That never-ending pain in the a**

hip-painfulI originally posted this on the Yoga and Movement Research Community Facebook group earlier in the week and then realized I should probably do so for my own readers.

Hip pain, SI joint pain, osteoarthritis of the hip, scoliosis, etc. often come up for discussion as a topic of pain and injury and there’s new research that may be helpful to others experiencing these conditions or symptoms.

“Gluteal tendinopathy, often referred to as greater trochanteric bursitis or greater trochanteric pain syndrome, has a prevalence of 10-25% and is experienced by one in four women aged over 50 years. The disorder presents as pain and tenderness over the greater trochanter and often interferes with sleep and physical function. The level of disability and quality of life is equivalent to that of severe hip osteoarthritis, and effective management strategies are required.”

I’ve just been listening to a podcast, which led me to the guest’s (Tom Goom, physiotherapist) blog post, which led me to a new (May 2018) study he references, which then led me to some other information about hormones.

First, I find it interesting, that gluteal tendinopathy has commonly been misdiagnosed.

“GT typically presents as pain over the greater trochanter (the bony lump felt at the side of your hip). Symptoms may spread into the outside of the thigh and knee. It is commonly misdiagnosed as hip joint pathology, ITBS, sciatica or as being referred from the lumbar spine. GT is a good example of how clinical knowledge has progressed in recent years. Initially it was thought of as inflammation of the trochanteric bursa – a fluid filled sac that sits over the trochanter. However as research developed we realised 2 rather important things. The bursa may not be the issue and there isn’t really any inflammation. Later the condition was termed Greater Trochanteric Pain Syndrome (GTPS) but further research has enabled us to be more specific with the diagnosis. Bird et al. (2001) examined MRI findings of patients with GTPS, they found that nearly all patients had evidence of Gluteus Medius Tendinopathy. Swelling of the bursa was present in just 8% of cases and did not occur in the absence of gluteal tendinopathy.

The primary pathology of Gluteal Tendinopathy is most likely an insertional tendinopathy of the Gluteus Medius and/ or Gluteus Minimus tendons and enlargement of the associated bursa.”

Second, a study published in the BMJ (May 2010) shows its both education AND exercise which results in greater improvement at both 8 and 52 weeks (as compared to corticosteroid injections or ‘wait and see’ approach) in Gluteal tendinopathy. Again, how education is an important piece of the pain puzzle. Most often people experiencing pain do better with both education and movement, according to current research.

Third, right at the end of the podcast, Tom briefly mentions how hormones may play at part. Interesting again, as this is very common presentation for women who would be experiencing menopause. As noted above, 1 in 4 women over the age of 50 (myself included 🙂 )

In this systematic review and meta-analysis of 102 studies, published in the British Medical Bulletin, Jan 2016 they conclude “the role of hormones in tendinopathies is still controversial.”

However,

“The continuous modulation of female sex hormones during the menstrual cycle affects the composition of tendon collagen, because the connective tissues express receptors for both estrogen and progesterone. This leads to a clinically relevant condition in relation to physical training and musculoskeletal performance of female athletes.” 

Key points for me through all this is that education is a key component so “the patient” has some control. Our current systems typically leave out self-efficacy or agency of a person and rather encourages a dependence, passivity and ‘have someone else fix it’ situation. Knowing you have some understanding and influence over your health rather than the usual doubt, uncertainty and fear can go a long way.  Though this does involve engagement, commitment and doing the work.

On the topic of hormones, well let’s hope that future researchers will see the need to account for such differences rather than using only males for most health-related studies. I understand it’s difficult to do given the cyclic nature, but surely it makes a difference.

If you’re interested in this, suffer from on-going pain in your a**, or are curious about how hormones may play a part I encourage you to read further. Or, you can always comment below to discuss.

  1. Running Physio blog post: New study is a LEAP forward. He’s written a few over the last month, you may want to check out.
  2. BMJ (June 2018): Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial.
  3. British Medical Bulletin (Jan 2016): Hormones and tendinopathies: the current evidence

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