Glute Tendinopathies and Pilates – Love Me Tendon

Glute tendinopathy explained – symptoms, exercises and more

Glute tendinopathy is commonly seen in a Pilates studio. In this article we explore glute tendinopathy its pathology and its symptoms. It is important to understand appropriate exercises and great ideas on programs when working with glute tendinopathies. And your clients will love the improvements to their glute med tendinopathy!

This blog is an introduction to the concepts of tendinopathy and also the pelvis. If you are wanting to learn more about the concepts we suggest you try our Foundational online courses.

Gluteal tendinopathy and its associated lateral hip pain is the most common form of hip tendonitis or hip tendon injury. Gluteal tendinopathy is also known as gluteus medius tendinopathy (glute med tendinopathy), gluteal tendinitis or even gluteus medius tendinosis.

Explaining tendons and their functions – using a horse and cart analogy

Tendons are perhaps the anatomical equivalent of the middle child; they do a lot of work holding things together, but aren’t talked about as much as the firstborn (the bones) and the youngest (the ligaments).

Scientifically speaking, a tendon is flexible but tough fibrous band of connective tissue that is responsible for attaching muscle to bone.

From a functional point of view, I like to explain tendon issues to clients by relating it to a horse and cart. Let’s elaborate:

//   The horse represents our muscles. The horse provides the power for movement;

//   The cart represents our skeletal system and the load for the muscles (the horse) to pull;

//   The ropes and bridle that attach the horse to the cart are our tendons. As such, the tendons need to have good integrity in order to distribute power evenly when moving a load.

When moving, we want to ensure that the cart (skeleton) moves as efficiently as possible. For this to occur, all three of the aforementioned elements need to be working together.

From a Pilates perspective this really highlights the importance of applying the pilates principles:

//   Alignment of the skeleton;

//   Control of muscle and tendon as they work through their range of motion (ROM);

//   Precision of movement.

Exercise is considered a good method for treating tendon-related issues (Cook & Purdham 2009). Having an understanding of the presenting tendon issue and, therefore, the appropriate type of exercise to administer is key to optimal recovery. In this article we will look at:

//   What is tendinopathy?

//   Gluteal tendinopathy and the relationship with greater trochanteric bursitis;

//   Load, progression and the continuum;

//   Protocol for tendon repair – staging;

//   How to get the best result for individual clients from a pilates perspective.

What is a tendinopathy?

Put simply, the term tendinopathy describes the clinical conditions associated with overuse in and around tendons.

Tendons can be damaged at the:

//   Insertion point to the bone;

//   Belly of the tendon;

//   Attachment point to the muscle.

Tendon pathology has been described as a continuum (Cook & Purdam 2009) with three distinct stages:

//   Reactive tendinopathy;

//   Tendon disrepair;

//   Degenerative tendinopathy.

From a pilates and exercise perspective, it is important to note that load is considered to be the primary stimulus which drives tendon health forward and back along the continuum.

 //   Low load will result in the tendon decreasing in size or furthering into degeneration;

 //   High load will result in inflammation or further tendon degeneration;

//   The “Goldilocks Zone” will result in tendon growth and repair.

Pain response to loading is the current gold standard for measuring what load is suitable for a particular stage of degeneration. The table below illustrates how load can help to create a healthy tendon response, with the “Goldilocks Zone” marked A.

Gluteal tendinopathy and the relationship with greater trochanteric bursitis

Traditionally it has been thought that greater trochanteric bursitis and gluteal tendinopathy were a team of pathologies. However, research by people such as Dr Alison Grimaldi indicate that the greater trochanter bursitis element is probably better described as lateral hip pain that can be attributable to compressive forces such as lying on your side or the collapse into the hip when standing on one leg.

Load, progression and the continuum

Within the constraints of recovery proposed by Cook & Purdam (2009), relative rest or load adjustment may allow the tendon to return to a previous level of structure and capacity within the continuum.

When a physiotherapist discusses load they will consider a number of factors:

Exercise type

//   Open versus Closed chain;

//   Eccentric versus Concentric;

//   Isometric versus Dynamic;

//   Number of repetitions;

//   Degree of resistance.

Stage of disrepair

//   Degenerative tendinopathies will react better to eccentric exercise based intervention. Tendons respond better to work than rest

Pharmacotherapies

//  Therapy using pharmaceutical drugs, as distinguished from therapy using surgery, radiation, movement;

//   Examples are NSAIDS or pain medication.

When working with a physiotherapist, a movement teacher and client need to be aware of these considerations and how they are going to affect decisions about the staging of movement and exercise in order to achieve tendon repair and balanced movement.

Staging and a protocol for tendon repair

Staging of the appropriate load in exercises and movements is an important aspect of tendon recovery. A decision is made on how load-tolerant a tendon would include an identification of where the person is within these stages:

//   Stage One: Is the person presenting as intolerant to load, i.e. are they showing a painful response to any load?

//   Stage Two: Is the person presenting as load tolerant, i.e. manages to achieve a positive response to slow speed and high load, e.g. standing on one leg?

//   Stage Three: Is the person presenting as load tolerant to fast speed and high load (energy storage) e.g. walking?

The rest of this article including examples of exercises is available to subscribers only.

One sample of the exercises taught is included below in this article.

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