Lateral hip pain (Gluteal tendinopathy) – LEAP Trial

Today, we are going to cover gluteal tendinopathy, which is often called greater trochanteric bursitis or greater trochanteric pain syndrome (GTPS).

According to recent studies, 25% of women aged over 50 years are experiencing gluteal tendinopathy. As well as this, it is the highest prevalence and incidence in lower body tendon issues. Patients typically present with pain around the outside of the hip when lying on the affected side or during activities like walking, stairs, or standing one leg.

As we have covered in Achilles Tendinopathy, tendinopathy occurs when the collagen fibres in the tendon become disorganised. Overloading the tendon results in less effectiveness in transmitting force and less efficiency in performing activities.

(Mallor et al. 2018)

Recent studies, called the LEAP trial, have demonstrated the significant effectiveness of a physiotherapy exercise program for treating gluteal tendinopathy. The study involved three different groups:

1. Education and exercise led by physiotherapists
2. Corticosteroid injections
3. Wait-and-see (resting) approach

The patients were monitored at 8, 12, 26, and 52 weeks. By 52 weeks, nearly 80% of those in the exercise and education group had successfully rehabilitated, which was notably better than the success rate of around 50% seen in both the corticosteroid injection and wait-and-see groups.

How to be diagnosed with Gluteal Tendinopathy?

Imaging can be helpful in confirming the diagnosis of gluteal tendinopathy and in ruling out other potential conditions, such as osteoarthritis, bursitis, or muscle atrophy. However, clinical diagnostic tests based on symptoms conducted by a physiotherapist are typically sufficient to diagnose gluteal tendinopathy. Imaging alone can sometimes be misleading, as it may reveal tendon changes even in the absence of symptoms.

Clinical tests include:

1. Palpation

2. Hip joint

• FADER passive

• FADER (Patrick’s)

3. Muscle strength testing

• Glute medius & Glute minimus

4. Muscle length testing

• Ober’s

5. Functional Testing

• Single leg stance for 30sec

How to manage Gluteal Tendinopathy?

There is a variety of non-surgical treatments recommended for gluteal tendinopathy, such as anti-inflammatory medications, rest, stretching, strengthening exercises, ultrasound, shock-wave therapy, and corticosteroid injections. Most research focuses on corticosteroid injections. Corticosteroid injections had good short-term relief for hip pain, but over time, the effect has decreased. By 12 months, studies have found no difference in outcomes between patients who received an injection and those who simply waited to see if the condition improved on its own. Therefore, the most effective management strategy for gluteal tendinopathy remained uncertain.

However, as the LEAP trial studies concluded, education and physio-guided exercises can be strongly recommended as this trial was significantly more effective in the short-term as well as long-term management of gluteal tendinopathy.

What Kinds of Exercises?

These are some exercise examples that were included to the ‘Exercise and education’ group.

• Sitting
• Standing
• Mini squat
• Upright

• Double leg
• Offset bridging / Single leg bridging

• Double leg / Offset squat
• Single leg

• Side stepping
• Band side slides