Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management
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REVIEW ARTICLE
Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management Alison Grimaldi1 • Rebecca Mellor2 • Paul Hodges3 • Kim Bennell4 Henry Wajswelner5 • Bill Vicenzino2
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Published online: 13 May 2015 Ó Springer International Publishing Switzerland 2015
Abstract Tendinopathy of the gluteus medius and gluteus minimus tendons is now recognized as a primary local source of lateral hip pain. The condition mostly occurs in mid-life both in athletes and in subjects who do not regularly exercise. Females are afflicted more than males. This condition interferes with sleep (side lying) and common weight-bearing tasks, which makes it a debilitating musculoskeletal condition with a significant impact. Mechanical loading drives the biological processes within a tendon and determines its structural form and load-bearing capacity. The combination of excessive compression and high tensile loads within tendons are thought to be most damaging. The available evidence suggests that joint position (particularly excessive hip adduction), together with muscle and bone elements, are key factors in gluteal tendinopathy. These factors provide a basis for a clinical reasoning process in the assessment and management of a patient presenting with localized lateral hip pain from gluteal tendinopathy. Currently, there is a lack of consensus as to which clinical examination tests provide best diagnostic
& Bill Vicenzino [email protected] 1
Physiotec, 23 Weller Road, Tarragindi, QLD 4121, Australia
2
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
3
NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, St Lucia, QLD 4072, Australia
4
Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Carlton, VIC 3053, Australia
5
Department of Physiotherapy and Lifecare Physiotherapy, LaTrobe University, Bundoora, VIC 3086, Australia
utility. On the basis of the few diagnostic utility studies and the current understanding of the pathomechanics of gluteal tendinopathy, we propose that a battery of clinical tests utilizing a combination of provocative compressive and tensile loads is currently best practice in its assessment. Management of this condition commonly involves corticosteroid injection, exercise or shock wave therapy, with surgery reserved for recalcitrant cases. There is a dearth of evidence for any treatments, so the approach we recommend involves managing the load on the tendons through exercise and education on the underlying pathomechanics.
Key Points Gluteal tendinopathy is the most prevalent lower limb tendinopathy, substantially impacting quality of life. Excessive hip adduction, in conjunction with other muscle and bone factors, is considered a key driver in the pathomechanics of gluteal tendinopathy. Load and exercise management based on pathomechanics is proposed as a biologically plausible and viable approach to rehabilitation.
1 Introductio
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