Gluteal Tendinopathy

Have you recently started to experience pain at the side of your hip? With the turn of the new year now behind us, maybe you’re embracing your new healthy lifestyle and have been going for a solid run several times a week to shift some of those festive kilos… Or it might just be that you’re getting a bit older, hitting the middle decades of life, and you’ve had a nagging hip for a while. There are a few structures in and around the hip that can lead to pain felt at the very outer aspect of it. Problems in the low back, the hip joint itself, and soft tissues that surround the joint can all be viable culprits.

Common culprits in the running and middle-aged populations are the tendons of the gluteal muscles. These muscles are responsible for movement at the hip (outwards, backwards and forwards) and stability of the pelvis and hip during movement. There are three gluteal muscles or ‘glutes’. The deepest muscle is the gluteus minimus, followed by gluteus medius, and finally gluteus maximus (which is the largest and most superficial of all three). Where the gluteus medius and minimus tendons wrap around the bony outer part of the hip and insert into the bone, are the areas most commonly associated with disease leading to pain in the outer hip.

Tendon disease

There are a few terms that can describe a diseased tendon. An acutely inflamed tendon is known as ‘tendinitis’, where ‘itis‘ means inflammation occurring at the tissue. A tendon which is chronically diseased (i.e. long-standing pain that may have been present for several weeks, months or years without the presence of inflammation), is known as ‘tendinopathy’. Historically the term ‘tendinosis’ was used to describe a chronic tendon problem, but tendinopathy is now the favoured term. The important thing is to think of a tendon problem sitting somewhere on a continuum between acutely inflamed and chronically degenerated and/or torn.

Let’s take our aforementioned population, a middle-aged female (females are more affected by this issue than males), who runs. What typically happens is they will start to run with the full intent of bettering themselves. Due to poor running technique, the tendon becomes overloaded and after a few weeks or months… Bang! Inflammation, pain, can barely walk! Once the initial pain settles and movement resumes, they start to run again. If they haven’t corrected the problem that underlies the initial acute episode, the problem compounds itself. The body will compensate, and further excessive load and compression are placed on the tendons and other surrounding structures. This might go on for a while with the hip grumbling from time to time. Eventually, the changes that have occurred to the tendon tissue result in widespread degeneration and derangement of the tendon fibres and you are left with a tendon incapable of dealing with the high loads required to do something like running. If left untreated, the tendon eventually tears and leaves you with a very unhappy and less mobile hip.

Signs and symptoms

The signs and symptoms of a gluteus medius and/or gluteus minimus tendinopathy include any or all of the following:

• Pain felt on the outside of your hip
• Pain that radiates down the thigh to the knee
• Pain that is worse before and after exercise
• Pain that improves initially with exercise (depending where on the disease process you are)
• Pain when lying on the affected side
• Difficulty walking up stairs or hills
• Difficulty standing on one leg (on the affected side)

Treatment

Your first port of call is to temporarily cease the activity that is aggravating your hip, and ring your osteo (ahem… 416-546-4887). This will help to de-load the injured tendon, and give you relief knowing soon you will be in the hands of an expert who is going to guide you through your recovery journey. We will assess your movement from top to bottom and work out where the root cause of your problem is. This is what osteopaths are great at doing. We look beyond the pain, take a picture of your whole life (occupation, hobbies, family life, etc…) and work out all of the contributing factors, so we can put a comprehensive plan in place to rid you of your problem forever.

For a gluteal tendon problem to occur in the first place, there will likely be mechanical issues to correct in the spine and/or lower limb (from the foot up). We do this with a combination of:

• Hands-on therapy to soothe your pain and improve muscle and joint health
• Re-training of poor movements into more efficient movements
• Strengthening exercises for the muscles / tendons
• Alterations to your daily life which may be contributing to your issue (i.e. increasing particular activities, decreasing aggravating activities, changing a work posture)

Over time, treatment will aim to progressively strengthen the gluteal tendons, so they are capable of withstanding greater loads again. Combined with correction of poor, inefficient movements, this will also decrease the compressive forces acting on the tissues in and around the hip, leaving you with greater strength and more flexibility.

We will be with you every step of the way. A gluteal tendinopathy doesn’t mean you have to give up running. We might need to change focus for a short period during rehab, but our goal will be to get you back to your pre-injury state… with a little extra in the tank so you’re not back with us for the same issue within two months.

