This is the condition pain occurs at the lateral side of the hip. This usually occurs at gluteal medius which supports to balance the body and control the hip and gluteal minimus.
This is still determined as trochanteric bursitis or greater trochanteric pain syndrome since they are quite similar conditions. However, gluteal medias or minimus tendinopathy is now more prevalent than trochanteric bursitis.
Aetiology *1
- Overload and excessive stress on the tendon
- Sudden trauma
- Mid-life athletes
- Muscle weakness of gluteal medius and minimus (no exercise regularly)
- Happens to women more than men
- Prolonged sitting and get up instantly
Tensile load
This is caused by ITB (TFL, gluteus maximus and vastus lateralis tightness). This ensile load can apply tension on the tendon.
Compression load
When the hip adducts, gluteus medius and minimus tendon gets compressed between ITB and greater trochanter.
Sign and symptoms *2
- Pain at the lateral side of the hip
- Pain with weight bearing exercises such as walking, running, standing, walking up and down stairs, even sitting.
- Tenderness, swollen and warm if it is inflamed
- May find cracking and crunchy sound when you use tendon
- Nocturnal pain (pain when side-lying)
Differential diagnosis
- OA (osteoarthritis)
- Femoral acetabular impingement (FAI)
- Referral pain from lumbar
- RA (rheumatoid arthritis)
Treatment
- Reducing compression posture (hip adduction) on gluts tendon (stand on one leg, cross legs, sitting with knees inwards and side lying)
- Strengthening training, exercise and stretching when the condition stars to heal
Isometric (avoids compression exercise on gluts tendon which is adduction exercise)
Assessment to find out if it is positive or not
- Ober’s test (sensitivity 41 and specificity 95) https://www.youtube.com/watch?v=Amjv6FzDeLE
- Fader test (sensitivity 82.9 and specificity 90)
- Faber test test (sensitivity 82.9 and specificity 90) https://www.youtube.com/watch?v=89Qiht82zmg
- Resisted medial rotation (sensitivity 55-61 and specificity 69-90 and lateral rotation (sensitivity 88 and specificity 97,3)
*A study shows that hip abductor strength does not improve pain and knee valgus during single leg squat and running with PFPS. Therefore, when the pain is settled, functional movement needs to be assessed and modified to minimise hip adduction during functional movement (3,4)
Reference
- 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(8), 1107–1119. https://pubmed.ncbi.nlm.nih.gov/25969366/
- 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. https://www.jospt.org/doi/full/10.2519/jospt.2015.5829
- DiMattia, M. A., Livengood, A. L., Uhl, T. L., Mattacola, C. G., & Malone, T. R. (2005). What Are the Validity of the Single-Leg-Squat Test and Its Relationship to Hip-Abduction Strength? Journal of Sport Rehabilitation, 14(2), 108–123. https://doi.org/10.1123/jsr.14.2.108
- Ferber, R., Kendall, K. D., & Farr, L. (2011). Changes in Knee Biomechanics After a Hip-Abductor Strengthening Protocol for Runners With Patellofemoral Pain Syndrome. Journal of Athletic Training, 46(2), 142–149. https://doi.org/10.4085/1062-6050-46.2.142
