and mind.
What is pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage (International Association for the Study of Pain). When you feel pain, it is always real, no matter what is causing it.
What causes pain?
Pain is your brain's best guess at what you need to feel in order to protect your body. You have nerves in your body designed to identify if there is something wrong and these nerves will send a small electrical signal to your brain. Your brain analyses this signal and all sorts of information such as memories, beliefs, emotions, your current level of danger and what you see hear and smell in your environment. Your brain will then decide whether there is actual or the potential for tissue damage. Having pain for a few weeks after an injury is normal, it's the way your body protects itself from further injury.
If you are still experiencing significant pain once your injury has healed, we say this is persistent pain. Usually we would expect things to heal between a couple of weeks and a couple of months, so anything beyond that we would say it is persisting.
What makes pain persist?
Your body and brain have evolved to protect itself at all costs. We know that after a few months of pain persisting, your body will become more efficient at producing pain, which in other words is your body becoming more sensitive to pain! Cells in your spinal cord and brain change to become more responsive, this gives you an increased 'buffer' between when you feel pain and when tissue damage will occur.
Not everything you perceive is real and exactly what you think it is. Think of visual illusions, even though you know they are an illusion, your brain will show you what it thinks is most beneficial. The same thing can happen with pain; regardless of what your body is sensing, your mind can change that if it thinks it will be beneficial. If you are fearful or worried about using a body part after an injury, that can make the pain worse because your brain will take these emotions into account when deciding if it is in danger.
What should I do if I have persistent pain?
There are many ways to treat persistent pain and it's all to do with re-training your pain system. The more you understand about how pain works, the more you will understand that pain and injury are often quite different things.
The good news is, you've already made a start at learning how pain works and what to do about it. Once you understand how pain works, you can start to do a little more than you normally do and gradually build up. Movement and activity is a great way to gradually re-train your pain system and modify how your brain responds to what you do. There are different ways to build up and our Physiotherapists can help you do that. Initially it's a good idea to focus more on the things you can do and try not to focus too much attention to your pain. Trusting that your body can adapt and get used to activities if you give it time is a great mindset to have. Through your journey with persistent pain there will almost certainly be ups and downs and it's important to remember that the pain is protecting you, not telling you that you have damaged yourself.
Sometimes it's useful to discuss things that have affected you in the past because memories and emotions can sometimes be enough to trigger your pain system. It's important to be aware of this so that you know that when your pain flares up, it isn't necessarily because of damage to the system. Having pain like this is quite common and doesn't make it any less real, it still just means that you need to re-train your pain system to be less reactive.