Hip pain, was it? No problem. We got this! Contact us

De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a condition that affects some of the tendons of muscles that help control thumb movement. It can cause considerable pain and disability in the process. It is also known as blackberry thumb as it is common injury with cell phone and tablet use.

Anatomy

If you lie your hand flat on a table and spread your fingers (and thumb) as wide as you can, you will notice a small hollowed-out section on the thumb side of the wrist. This region is known as the ‘anatomical snuffbox’. The walls of the snuffbox are made up of two tendons that pass from the forearm to the thumb. These tendons belong to two muscles: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). The words abductor and extensor refer to the movements they help the thumb to perform… abduction (taking the thumb away from the palm) and extension (taking the thumb out to the side of the hand). Pollicis refers to thumb, and longus and brevis refer to long and short respectively.

Tendons are cord-like structures that attach muscle to bone. At the point where these tendons pass over the wrist joint, they pass through a thin, tunnel-like structure called a sheath in a smooth and frictionless manner. ‘Tenosynovitis’ refers to inflammation of the tendons and sheaths.

Cause

The cause of De Quervain’s is not completely understood, but it is strongly associated with overuse of the previously mentioned structures. Overuse leads to degeneration of the tissues, and one of the ways the body adapts to these changes is thickening of those affected tissues. This leads to the tendon being trapped within the sheath, which ultimately leads to poor movement and pain. Any activity that leads to chronic overuse of the thumb can lead to the development of this problem. Common activities include playing the piano, fishing, and typing. New mothers are regularly affected due to the repetitive action of picking up their baby with thumbs held out from the hand. With the explosion of smart phones and other technologies over the past decade comes a new population of sufferers also… texters! Those people who spend long periods of the day sending text messages and typing on mobile phones are more likely to experience this disorder.

Signs and symptoms

The main symptom of De Quervain’s is painful thumb and wrist movement. Any movement where the thumb moves away from the hand may be painful. The pain is mainly felt around the snuffbox area of the wrist.

Other signs and symptoms include:

  • Restricted thumb and wrist movement
  • Difficulty and pain with gripping objects
  • Pain that radiates up the forearm
  • Swelling over the snuffbox region
  • Popping and clicking of the tendons as they move through their sheaths
  • Weakness of the thumb
  • Tingling and/or pins and needles in the hand

Treatment

In order to get the right treatment for this condition, you must first be diagnosed correctly. Your first port of call should therefore be a consultation with us (your friendly osteopaths!). We are armed to the teeth with ways to treat this sometimes-menacing condition. We may use any or all of the following techniques to help you in the process:

  • Soft tissue release of the tight and/or shortened muscles that help to control thumb and wrist movements. We may massage you all the way from the neck down to the hand during treatment.
  • Mobilisation of the joints. Again, we might focus on joints in the neck, all the way down to the smaller thumb and wrist joints.
  • Stretching of tight muscles during treatment and also as part of a home exercise program.
  • Taping of the forearm, wrist and thumb to decrease pain and improve function of the hand.

Some of the things you can do at home to improve this condition include:

  • Ice or heat pack therapy to increase flow of blood through the region to aid with recovery and decrease pain.
  • Exercise to help strengthen and stretch weak and tight muscles.
  • If in doubt, check all homework by us first – it’s always better to get tailor-made care when injured.

Other forms of treatment include splinting, steroid injection and surgery. These forms are either more disabling to begin with, or more invasive. We always try to take a gentler approach to start and leave these treatments for those instances that do not respond to gentler techniques.

If you need help with thumb or wrist pain call us today on (416) 546-4887 to begin your journey to pain-free movement… and happiness! Now that’s something we’ll give a thumbs up to! 👍🏼

 

References
1. Physiopedia. 2020. De Quervain’s Tenosynovitis. [Online]. Available from: https://www.physio-pedia.com/De_Quervain%27s_Tenosynovitis. [Accessed 06 Oct 2020].
2. American Academy of Orthopaedic Surgeons. 2013. De Quervain’s Tendinosis. [Online]. Available from: https://orthoinfo.aaos.org/en/diseases–conditions/de-quervains-tendinosis/. [Accessed 06 Oct 2020].
3. Ali, M. et al. 2014. Frequency of De Quervain’s tenosynovitis and its association with SMS texting. Muscles, Ligaments and Tendons Journal. 4 (1). 74-78. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049654/
4. Oh, JK. et al. 2017. Effectiveness of Corticosteroid Injections for Treatment of de Quervain’s Tenosynovitis. Hand. 12 (4). 357-361. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484456/