Gluteal & Hamstring Tendinopathy Flashcards
what is the primary pathology of tendinopathy? secondary?
gradual change
inflammation
what is the most prevalent LE tendinopathy?
gluteal tendinopathy
who is more at risk for GTPS?
women
> 40
sedentary individuals (doing too little is same as doing too much)
what are risk factors for GTPS?
female
high BMI
excessive hip ADD
weak hip abductors
coxa vara
plyometric overuse
what structure is primarily involved in gluteal tendinopathy?
greater trochanteric bursa
what muscles are involved in GTPS?
—primary
—secondary
primarily glut med/min
secondarily TFL/IT band
in relation to greater trochanter what position does the following muscles sit:
GMed
piriformis
GOGOs
quadratus femoris
12 o’clock
11 o’clock
10 o’clock
9 o’clock
what is the primary driver of gluteal tendinopathy?
abnormal mechanical loading
what are the two ways excessive loads are applied longitudinally or perpendicularly?
tensile loads occur with concentric loads
tensile and compressive loads occur with eccentric loads, particularly in lengthened ranges
could TFL/IT band over recruitment play a role in GTPS?
yes - L4-S1 regional interdependence can also play a role
could excessive femoral adduction (one example of impaired LE control) cause GTPS also?
yes - excessive loads can occur with impaired LE control
what are symptoms of GTPS?
gradual and unknown onset but possible overuse/lower supply
increasing lateral hip P! and maybe lateral thigh
what could increase symptoms of GTPS?
walking, running, stairs, any single leg loading
prolonged sitting, esp crossing legs as IT band tension increased thru Gmax lengthening, particularly in lower seat and then first few steps
lying on involved side - interrupts sleep
–> could be painful to lay on other side due to hip ADD
what would decrease symptoms of GTPS?
rest
what would you possibly also find with GTPS?
lumbar hypermobility/instability symptoms if aggravated
what would you find in your observation/functional tests for GTPS?
possible antalgic and/or trendelenburg gait
impaired LE control
–> P! and/or weakness with 30 sec single limb stance
–> may need to assess higher level ADLs like jumping/running
what would you find for ROM for GTPS?
- possible lat hip P! and limitation with adduction and IR in neutral (glut med is compressing bursa and/or tendon)
- limitation w/ ER (GMed/Min lengthening) and H add (piriformis lengthening) in 90 deg flexion
where would you find weakness and P! with resisted testing for GTPS?
abduction, esp in adducted position
ER in neutral
IR and H ABD in 90 hip flex
abductors and ERs weak and atrophied
what special tests would be (+) for GTPS?
(+) ER (g med and min lengthening) and H add (piriformis lengthening) in 90 deg flexion
possible (+) Obers
where would appear to be TTP with palpation for GTPS?
over bursa (hallmark sign) > GMed
what is PT Rx for GTPS?
address the cause (victim or culprit?)
–> itis or osis
–> regional interdependence
patient education
– soreness rule
– load management
– avoid provoking positions (prolonged sitting, esp crossing legs and lying on involved side)
– pillow between knees when on uninvolved side to keep you from going into more adduction
POLICED
modalities - shockwave therapy proposed but not substantiated
should you recommend stretching for a patient with GTPS?
no
that is causing max compression and lengthening and may keep it inflammed
what are the primary purposes for MET for GTPS?
tendon proliferation and stabilization (hip and lumbar)
tendinosis parameters - 3 sets, 10-15 reps, heavy load
how should you progress MET exercises for a pt with gluteal tendinopathy?
- isometric loading without compression from lengthening
- isotonic loading without compression from lengthening
- isotonic loading with compression from lengthening
- Closed chain hip abd, ER, ext
- plyometric loading
