Gluteal tendinopathy is a fairly prevalent condition we see in runners. This condition, characterised by pain and tenderness in the gluteal region, can significantly hinder a runner's performance and overall well-being.
Gluteal tendinopathy involves the tendons in the gluteal muscles, particularly the gluteus medius and minimus, which are crucial for stabilising the pelvis during running. When these tendons become irritated, it can lead to persistent discomfort and even impact one's daily activities.
Understanding the causes, symptoms, and treatment options for gluteal tendinopathy is essential for runners looking to maintain their stride and prevent long-term injury.
What causes Gluteal Tendinopathy?
Gluteal tendinopathy, also known as trochanteric bursitis or greater trochanteric pain syndrome (GTPS), occurs due to an overload of the tendons that attach the gluteal muscles to the outside of your upper leg. If you have this condition, you’ll likely feel tenderness over your outer hip bone (greater trochanter) with pain sometimes referring down your outer thigh and occasionally the outer calf muscle.
1. Training Errors:
Spiking running load, particularly long distances or at high intensities, places significant stress on the gluteal tendon. Overuse without adequate rest can lead to micro-tears and inflammation, eventually resulting in tendinopathy.
2. Biomechanical Factors:
Hip Drop: Weakness in the gluteus medius muscle and poor pelvic control during running can lead to a hip drop of the opposite limb during the single leg stance phase of the running gait cycle. This can cause the gluteal tendon to take on excessive compression and strain everytime you make contact with the ground.
Cross-Over Gait: A zigzag running style where the foot crosses the midline forces the muscle and tendon to work in lengthening and difficult positions to absorb force at the time of contact. The overload increases tendon stress and strain.
Overstriding: Over-striding, where the foot lands too far in front of the body's centre of mass, increases the braking forces and places additional stress on the gluteal tendon.
3. Anatomical Factors:
Anatomical features may predispose someone to gluteal tendinopathy.The most common reasons can be due to congenital (at birth and infancy). Children born with developmental dysplasia of the hip (DDH) present with great mobility and consequently increased hip instability. This abnormal positioning can place increased stress on the gluteal tendons, making them more susceptible to irritation, and tendinopathy over time. There can be other developmental factors in adolescence such as exposure to kicking sports (e.g. football) and to dance (especially ballet and classical) that will impact the mobility, strength and stability in the hip.
4. Environmental Factors:
Changes in terrain such transitioning to trails, adding in hill repeats and shifting to cambered/uneven ground can impact how much your hip will need to stabilise to match the demands. When these types of loads are brought in too fast or in large volumes and intensities, it can result in overloading the gluteal tendon.
Signs and Symptoms
Understanding tendinopathies is as much about understanding a runners training history as it is performing diagnostic tests. You should always seek the help of a health professional to confirm your injury and get a suitable management plan. Here are some common signs and symptoms we see with gluteal tendinopathy.
Tenderness over the outer hip bone.
Pain radiating down the outer thigh and occasionally the outer calf.
Pain and tenderness at night especially if lying on the irritable hip.
Morning pain and stiffness that settles after a few minutes of movement.
Pain is typically worse after running.
Pain is typically worse after long runs and/or fast runs such as hill intervals or tempo sessions.
Self-Management Strategies
Rest: Rest is by far the most talked about and misunderstood topic when managing tendinopathies. As a general rule, rest (no running or loading) is typically not a solution for tendinopathies. Rest needs to be relative to the level of loading your tendon can manage. This could mean the runner may require rest from running but still be able to load with exercise. Or the runner may load concurrently with a reduction in running load. This balance of rest and rehab needs to be carefully tuned to the individual.
Training Load: Addressing training load is critical in allowing the tendon adequate rest to repair. In the early stages, pausing fast runs like interval and tempo runs and avoiding back-to-back run days are great ways to reduce load while still keeping some load that the tendon can handle. As tendons continue to be irritated, runners may need to progressively reduce run days, leading to rest from running and potentially a reduced daily step count. As the gluteal tendon builds strength with rehab (exercises), runners can progressively start to add more time or days, followed by adding pace back into runs. Monitoring symptoms during and after runs, coupled with slow increments in training load, is crucial to ensuring the gluteal tendon adapts positively to rehab.
Exercise Rehabilitation: Research has shown that tendons respond best to heavy stimulus. The aim of a good rehabilitation programme should be to progressively increase the amount of weight you add to loading the tendon during exercise and reduce the volume of repetitions to maximise adaptation and minimise overload. Exercises designed to build strength in the gluteus medius muscle such as side lying hip raises, lateral toe taps and step up/down are great movements that should be progressively increased in intensity as tolerated. You should also look to incorporate compound movements such as squats and deadlifts as they produce a large amount of force around the hip joint. Once your symptoms begin to settle following the commencement of your rehab, plyometrics are an essential to build tendon stiffness and power. Finally look to build in accessory movements around foot and core stability to address global factors that may contribute to the development of gluteal tendinopathy. As you phase in running, look to reduce but not remove your exercise programme. For those running 4-5 times a week, 2 exercise sessions per week is an ideal recommendation.
Achieving optimal rehabilitation requires careful implementation of all the factors mentioned above, all working in harmony with each other.Remember, Gluteal tendinopathies don’t always play by the rules. Listen to your body, always seek professional guidance, and prioritise your rehabilitation.
For expert help and management please feel free to contact my team at The Running Room (www.therunningroom.net)