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Yikes! I have gluteal tendonopathy. Anyone experienced this? I need advice on treatment and recovery. With race season right around the corner I want to get back on the road! PLEASE help!
2007 AUG 14 -- "Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females," scientists writing in the journal European Radiology
While that statement is based on scientific analysis, the simple question is to ask why you may have this problem in the first place. Do you just run, or do you bike as well? Do you spend a lot of your day seated? Can you stand comfortably on one leg? If your answers are Bike, Yes, and No, you have a lot of work to do before hitting the road. We'll take it from there. (pic from washington.edu)...
Thank you so much for your response! I can use all of the advice I can get. Hmmmm, well since posting I went to a pt who says that my pain stems from my lower back. I do know that I have degenerative disc disease so this could indeed be the problem. I've tried to pay close attention to the pain and here is what I come up with. My back does not hurt. I have sharp pain down the back of one leg while running and when sleeping on my left side I am awakened with intense ache in my right hip.( this is relieved a great deal by sleeping on my back, pillow under knees). In fact, my right hip and glute are "achy" all the time. Sitting brings alot of discomfort in both hip and back of leg if I sit long enough. Stretching by bending forward from the waste with straight legs brings sharp pain down right leg. As for treatment, the pt said I can run to my hearts content, so I have. When I get warmed up the hip ache subsides. At about 2.5 miles the sharp back of the leg pain begins. I've only pushed through about to about 4 miles so far. I am taking Aleve (doesn't seem to help) and icing my back at least twice a day. Lots of hip stretching and using the foam roller on the hip. Had two deep tissue massages that focused mainly on the hip. So far I am not seeing any sign of things getting better. (that is a picture of me being very sad)
PS Yikes! I think I am a late middle-aged woman! (48)
One thing to bear in mind is that problems with your spine do not always result in back pain. After reviewing hundreds of scan results versus pain symptoms, I can tell you that there is no direct correlation. Many people with junk in the back have no back pain, and many people with clean scans have plenty of back pain. Where spinal problems usually matter is when there is direct pressure on the nerve roots exiting the spine, due to bulging or herniated disks. Disk degeneration and dehydration are normal as we age.
But how do we tie this in with the Glutes? Look again at the picture above, and imagine... What happens if the pelvis, in the horizontal center of the picture, were to rotate, so the Lumbar spine shown at the top would shift to the rear of the longitudinal axis of the Femur and Hip socket, which would be thrust forward? Your spine, in order to keep your back erect, would flatten the normally inward Lumbar curve, and the disks (one shown above the pelvis in the pic) would be compressed as a result. Any bulge here would worsen, possibly putting pressure (depending on where the bulge occurs) on the nerve root as it exits the neural foramen (small hole near bottom center of vertebra as pictured).
If you also had tight hip flexors which attach to the lumbar spine), there would be additional pressure on these disks, whether standing or not. Putting your knees up while lying down relieves this pressure.
One tie-in with the glutes is the likelihood that the pelvis is not neutral and your disks are compromised. Symptoms of Sciatica, or pain running down the legs, can result from this scenario if the sciatic nerve roots are impinged in any way. Another connection is that portions of these nerves pass between the minor glutes, where swelling or chronic contraction can pressure them as well. In this case, It is more likely to be pain down the legs without tingling and numbness, which is normally associated with the spinal version of sciatica.
In other words, your symptoms can result from gluteal pressure alone, though it appears there may be a connection to a degenerated spine. The important thing to check for is the rotation of the pelvis, which is a sign of glutes in spasm. Other signs of gluteal problems are the pain you feel when the affected hip is on top when you are lying down, which causes the femur to drop and stretch the tight gluteal muscle, resulting in a burning pain that wakes you up. If this were from your back, you could expect it to intensify when the ful weight of your body is compressing it while standing, which also brings tight hip flexors into play.
While pain from a forward bend could be from either cause, it is a helpful clue when considered in conjunction with the above signs. The way to tell would be to flex the spine forward without stretching the glutes. To do this you would have to immobilize the pelvis with respect to the hips, bending forward only at the spine to check for symptoms, glutes mostly out of the picture. Outside of clamping yourself into a vise this is hard to do, but you may find a way.
Thank you again for your insightful reply. Am I correct in that what you are saying is I will have to go see the doctor and or pt to get this taken care of or are there exercises I can do at home that would help? Also, can I continue running or am I worsening the condition?
Normally, exercise is far better for the gluteals than sitting, but you have certainly been getting some exercise. Each time you take a step, these muscles keep your hips level. They have to carry about twice your weight to do this, because the muscle pulls on the short end of the hip to balance the other (longer) end. When you run, the pressure increases by a factor of how many Gs of impact your running produces. In most people this is about triple the normal force of just standing on one leg, so you can see how the added impact of running can irritate these muscles when they are already in spasm. In fact, almost any exercise can potentially make them worse. They may even be reacting to over-exercise at this time.
The irony is that an over-exercised muscle can become stiffer or less active, depending on the muscle and its location. This might be restated, as too much or too little tone. Tone is controlled by your brain in response to the perceived health of the muscle. In your case, I would guess stiff (too much) and resistant to movement. Neither state bodes well for exercise of any kind, even though they may appear weak and in need of strengthening. The best time for strengthening is before an injury to prevent injuries from happening, and after injuries begin to heal, to condition them for use. In between, during injury, bad timing of the exercise can delay your progress. Just resting them, on the other hand, is of little benefit.
The ideal therapy at this point is to stimulate circulation in the muscle without loading it. This can be done with a combination of contrasting hot and cold packs, and static massage of the muscles in between the hip and rim of the pelvis as pictured above, best accomplished at home by laying on a tennis ball and rolling it into that area. Pause on sensitive spots to interrupt circulation, then release the pressure to stimulate blood flow. You don't have to smash the area around to irritate it further, just apply strategic control of circulation to encourage vasodilation. It's easy, but is not a magic bullet; you still need to heal, but increased circulation creates the ideal conditions for healing to occur. Plan on spending a few days to a few weeks facilitating repair. Painkillers and/or targeted exercise at this point can be counterproductive, even though drugs can deaden pain and exercise can stimulate the production of natural painkilling endorphins. It's not about the pain, it's about the healing, and about restoring proper function to these very important muscles. Properly treated, they will improve. Otherwise, they will continue to malfunction under heavy use.
To answer your question fully, this can be done professionally, or under the supervision of your Dr. or P.T.. The principles on which this type of therapy is based were developed over years by physicians, and have come into wider use since the 1990s. I perform this kind of work for a living by prescription, and can tell you it works quite well. It's hard to find an elite athlete who does not use it to their advantage. I also work on myself, as anyone can - as long as they know where to work to acheive the desired results. Once things are on the mend, it will be time to conclude the rehab process, by completing a course of targeted exercises. Then, if all goes well, you can run injury-free!
Well....found a fabulous PT who sent me to the fabulous Ortho that I should have gone to see in the first place! Turns out I have a labrum tear in the hip and a stress fracture in the low back. Lucky me. Meeting with the doc on Tuesday to set up course of treatment. Hopefully a shot and some pt will do the trick. Oh and rest....what's that?
Well it's been over two months since this "injury" occurred. Physical Therapy, massage therapy and complete rest have all been used to try to alleviate the pain with no success. Today my doc suggested PRP injections. Any opinions or experience to share about this type of treatment?