Medical: Hip Pain / Gluteal Tendinopathy

Persistent hip pain doesn’t have to signal the end of your riding if you know how to overcome it. Here, Suzie Bostock discusses how best to treat it.

Gluteal tendinopathy is a very common complaint causing pain in the side of your hip and is often mistaken as trochanteric bursitis (inflammation of the fluid-filled sac that decreases friction in your hip joint). It can detrimentally affect sleep and function, especially when sitting or standing up on your bike for hours, plus it can cause issues equivalent to that of severe hip osteoarthritis! Weekend warriors or those who suddenly take up off-road riding, with a lot of standing and moving the hips side to side (suddenly increasing the load on the tendons) are more at risk. 

You may think that an injection is an easy and simple way to get rid of it, however education and exercise has been shown to work significantly better in terms of global improvement, particularly in the long term, so avoid the injection and put in some work. 

Here, I have put together some exercises and advice to get you on the right path to overcoming this persistent condition. Exercises should not cause pain over five out of 10 and should not cause flare up. If this happens you are doing too much.

EXERCISES

1.STATIC ABDUCTION LYING 

Static Abduction Lying

Lie on your back with a pillow under your knees, legs slightly wider than hip-width apart and a belt around your lower thighs (above your knees). Gently try to move your legs apart against the tension of the belt. Hold for 5-10 seconds. Relax. Repeat 10 times and do this twice a day.

2.STATIC ABDUCTION STANDING 

Static Abduction Standing

Stand with your feet slightly wider than hip-width apart. Gently imagine sliding your legs outwards – your feet should not move but you should feel your hip muscles activating. Hold for 10-15 seconds. Repeat 3-5 times, twice a day.

3.BASIC BRIDGE 

Basic Bridge

Lie on your back with knees bent up, feet flat on the floor. Tense your bottom muscles and slowly lift off the floor for a count of 3-4 seconds until your body is almost in line, and then slowly lower over 3-4 seconds keeping your bottom tensed. Repeat 10 times, once a day. 

4.BASIC SQUAT 

Basic Squat

Stand with your feet hip-width apart. Slowly initiate a small squat, pushing your bottom back slowly over 3-4 seconds rather than letting your knees drift forwards. Keep your knees pointing forwards. Return to the start position over 3-4 seconds. Repeat 10 times, once a day.

5.SIDE STEPPING 

Side Stepping

Stand straight. Slowly step to one side and then to the other side keeping knees pointing forwards. Never let the feet come closer together than hip width apart. Do this 10 times, once a day. Increase to 15 as it gets easier.

Progressions (within pain tolerance)

1.OFFSET BRIDGE 

Offset Bridge

Lie down with one foot closer to your bottom and the other further away. Use primarily your close leg to lift your bottom off the floor over 3-4 seconds and then lower over 3-4 seconds. Repeat 5 times, once a day. Increase to 10 times as it gets easier. 

2.OFFSET SQUAT 

Offset Squat

Stand with feet a little wider than hip-width apart. Have one foot flat, and the ball of the other foot on the floor just slightly back. Slowly squat over 3-4 seconds using primarily the leg of the flat foot to do the work, then return to the start position over 3-4 seconds. Repeat 5 times, once a day. Increase to 10 times as it gets easier. 

3.SINGLE LEG STAND 

Single leg stand

Always do a static standing abduction first before this exercise to wake up your glutes. Hold on to a support and lift one leg off the floor slowly so all your weight is on one leg. Make sure you keep your pelvis level and not twisted throughout. Your hip should not drift outwards. Hold for 5 seconds and build up to 15 seconds. Do this 5 times, once a day building to 10 times, twice a day over time. 

4.SIDE SLIDES 

Side slides

Place an exercise band around your ankles. Stand in a doorway, ideally without carpet. Make sure one foot remains still and you wear only a sock on the other so it can slide. Get into a shallow squat position. Slide the ‘sock’ foot out to the side over 2-3 seconds, pushing against the resistance of the band, and take your knee almost to a straight position if comfortable, keeping your other side still. Return to start over 2-3 seconds. Repeat 5-10 times, once or twice a day.

Advice: 

  • Limit pain-provoking activity, especially demanding offroad riding where you are having to move around a lot and bend and straighten your knees frequently. 
  • Forget the stretching of your hips and outer thigh, it will make it worse! 
  • Avoid sitting with your legs crossed. 
  • Don’t lie on your affected side. Lie on your back (put a pillow under your knees if needed) or lie on your good side with a pillow to stop your affected leg dropping downwards. 
  • Don’t stand in ‘lazy’ pose, hanging on your hip. 
  • Limit use of stairs and uphill walking and take shorter strides. 

Please email me at suzie@overlanderhealth.com for further information or a full reference list. For a full video explanation of how to perform the exercises described, head to www.bit.ly/ABRhip pain.