GT

Question 1

Ticket Muscles

Answer 1

GMe, GMi and hip abductors

Question 2

What is GT?

Answer 2

The degenerative conditions of the glut medius and glut minimus tendons that cause pain over the lateral aspect of the hip

Question 3

The role of the hip in GAIT and how it contributes to GT

Answer 3

during gait contralateral hip drops into adduction due to weakness in GMe and GMi. This places pressure on the tendon as it’s stretched across the greater trochanter. There are high levels of compression due to ITB and TFL tendon

Question 4

What are the risk factors for the development of GT?

Answer 4

Female, over age 40, hip abductor weakness, work load spike and co-existing metabolic conditions

Question 5

Why are females more at risk?

Answer 5

tendon health can be negatively affected by hormonal fluctuations (natural menstrual cycle) Magnified during premenopausal period which is why women in40/50 at risk. Tendon insertion onto greater trochanter is smaller and pelvis relatively wider these increased load of GT

Question 6

List the pathogenesis of GT

Answer 6

1. Hip abductor weakness
2. excessive adduction
3. Spike in work load
4. tendon overload
5. tendon degeneration
6. pain and disability

Question 7

What is the histology of tendinopathy?

Answer 7

1. Tenocyte alterations (areas of increased & decreased cellularity)
2. Collagen disorganisation (loss of alignment & microtears)
3. Proteoglycan changes
4. Neovascularisation (infiltration of new blood vessels

Question 8

Presentation of GT

Answer 8

• Lateral hip, over GT
• “tightness” in gluteal region
• pain can refer down to lateral thigh, even lateral leg
• Symptoms aggravated by activities which compress
the gluteal tendon: walking, steps, running, sleeping
(side-lying), sitting cross-legged

Question 9

Physical features

Answer 9

Palpation of gluteal tendon, lumbar spine and gluteal muscles
external derotation test
isometric hip abduction

Question 10

Initial Management

Answer 10

• POLICE (avoid positions that compress gluteal tendon & optimise load)
• Manual therapy: massage (glutes, lumbar spine)
• Exercise for pain relief- isometric loading
• General strength & conditioning
• Psychosocial & general well being

Question 11

Medical referral in initial management

Answer 11

• NSAIDs beneficial: process of tendinopathy involves inflammatory components and tendinopathy is driven by tenocyte activity which is believed to be down-regulated by NSAIDs
• Corticosteroid injections: direct effect on local inflammation, nociceptive pathways. Short term not long term affect

Question 12

What positions should be avoided?

Answer 12

Day time activities to avoid:
→ Stretching the hip into flexion/ adduction

Day time positions to avoid:
→	Hanging on 1 hip
→	Standing with legs crossed
→	Sitting with knees crossed
→	Sitting with knees together

Night time postures to manage:
→ Modified side lying with pillow between knees is generally the best compromise
→ Supine with pillows under knees
→ Side lying compresses both tendons so should be avoided

Question 13

Rehab

Answer 13

1. restore hip abduction strength
2. restore strength of other muscles
3. restore functional strength
4. load management