Hip pain is a persistent complaint that can be caused by a broad variety of problems but once the precise position of the hip pain is known it can give valuable clues about the underlying problem. Intricacies within the hip joint itself tend to end in pain towards the inside of hip or genital region whereas when the pain originates outside of the hip & upper thigh then it is induced by problems with muscles, ligaments, tendons and other soft tissues that envelope the hip joint.
Pain discovered on the outside of the hip might also flow down the outside of the leg and is a fairly general condition that communicates peoples floundering to the physiotherapist’s department for treatment.
Female over 40 are at a slightly much higher risk. The history reveals that the pain, and tenderness over the side hip were frequently diagnosed as bursitis or more particularly trochanteric bursitis. After so much of studies and research work we now know that there is occasionally swelling already in this bursa or have Greater Trochanteric Pain Syndrome (GTPS).
Understanding the Hip Gluteal Muscles & Their Role
The muscles that generate the shape of the buttocks are described as the gluteal muscles. There are 3 main muscles the outermost muscle is gluteus maximus, the next one is Gluteus Medius, and gluteus minimus is the deepest gluteal muscle. These tissues have very distinctive roles i.e. to move the hip joint in certain directions and they also work to support the pelvis throughout the activity. Gluteus Minimus and medius are connected to the greater trochanter by the gluteal tendons.
The tendons play a key role in attaching muscles to bones and if a gluteal tendon is injured or unhealthy it can result in lateral hip pain and the diagnosis of GTPS. Once this tendon is damaged it is termed gluteal tendinopathy and is the most common cause of GTPS.
What Causes Gluteal Tendinopathy?
Usually, within a healthy tendon, there is a stable cycle of tissue breakdown and repair. Obstacles occur still when there is an increased breakdown of cells in the muscle tissue than restoration and this inequality commences to damage inside the tendon denominated as tendinopathy.
This process of aggravated break down in the gluteal tendon might be triggered by an extension in operating distance or hill walking or hiking with a lot of inclinations. The magnitude and the incidence of these types of movements result in longitudinal loading into the hip joint and if there is unfinished recovery or adjustment time factored into exercise or recreational programs the gluteal tendon is stressed toward injury. The other major supporting factor to the progress of gluteal tendinopathy is vertical loading within the hip joint which is cited to as compression.
Therefore when this combination of compression (perpendicular load) and high tensile loads (longitudinal load) arrives, it is the most damaging fact for the gluteal tendon. These loads, in sequence with increased activity, can sometimes be too much for the tendon and lateral hip pain results.
Symptoms of Gluteal Tendinopathy
If you have Gluteal Tendinopathy, the most common symptom is the pain on the outside of your hip. The pain can grow quite acute and even can transfer down to the outside of the leg or seldom below the knee. The pain of gluteal tendinopathy can become worse when lying on the affected side, sitting with crossed legs, standing on one leg going up or down the stairs etc.
Managing Gluteal tendonitis
Tendon reloading policies are suggested in managing tendinopathies. When we say managing of Tendonitis it mainly includes load management and exercises. Learning and training on delivering optimal biomechanical positions and avoidance of stimulating positions such as prolonged seating, sitting on a low seat, crossed knee sitting, hanging on hip and sustained hip adduction places.
Extending should be withdrawn as it combines strong passive tensile loads. Therefore, Subjects with GT should avoid hip adduction stretches both from flexed or extended hip. Massage and dry needling could succeed in stretching for pain management, however, strong Iliotibial Band (ITB) release could be pain intriguing.
Nighttime pain is a vital issue in GT patients. Educating patients to use alternative positions such as supine or using a pillow under the joints to unload the anterolateral hip or using an eggshell bedding with pillows between knees and shin reduces the compression on the lateral hip.
Nighttime pain is a vital issue in GT patients. Educating patients to use alternative positions such as supine or using a pillow under the joints to unload the anterolateral hip or using an eggshell bedding with pillows between knees and shin reduces the compression on the lateral hip.
Reference
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