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The Injurance Blog Pt 6 - A Pain In The Arse Part 2

In addition to our regular Endurance Blog, which covers topics related to endurance coaching and nutrition, we will also be publishing Injurance Blog, which cover common injury topics for endurance athletes.

We work in conjunction with A6 Physiotherapy and Axis Podiatry who contribute their expert advice for each blog post. If you have any questions, post them on THE ENDURANCE STORE Facebook Page, where this blog in posted.

What does the physio say?

In the last blog we talked about buttock pain in the forms of piriformis syndrome and disc prolapse. This week we are exploring another cause of pain to the buttock muscles but instead of experiencing buttock pain this problem presents itself as lateral hip pain, known as gluteal tendinopathy.

From the illustration the gluteal tendons are the tough fibres that connect your gluteal muscle to your hip bone. There is a bump at the top of your thigh bone called the 'Greater Trochanter' it's easy to feel with your fingers. Gluteal tendinopathy is pain around or on the outside of the bump (greater trochanter). You can see from the diagram where the glutes and piriformis muscles attach to the greater trochanter.

Common symptoms of gluteal tendinopathy are:

Pain localised to outside of hip.
Feelings of tightness across outer hip.
Pain walking up and down stairs.
Pain sitting cross legged for long periods of time.
Difficulties increasing mileage when running.

Whilst gluteal tendinopathy is assciated with distance running, it's also common in cycling, especially the 'aero position'. Being in a low profile position can increase stress on the back, glutes and hamstrings and outer hip pan is a common symptom.

Pain can occur during or after training. The most common cause of gluteal tendinopathy is due to poor hip and gluteal control causing overstress to the gluteal tendons. Tendons are designed to withstand high repetitive loading but in cases where too much loading occurs the tendon begins to become over stressed. When tendons are stressed they can sustain small micro-tears which, if not addressed, can result in pain and dysfunction, known as tendinopathy or tendinosis.

Unfortunately many gluteal tendinopathies go undiagnosed and are incorrectly labelled as bursitis. In these cases treatment is usually via a cortisone / steroid injection which may not solve the underlying tendinopathy. It is therefore important to be properly assessed by a physiotherapist in order to gain the correct diagnosis and management. Correct treatment for gluteal tendinopathy involves hands on soft tissue release with advice and education on self managing symptoms correctly.

It also includes rest, ice, mobilising exercises to a gradual loading program aimed at strengthening the gluteal muscles and improving the biomechanics for return to optimal performance.

What does the podiatrist say?

If a physiotherapist diagnoses you with gluteal tendinopathy then it would be advisable to seek a biomechanical assessment and shift the focus to your foot biomechanics. It’s a possibility that your gluteal muscles have become overloaded due to the work they are doing controlling the pelvis and also lower limb internal rotation.

In simple terms, your glutes control the inwards rolling of your lower limb. If your foot, shin bone, knee etc are rolling inwards excessively, your glutes are over-working, trying to slow and reduce this movement. This over-working leads to the tendinopathy desribed above.

This internal rotation could be controlled better with either footwear and / or an orthoses prescription. Thus taking some of the load away from the glutes and therefore helping to settle your hip pain.

A good way of assessing if this might be the case is to test your balance or proprioception. Stand on one leg for a few seconds and then make it more difficult by closing your eyes. If you find this very difficult or can feel a tendency for your foot to roll in or pronate and you’ve been getting lateral hip pain then the two could be linked. Alternatively, have your gait checked in your current shoes.

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