- Kiley Holmes, PT
Glut Med Tendonitis: More Common Than You’d Think
Everyone always talks about hip bursitis like it's a common issue, but more often than not it's your gluts. Sometimes we forget how much like the shoulder the hip really is. It's the same type of joint, and the gluts with the little muscles under it act as a sort of rotator cuff, it only makes sense that they would have the same issues that the rotator cuff does.
If it's clearly just a simple bursitis issue and you're treated for bursitis it should go away pretty quickly. However, if it doesn’t go away quickly you should start looking at the gluts.
If you put your hand directly over the boniest spot on the side of your hip and you push on it and it's painful, and that's your pain, congratulations, it looks like you may actually have hip bursitis. However, if you go just back from there and then press and that's your pain, you have something going on with your gluteal tendons. Unfortunately, you don't know if you really do have glut med tendonitis, or if you have a glut med tear. The good news is that very rarely does a glut med tear need to be operated on (in fact, it's hard to even find a surgeon to do the repair), and it's definitely rehabable (honestly, a tear is just a bad case of tendonitis, but that's the subject of whole other post).
You are first going to need better blood flow to promote healing - massage to the affected muscle and tendon will help tremendously, being careful to avoid massaging directly over the bony prominence, otherwise you will experience trochanteric bursitis. Starting isometrics is incredibly important to promote healing as well.
For massaging your glute go ahead and lay on your side with the affected side up, take a tennis ball or a lacrosse ball, and gently rub the ball over the painful spots of your glute.
For a clam hold go ahead and lay on your side with a band over your knees. When you are ready go ahead and pull your knees apart while keeping your back and hips straight toes apart and heels together. Start with 5 to 10 second holds building up to one minute holds.
Stretching, and I really do hate that word, more of a controlled stretch to the anterior musculature of your hip would be quite beneficial. Yes, you can lay on your back drop that hip right off the side of the table and stretch it out, and sometimes I do that. But, you may be better off just doing some gentle massage to the front of your hip. If you can tolerate it I really recommend doing the hero instead of stretching the hip while laying down. You can easily hurt yourself by overstretching if you're not controlling the stretch yourself.
An important note, none of these things should increase your pain. While you're in this phase of healing, it is essential to limit the amount of pain you are in. As your constant pain becomes intermittent and less intense this changes. If these exercises increase your pain, tape it, and try again in a couple of days.
Once you're not having as much pain or intensity, it's time to change up your treatment - still continue to do some massage over the area, unless you don't feel like you need it anymore, which is very possible.
When it comes to stretching, I would continue to do some controlled stretches. I am sure that you're hero is starting to look more beautiful.
Now, to exercise your gluts, what we need you to do is start with that big terrible word - eccentrics! Now it's time to learn how to control your movement.
I like to start with single-leg deadlifts focusing on controlling the movement down, as well as continuing gluts isometrics, because most of the time your glutes work isometrically. Monster walks, squats, lunges, slider lunges - take your pick - any exercise that you do after getting your glutes going will increase your glute strength. Try it and let me know how it goes!
To do a single leg deadlift, bend forward using only your hip joint while standing on one leg. Easier said than done - you need to make sure that your back stays completely straight as you bend forward, it will be incredibly limited in the beginning but will slowly get better.
After the clam holds get easier, move to a straight leg hold with a goal of one minute holds.
Monster walks are wonderful. They work best when you maintain an athletic stance throughout the walk. With a band around your knees or ankles keep an athletic stance while stepping to the side.
Wishing you a quick recovery!