Some people will choose to manage their hip pain with pain relief, whilst some may choose to avoid medication. Applying something cold to your hip may also be useful in helping with some of the pain (do remember to wrap your frozen peas in a towel before applying them to your skin to avoid cold burns).
Gluteal Tendinopathy
This page has been designed to provide you with the right information about gluteal tendinopathy (pain on the outside of the hip) and the rehabilitation that may help you in your recovery.
What is gluteal tendinopathy?
Firstly, gluteal tendinopathy is not a dangerous issue. It relates to pain around the outside of the hip.
Pain around the outside of the hip can be caused by a number of things, but recent changes in the understanding of hip issues means that gluteal tendinopathy is thought to be one of the most common causes.
Gluteal tendinopathy itself appears to be relatively common, with 1 in 4 women over the age of 50 affected (Mellor et al, 2018).
You haven’t explained what it is yet!
You’re right, we haven’t!
Gluteal tendinopathy refers to an irritation of the tendons (which attach muscle to bone) from your gluteal muscles (bottom muscles) to the top of your femur (thigh bone).
It is thought that the two tendons that are often irritated in gluteal tendinopathy are gluteus minimus and gluteus medius.
What is a tendon and why are mine irritated?
A tendon is a normal part of your anatomy. Their main job is to connect muscle to bone so that when your muscle contracts (works) it passes the force (or energy) to the tendon and then to the bone which creates movement.
Tendons are incredibly strong and robust things. This means they are designed to work hard and they normally do this without any issues. Just like any other body part, they can be trained to work harder if you need them to (i.e. by lifting weights or doing your job) but equally, they can become less efficient at doing their job if you don’t use them.
Tendon irritation can be caused by many things, but in a lot of cases it is normally caused by one of the following things:
OK, so what happens to the tendon?
If you think of your tendons as being really good at doing their job (passing the energy from the muscle to bone to create movement), it means they can put up with a lot of work when they need to. If you find yourself doing more than you are used to, doing something you are not used to doing or more importantly, having a period of doing less activity before, then you can push your tendon’s ability to cope. Most of the time you notice very little, maybe a bit of an ache here and there, but sometimes your tendons can react and say, “I’m struggling”.
If this happens, you will normally notice some discomfort and may find that moving can be uncomfortable. Think of this as your tendon being an ‘unhappy worker’, now struggling to do its normal day job and complaining about the work it has to do. Most of the time the soreness will settle with time, but sometimes it can last a bit longer, maybe into weeks or months.
So, what are the common symptoms in gluteal tendinopathy?
In most cases, gluteal tendinopathy results in discomfort on the outside of your hip. This discomfort can sometimes spread up or down your leg, occasionally to the knee or to the buttock.
People with gluteal tendinopathy often find that crossing their legs, walking, lying on the affected side or putting pressure on the outside of their hip (poking it!) makes their discomfort worse.
Ok, I think I might have gluteal tendinopathy, but what can I do about it?
Firstly, you can feel better. Sometimes, these issues can be really quite sore and can get in the way of things that you would normally take for granted, making you feel that you’ll never get better. However, if it hasn’t settled by itself, then physiotherapy can help.
Understanding the issue is often the best place to start. Reading the information above can help you better understand that gluteal tendinopathy is not a damaging or dangerous problem and that it can get better.
Secondly, there are two important things that can help you on your recovery:
What does ‘calm the problem down’ mean?
If you think back to the idea that your irritated tendon is an unhappy worker, then if you keep asking your tendon to do the same job, in the same way that it always has, the tendon will keep being sore. In other words, when something is sore, think of it like your tendons saying, “I can’t do that as easily as I used to at the moment”. Making some changes to the things that are sore may help calm the issue down to then allow you to move on with your recovery. Think of it as putting the tendon on lighter or amended duties whilst it’s sore.
We have written a whole page on ‘calming things down’, called ‘Load Management'. You can find it here along with some homework to try to help your hip’s recovery.
Can you give some examples of what you mean?
Sure, but remember everyone is different and you will have to do some thinking yourself around how your hip is affecting you and some of the changes you might need to make.
|
Things that are sore |
Why is it sore? |
Possible solution |
|
Lying on the painful side |
Sore tendons often don’t like pressure |
Lie on opposite side (with or without cushion between knees) |
|
Walking |
Sore tendons will tire more quickly |
Reduce how far you walk or take more breaks or shorter strides |
|
Crossing legs |
Sore tendons often don’t like too much stretch
|
Try not to cross your legs |
|
Climbing stairs |
Sore tendons will tire quickly/knee may move inwards and increase stretch on tendons |
Climb one step at a time or use the hand rail to help pull yourself up |
How long should I work on ‘calming things down’?
This is a little tricky to be specific about and it is probably best to think about what your hip is saying. If you have been really good at adjusting, modifying and looking at the things that make your hip sore, then you should notice some changes within a few short weeks.
Ok, what do I do once it feels calmer?
Firstly, well done! Often ‘calming it down’ is the hardest part of your recovery.
Now that your hip feels somewhat calmer, the temptation might be to start going back to your normal activities in the same way you did before your hip issue. Sometimes this can be ok but equally, sometimes you might find that your hip is not quite ready to return to normal just yet and may get irritated again. It might be best to think that your hip needs to get fit and strong again in order to get back to doing normal things in normal ways.
As we’ve said before, if you consider your sore hip as an unhappy worker then you’ve adjusted and modified things (putting it on ‘lighter duties’) to help calm it down. Now you’ve got to start a gradual or phased return to work (or normal). Jumping in at the deep end and going back to normal might result in your hip becoming grumpy and sore again.
