Have you developed some new aches and pains or aggravated some old ones after following free online exercise classes? Or perhaps you have increased your normal activity level by doing more walking, running, stair or hill climbing to try and stay fit and healthy during the COVID-19 restrictions. At Physiotec, we have seen an increasing number of people who have developed or aggravated their hip pain during the covid-crisis. In fact, pain over the outer side of the hip is one of the most common problems we see. This is usually related to a condition called gluteal tendinopathy, also sometimes referred to as trochanteric bursitis.
There are some challenges with going it alone with a new exercise program. If you do have a pre-existing or new injury, how do you know:
- which exercises or programs are the best options for you?
- what are the correct techniques to use?
- how do you make the exercise harder or easier if you need to?
- how do you alter your program if you develop pain?
If you are struggling with any of these challenges, a physiotherapist can assist with either a telehealth or face-to-face consultation. For many painful conditions, good education and advice will help you stay active while minimising the risk of pain or injury.
For specific hip conditions such as gluteal tendinopathy or trochanteric bursitis, many factors influence the health of the tendons and bursae at the side of the hip. Either too much or too little stimulus may result in changes in tendon health and consequently, your ability to perform normal activities without pain. Too little load may be associated with a sedentary lifestyle where the muscles and tendons aren’t working enough. Too much load may be associated with a quick increase in activity (either a new or existing activity). Particular sustained positions or repetitive movements may also contribute to reduced tendon health or the development of pain over time.
So, who is most affected with this condition and why? 18% of the population aged over 50 suffers with this type of hip pain, and women are 3 times more likely to develop the condition than men. While the causes are often multifactorial, a change in hormones is thought to contribute to the development of tendon changes. A common story we hear from our patients is that there was an onset of pain associated with a combination of the following:
• Peri or post menopause and the associated hormonal changes
• Weight gain during this time, and
• A sudden increase in activity levels to counteract the weight gain
It should be said that changes in the health of tendons and bursae are not necessarily painful. Pain may develop if weakened tendons are unable to cope with their workload. Pain is often triggered by sudden increases in activity levels, where the tendons have not been given adequate time to adapt to the new loads. Examples include taking up a new sport or activity, or returning to activity after illness, injury or pregnancy. Going on holidays and walking lots of hills or stairs or for long distances along the beach may cause a problem. Sudden loads on the tendon during a slip or fall can also result in pain and injury, or a gain in weight may add more load to these tendons that support your bodyweight when standing on one leg.
How do you know if you have a gluteal tendinopathy or trochanteric bursitis?
Do you have pain over the side of the hip with any of the following?
• Lying on your side
• Walking up hills or stairs
• Standing on one leg
• Sitting in low chairs especially with crossed legs
• Getting up from chairs and during the first steps
If you answered yes to most of these, you may have gluteal tendinopathy or trochanteric bursitis. The good news? Education and exercise provided by a physiotherapist provides an 80% success rate, with significantly better outcomes than a corticosteroid (cortisone) injection or a wait and see approach (i.e. basic advice and monitoring the condition)*. The even better news? Dr Alison Grimaldi was instrumental in the development of this successful program and all physiotherapists at Physiotec have been trained in the protocol.
We are now back in clinic for face to face consultations – if you have flared or developed hip pain (or any other pain), give us a call to book in! We are also still offering Telehealth consultations for those who are continuing to isolate or those who find it more convenient to attend an appointment ‘virtually’. You can read more about our Telehealth service here.
*Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B., 2018. Education plus exercise versus cortico- steroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. May 2;361:k1662. doi: 10.1136/bmj.k1662.