Hi guys, Mr. Physio here from Australia. Today I’ll talk about ‘Gluteal Tendinopathy’. Studies show it affects 25% of women at some point in their lives. Not surprisingly it affects females 3x more than males. So, even if you do not have any problems at the moment, there is still a 25% chance that this could change. If you’re a woman, unfortunately. 🙁 I will tell you why this is the case, so please watch until the end ,and share it with the women you care for. 🙂 Let’s look at the structure first. Gluteal Tendinopathy is a problem of the Gluteus Medius, and the minimus tendons. Anatomically, the Gluteus Medius tendon inserts onto the outer and back side of the greater trochanter, and the Gluteus Minimus is on the front of the thigh bone (Femur). They keep the head of the thigh bone onto the hip joint, and also stabilises the pelvis. But, if they’re weak, problems begin to occur. I’ve been telling you in all of my tendon videos, that most tendon problems occur on the bony areas. This study also supports my statement: It states that if these muscles are weak, it causes compression of tendons against the bone. So, the pain can be reproduced with passive elongation and stretch of the tendons involved. If these muscles are stretched, there will be compression against the bone. There will also be stretching at the tendon at the same time. When you cross your legs, or sleep on your side you compress your tendons against the bone. Your tendons don’t like this at all! The reason why this affects females more than males, is because women generally have: A wider pelvis and a narrower stance than men. This causes stretching and compression of these tendons on the outer side of their hips. Women have wider pelvis and a relatively narrow stance, so this angle is sharper. This puts a prolonged stretch on these muscles If your muscle’s being stretched out, they will get weak, because your pelvis isn’t stabilised. Your hip will drop on the other side and that will stretch out this muscle more, and the vicious cycle continues… Therefore, this kind of stretching is the worst kind you can do it your tendon. Instead, I’ll show you some exercises based on this study. This found that education and exercise is more beneficial than injections or the wait and see approach. Before this, we’ll loosen up muscles with a tennis ball. The first one is for tight adductors. If adductors are tight, it will bring your leg inwards, stretching the hips. Sit down like this with the ball onto the muscles, on the inside of the thigh. Press down and roll side to side above the knee for about 30 seconds. You can do this on a chair or bed. We’re going to massage the abductors now. This is the head of the thigh bone, so massage 2-3 inches above. Push against the wall, and move side to side. It has to be a very gentle pressure. If it is too painful, just stay on it. You don’t want to push into the bony area because you’re gonna compress the tendon again. If it’s too painful you can skip this part. 🙂 It is also very important to address IT band and TFL which will be in the next video. We’re gonna do some exercises now. The first one is the hip hitch. So if this left side is the affected side: Hold onto the wall, and slowly hitch your hip up. Even if you’re lifting the right side, your left side should still be activated. You should feel something here. Try to lift 5cm above, even 1-3cm is okay. Start with 5 seconds, 10 seconds and build up to 45 seconds, 5 times a day Once you can do that, hitch up, and just toe tap *tap* *tap* *almost tap* You can try the hip swing as well. Hitch up, and swing your leg back and forth Or make circles Again, 45 seconds five times. The next one is the ‘hip shift’ Have your legs about hip width apart, or a little bit more and toes pointing out a little. You toes should’t be facing forward, but rather little bit out to the side. Now, push out your legs, but keep your feet in the same position. Squeeze your glutes and bottom, and push your legs apart against the ground. You should feel your side hips activating. From there, you’re going to shift your hips side to side. This way And that way Basically, stand nice and tall with your knees straight and push your legs apart. Activate that muscle, and you’re going to move your hip side to side. Squeeze your hips as well! Or, you can rotate your body while pushing your legs out to the side. Keep pushing and rotating your body. When I move to the right, my left abductors get shortened. When I move to the left, this will get lengthened. This is really hard *overexaggeration* *death from exercise* But seriously don’t push yourself too much! You can also do it with one foot up on a footstool. Didn’t put the footstool against the wall, but it should be, so that it doesn’t get pushed away. The hardest exercise for GT, is the single leg wall squat, which I showed you in another video, So I will put a link down below You also need to work on ‘Quadriceps eccentric control’. According to many studies, the lack of Quadriceps eccentric control is a contributing factor for GT. When you walk, as you hit the ground, your knee is slightly bent at that moment. Your quadriceps have to stop your knee from going too far forward. Otherwise, your knee goes forward and inwards, and this will put stress on your hip. Check yourself! Many people bring their knee inwards when they go up and down stairs. This small faulty movement can put a lot of stress on the hips, knee and ankle as well. So, that ability to prevent your knee going forward and inwards has to be improved. We’ll start with partial squats. Have your legs wider than your pelvis, and just push your legs apart as we did just now. I’m doing this action, with my knees a little bit out to the side, and just squatting down. Try to do a 1/2 or 1/4 squat, and come back up. This lengthens the muscles, while still controlling your knee. Once you can do that, you can actually go all the way down. Then sit down on a chair. Stand up, and repeat, taking about 3 seconds when lowering down. When you are doing this, you should bring your hip all the way back. This will help you keep your knees behind your toes. You shouldn’t bring your knees in like this! alright? Bring your bottom all the way back. So, it should be nice and controlled at the end, rather than doing this: After this, you need to combine those muscle activations into one action, to improve the connection between those muscles. After, you can do these kind of exercises on a step. Going down and up, and touching the ground. The most important thing is to try to keep your knee a bit out to the side. You shouldn’t go in like that this, as it will stretch the hip. Going down, coming back up. You can start with your toe touching the ground, and going down like this: This is probably one of the most advanced exercises for Gluteal Tendinopathy. yay!!!! After this exercise, you can practice step ups with your knee out, as well as some double or single calf raises. It is also important to avoid aggravating activities such as: going up stairs with your knee in, and lying down on the affected side, and sitting in low chairs. When you sit down, your knees should be below your hip level. A recent study has found it is also related to hormonal changes after menopause. So,I will keep you updated if they have found anything fAnTaStIc So again, Glutean Tendinopathy is also associated with compression, stretching. That’s why you want to avoid activities that can cause compression and stretching. Instead, you want to do ‘gradual loading’, so that you tendon can be strengthened. I hope this video helps, and I will see you next time