are you currently suffering from pain on the outside of your hip that's made worse with such activities as stairs walking or laying on that painful side if these symptoms sound like the pain that you're currently suffering from there's a good chance you're suffering from something called gluteal tendinopathy which is more commonly known as gluto tendinitis or greater chronic pain syndrome my name is Dr Zach greenwade and in this video I'll be discussing how this condition commonly presents who most Comm is going to be affected by it some really important positions activities to kind of modify to let those tissues calm down and then the best rehab and strengthening exercises to help fix this condition in a permanent capacity if we look at this model this is our spine this is our pelvis and then this is our hip joint or our ball and socket joint and on the outside there's a bone part of that called the greater trochanter and this red band represents your gluteal tendon so it kind of lays over that and there's a bursae under there and these are important structures that can cause your pain that we'll discuss in more detail later gluteal tendinopathy comprises about 10 to 20% of all people suffering from hip pain so it's a pretty big deal and it most commonly presents as outside of the hip pain but it can radiate down the thigh into the front or groin area or into the back of the buttocks area it's most commonly seen in women between about 40 and 60 postmenopausal range and risk factors such as wider pelvises and smoking can be effective the pain will be aggravated with such things as prolonged sitting climbing stairs laying on the effect of her painful side and then single leg loading exercises such as running jumping or lifting with this kind of pain presentation it often gets diagnosed as gluteal brusitis and we talked about earlier that Bursea is in between the tendon and the bone so it can cause pain but you got to think to yourself why is that Bursa irritated in the first place and a good analogy here is if you think if you have a fever from a bacterial infection and you only take Tylenol it will help reduce your fever the symptom but you're not actually addressing the underlying cause and the underlying cause here is bad mechanics so that gluteal tendon the tendon getting excessively compressed against the bone and then bad mechanics causing that bursitis to get irritated so if you don't change those things you're not really going to fix the problem long term and so if you have pain in the hip for two years it's not gluteal bursitis and you have to strengthen the tendon and the muscles and remove those positions related to those positions we're going to tell you why you need to stop stretching your hip if you're suffering from this so back to that model this is our gluteal tendon and that's that bone when tendons get irritated the two things they hate are tension and compression and when you're doing hip stretches you're doing those exact two things you're tensing the tendon and compressing the tendon as well as irritating the burus so these stretches that we show you right here if you're doing them you need to stop right away and you're going to feel a lot better in a few days so next we want to talk about some positions that you need to temporally avoid or really modify because again they're placing tension on that tendon which can cause further irritation and these activities mostly are loading or bringing your leg across midline which is adduction for sleeping it's best to sleep on your back with your knee slightly bent with a pillow underneath your knees the second best position is to lay on the non-painful hip with the knee supporting between your knees and then lastly if you must place a pillow underneath that painful hip with standing we want to avoid leaning into that hip especially the painful side here the green check shows you what you should be doing and the Red X shows what you shouldn't with sitting you want to avoid prolonged sitting especially when your legs are crossed with walking we want to make sure that your feet are shoulder withth apart and not crossing midline here we show you the incorrect form of letting your foot come too close to midline or crossing over it lastly with stairs we want to keep that pelvis level you want to use one or both arms to help stabilize your pelvis so it doesn't tilt here we'll show you how to do it with the correct form with the green X and the incorrect form with the X we're going to show you some great level one exercises are strengthen that hip and reducing your pain and it's easier to do this in a seated position or a standing position so in a seated position with our hips and knees at 90 we want our feet wider than our hips and then using your hands you're going to place on the outside of your knees and then we're going to press our knees out into our hands and hold for 5 seconds we're going to relax and do that 10 times once or twice a day as you're doing this you want to feel tension on the outside of your hips you can also do this resistance ban we're going to do one set with our feet neutral and then we're going to Stagger your left foot forward and do the same thing and then right foot forward and do the same same thing for the standing version we're going to use our glut to try to push our feet outwards and rotate but we're not actually going to rotate it's going to be isometric so we're going to put our hands on our glutes and then squeezing your glutes you're going to try to rotate those feet again hold for 5 seconds relax and then repeat five to 10 times once or twice a day but again you want to kind of feel like your feet are trying to rip that floor apart and you're feeling your glutes engaged now we're going to show you level two exercises and we have a printable PDF so in case you want to just print off so you have like a reference you can just look in the detail or comment section and it'll be there there'll be a link so for these exercises the goal is to increase the intensity of that exercise and strengthen the tendon over time so each week you want to do more challenging exercises than the previous week and we give you several different versions but again you want to kind of tailor to yourself but again each week you got to do more than the previous week with the glute Bridge we're going to lay on our back with our feet even and then using our hips not our back we want to raise up in a slow tempo so we're going to go one 2 3 pause one 2 3 we got to work up to eight reps in this position but again it's better to go slow tempo and do two reps if that's what you need then do more at a fast tempo after we do that we're going to rest for 30 seconds or a minute and then bring our right heel all the way back and then this position we're going to raise up slow one two three pause one two 3 when you're doing this make sure you keep your pelvis level and don't let it tilt one thing to note is when your heel is back on the painful side is going to be more challenging so let's say if my left hip hurt more this side's going to be harder so when I go up I really want to make sure my pelvis doesn't fall down so as we do this we'll go one two 3 pause make sure you have good form and then come back down to increase the difficulty single leg Bridge so bring one leg up keeping our pelvis Square we're going to raise up one two three pause one two three again tension over the glute one two three not the back pause one two three we're going to do squats we're going to need a bench or chair to sit down with your arms straight forward and our feet normal we're going to squat down one two 3 pause up one two 3 make sure the glutes not the back we'll do that up to eight reps and then we're going to stagger so right foot back do only four reps of these up first because it can kind of irritate the knee and then left foot forward if the knee is good you can increase but again we want to add weight and make this harder over time level two version is the step up so with the bench or table place a fetch a leg up keep it our torso upright and use that glute drive up one two 3 pause one two 3 and again feel that glute one two 3 pause one two 3 wall slide with one hand on the wall with your foot on a slider if you don't have this you can use lenum and a washcloth we're going to press out one two 3 pause and back one two 3 work up to 12 reps if this is too easy you can add a resistance ban or go slower some clinical test that can be really helpful with knowing if this is the condition you suffer with is again those single leg loading exercises so stairs walking jumping and running does that cause lateral hip pain the fader and faddir which are two Orthopedic tests should again reproduce your pain on the outside of the hip there should be tenderness with palpation with a greater trochanter so that big bone on the side of your hip if you press on it is it way more painful than the other side and then lastly standing in a single leg does that cause pain within 30 seconds or weakness is with ton rehab some discomfort and pain is expected and this does not mean you're causing damage if you have like a sciatic nerve or acute back pain you don't want to push through the pain because you're going to cause more damage and irritation that way with tended rehab there's going to be some discomfort it's expected and you absolutely have to reframe your mind from this is more about strengthening things and I'm not harming myself some helpful parameters is the pain should be mild so for RS we're going to say four out of 10 on that oral Pain Scale 4 out of 10 or less is mild anything more than that is too painful and you should dial back the intensity any elevation and pain should be gone within 2 hours of after the exercise and the next morning you should wake up with Baseline pain so pain should not be elevated from the previous day exercises lastly we going to talk about this amazing podcast by Alison gardi she's a world renown therapist out of Australia and she made this amazing podcast where she talks about glut tendinopathy and some important facts and things to treat it and everyone that I recommend that listens to it always find it beneficial I highly you listen to it and it's in the description below thank you so much for watching our video on glut tendinopathy if you find it helpful please like our video and don't forget to check out our other channels