Pain particularly around the side of your hip could be caused by a wide variety of different reasons, however a common finding is tendinopathy of the muscles surrounding the hip and bottom – your gluteal muscles. If you get pain when you sit cross-legged; walk/run/go up and down stairs; notice tenderness when you press into the side of your hip; or have trouble sleeping on your side because of hip pain, you could very well be a candidate for gluteal tendinopathy.
So, what actually happens during gluteal tendinopathy? As is typical with most tendinopathies, gluteal tendinopathy often begins as a result of a sudden increase in physical activity frequency/intensity, which places increased stress on the tendon. Our tendons are actually quite well-designed to adapt to stress and loading, however if the forces going through the tendon exceed the rate of adaptation, this is when we start to see a breakdown of the tendon – resulting in an increased risk of tendon injury and ensuing tendinopathy.
Do I need a scan?
Imaging (typically an ultrasound or MRI) can be done to confirm the findings of a tendinopathy, however the results do not always correlate with what you are feeling. It is common for there to be evidence of tendinopathy without actual symptoms, and getting a scan done is usually reserved for cases that have been taking longer than expected to improve or when there is suspicion that other structures may be involved that may be causing or contributing to symptoms.
In most cases, a thorough physical examination is sufficient in identifying structures that are responsible for your symptoms.
What can be done about it?
There are several effective ways to address gluteal tendinopathy:
1) Understanding triggers: Being aware of the factors that might be aggravating your pain will allow you to implement appropriate strategies to reduce the frequency of flareups.
2) Rest: Your body will require a period of time to rest and recover from the additional forces that initially led to the onset of pain. It is important to note that rest in this sense does not mean a total cessation of movement – rather, it is more about avoiding painful positions and movements while continuing to move in a way that is tolerable.
3) Flexibility: Tightness often occurs as a result of overuse or sustained (and suboptimal) positioning of your muscles and joints.
4) Strength: As soon as able, progressively loading the tendon appropriately will be key in continuing the healing process. A graded exposure to load stimulates positive adaptations within the tendon and encourages re-orientation of cells in a way that promotes its overall structural integrity.
5) Steroid injection: In the case where things simply aren’t improving and your hip is preventing you from doing daily activities, an ultrasound guided corticosteroid injection can be administered which may bring some relief. It is important to note that the benefits from this is often short-term and will primarily serve to facilitate a good exercise program.
It can be tricky to identify your own signs and symptoms – and even then, being able to identify signs and symptoms does not necessarily mean you properly understand the processes leading to your symptoms and how to best manage it. It is always advised to see a health professional if you are experiencing symptoms that you are uncertain or concerned about.
Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy, 45(11), 910-922.
Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine, 45, 1107-1119.
Ladurner, A., Fitzpatrick, J., & O’Donnell, J. M. (2021). Treatment of gluteal tendinopathy: a systematic review and stage-adjusted treatment recommendation. Orthopaedic Journal of Sports Medicine, 9(7), 23259671211016850.