OK, I know I’ve got to build it up and understand it’s got to be done in the right way, but how?
Understanding that it might take some time and that your hip will be more likely to cope better if you do things in a gradual way, is very important as the temptation will be to rush in, especially if it’s less sore than before.
No one is the same, just like no hip problem is the same as the next, therefore there are no ‘formulas' that will be right for everyone. However, we have provided (below) an exercise programme that, if followed, can be effective to helping you move forwards with your ankle complaint.
Before I start, I’d like to know what the exercises are trying to do.
Excellent point, as it’s often useful to know what you’re aiming to do before you start.
Firstly, the exercises are aiming to introduce a little bit of work into the tendon by asking the muscles to do some work. The aim is to start with only a little bit of work (within what is comfortable) and not much movement.
As you move through the exercises (as your hip allows), you will notice that the amount of work/effort and the amount of movement increases.
Lastly, one of the most important things about all of these exercises, is they are trying to help you regain some trust in your hip. If your hip has been sore for some time, it is only normal to be a little cautious when you start to move back into doing things that caused you pain before. This is why the exercises are done gradually and shouldn’t be rushed too much.
What should I expect with these exercises? Will they be painful?
This is a very important question.
If your hip has been sore for some time, it would be a bit unrealistic to expect that it will be pain-free when doing these exercises. However, it is important that you don’t do too much to then upset the problem all over again.
A good marker for how hard to work is that you should feel some discomfort (not too much though), but it should settle within 24 hours. If you are still obviously sore the following day, you may have done too much/pushed too hard, therefore next time you do the exercises, reduce the effort a bit.
Will this get better with just adjusting the things that are sore and exercises?
Although it is impossible to predict how each and every person will respond to rehabilitation, a study by Mellor et al. (2018) looked at gluteal tendinopathy and the effects of exercise and education versus a steroid injection and simply ‘wait and see’ (not doing anything in particular to treat the issue). A total of 204 people took part in the study and the group that had exercise and education (similar to that laid out for you on this page) had a significantly better outcome in both pain and function (being able to do stuff) than either the steroid injection or the ‘wait and see’ groups.
Apart from these exercises, is there anything else I can be doing to help myself?
Yes there is - here are just a couple of the most important things.
Frequently asked questions
Q: Someone told me I’ve got bursitis of the hip. Is that the same thing?
A: In short, no. It wasn’t that long ago that healthcare practitioners used the word bursitis to describe all painful issues around the outside of the hip. Now we know more about the hip, we know that bursitis is a different thing to gluteal tendinopathy and less common.
A: Scans (MRIs or ultrasound scans) are very useful in a lot of cases, however, they are not normally needed for the assessment or management of gluteal tendinopathy. If your GP or physio decides they would like to arrange a scan for you, it is likely they are checking for something in particular, but the treatment (outlined above) remains the same and the most effective way of managing gluteal tendinopathy.
Q: Would an injection in my hip help?
A: A steroid injection for gluteal tendinopathy is an option. However, like most drugs, steroids come with side effects and some of these can cause problems in the future for your hip (particularly the tendons). Often, injections only help in the short-term and exercise and advice remains the most effective option for most people.
Q: I’ve tried the exercises and nothing works, why?
A: Firstly, ask yourself if you tried the ‘calm it down’ approach first. If you didn’t, then that might be the reason why you haven’t moved forwards. If you have, ask yourself if you did everything you could do and really commit yourself to adjusting/modifying all the things your hip was telling you it was struggling with.
Q: What if I’ve done everything that I should do, but I’m still no better?
A: Often, these types of problems take a long time (weeks into months) to settle, so be patient with yourself. If you have been dedicated to the ‘calm it down’ work and the exercises, as well as being patient and giving it time and still you feel no better, do discuss this with your physio as they may be able to discuss other options with you.
Exercises
Phase one:
Exercise tip: Use a rolled-up towel or something soft but firm under your toes. Raise up slowly (3 seconds), hold at the top of the movement (2 seconds) and slowly lower down again (3 seconds). Repeat 12 times for 3 sets (rest for 1 minute between sets). Aim to complete the exercise every other day.
Move onto the next phase when these exercises start becoming too easy.
Phase two:
Exercise tip: With a heavy backpack (loaded with books/bottle or bricks) on your back, use a rolled-up towel or something soft but firm under your toes. Raise up slowly (3 seconds), hold at the top of the movement (2 seconds) and slowly lower down again (3 seconds).
Repeat 10 times for 4 sets (rest for 1 minute between sets). Aim to complete the exercise every other day.
Move onto the next phase when these exercises start becoming too easy.
Phase three:
Exercise tip: With a heavier backpack on your back, use a rolled-up towel or something soft but firm under your toes. Raise up slowly (3 seconds), hold at the top of the movement (2 seconds) and slowly lower down again (3 seconds).
Repeat 8 times for 5 sets (rest for 1 minute between sets). Aim to complete the exercise every other day.
Move onto the next phase when these exercises start becoming too easy.
Phase four:
Exercise tip: With this phase, you can start to play around with speed. Try adding some speed to the second as shown in the video. This section is important to help your hip regain its ability to tolerate high level fast movements.
Phase five:
Exercise tip: With this phase, you can start to play around with speed. Try adding some speed to the second as shown in the video. This section is important to help your hip regain its ability to tolerate high level fast movements.
Phase six:
Exercise tip: With this phase, you can start to play around with speed. Try adding some speed to the second as shown in the video. This section is important to help your hip regain its ability to tolerate high level fast movements.
