Hip Pain (glute med tendinopathy)

Let’s please ignore bike fit (I’ve had several) for this post please. Assume my bit has a good fit

I have been dealing for several years now with pain in my left hip. The medical system has frustrated me quite a bit on this one. I’ve had all the xrays and mri’s and whatever and the best they can come up with is glute med tendinopathy.

In terms of treatments, I tried cortisone injections, massage, physio, stretching, etc. So far, the two things I’d had the most success with are a good old fashion hardball and a massage gun (thanks for the forum for that).

My question is, has anyone had this pain in the butt (technically the side of my butt) and did you have success treating it?

Yes, after an L4/L5 spinal fusion I have bouts of pain in my glute/hip, basically the side of my butt, especially while riding.

For me, strengthening the area has worked wonders when I keep up with my exercises, and relapsing to pain when I don’t.

Two examples:
hip raises - lay on my side with five pound ankle weights and with straight legs raise ankles upward. (25 reps each side)
“Figurehead ”? - Number 12 Here (10 reps)

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Hi had hip pain for years managed with Heat treatment to increase blood flow, I did use the gym X2 a week and did strength training also. I now do kettle bell training on top of cycling to keep things managed. And even after yesterdays 307KM cycle with 2700m of climbing the hip is fine, the rest of me beat up the road surface was rough.

Tendinopathies need to be loaded to rehabilitate and make the structural changes in the tendon required to function without pain. Too much to get into in this but google “Ebonie Rio” & “tendinosis” and you should unearth a goldmine. She presented at a conference I attended and is gold

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Do you sit for long periods of time during the day?

Yup.
I started riding again in Feb after a 4 month period off the bike. Developed glute-med issues soon afterward. It’s taken 7 months to finally work it out (90%). Hard massage was a big help, probably the biggest help in terms of both pain relief and restoring functionality. Stretching helped but was more of a keep-it-at-bay modality. It’s frustrating but keep after it.

Yes, this too! Haven’t done any gym work etc, but I have found when I do really hard Z6/Z7 efforts it makes the area feel much better (or at least not worse) and way better than long SS rides.

Sounds like you’re misdiagnosed. Pain in that area is more typically related to the spine than hip.

Yeah there is a possibility this is misdiagnosed, If your pain was caused by true tendinopathy a cortisone shot would have given you some excellent relief although short-lived. See if you can push for a Lumbar MRI and see if there is a large disc herniation. Otherwise topical Voltaren directly to the painful location may help.

-David

There can be positive findings on an MRI report that aren’t necessary the problem causing your symptoms. If the lumbar MRI doesn’t reveal much, then maybe a MRI arthrogram with contrast may help, it is a more sensitive modality.

Gluteal tendinopathy is pretty specific, especially if you have MRI evidence to support this. There are two main misconceptions 1) the injection is the cure- not true it makes it less uncomfortable to go hard at your rehab 2) the rehab takes 6 weeks - rarely true 3-6 months is more realistic.
Tendinopathy is generally due to weakness in the eccentric phase of muscle action, so side lying leg raises don’t work but slow lowering would. Google the Prehab Guys.
An L4/5 nerve root compression would give you pain in this area as a branch of the gluteal nerve drives gluteus medius. A good spine surgeon would pick it up on MRI. No need for contrast images.
Ironically, it may be your glute med is ok, but painful. You may have tight adductors on the inner thigh and these are inhibiting glute med. This often occurs with weak glute max, which is why when you actually recruit this Z6 work everything feels much better. Hope this helps

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All true. For me, at least.

Imbalance probs forcing quad overload, which doesn’t improve things.

Thanks!

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It is tough to know what is going on there but get a second opinion. Could be Bursitis, the Bursa is a fluid filled sack that sits under the tendon to stop it rubbing on the bone and can get inflamed.

Yep

Well the “professionals” say glute med tendinopathy. I just haven’t had any really luck with a long term solution.

I’m throwing out my experience just in case it is helpful at all. I’ve had bouts of pain in the same area, often radiating down the outside of my thigh. I went through rounds of PT and massage. I’ve more or less kept it under control for the last couple of years, and I think the solution has been a combination of single leg bridges, monster walks, banded side-steps, and bowler squats (really a single-legged hip hinge with a twist). I do that hip work every couple of days, and if things seem to be flaring up I work into that muscle with a lacrosse ball or even just my thump. The best I can figure, that muscle gets overworked and clenches up, squeezing a nerve or otherwise causing a lot of pain.

I didn’t have hip pain, instead it was knee pain. The Sports PT for my rotator cuff rehab (unofficially) recommended that I work on strengthening posterior chain and glutes. Humans weren’t made to sit. Following thru on that recommendation has made a huge difference in all areas of my life including cycling.

Maybe try a L-PRP injection. Leukocyte and Plasma Rich Protein. You own blood it taken spun down and the “good stuff” taken out and injected back in. Proven effective in a lot of tendonopathies.

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It may be worth trying to find a good trigger point therapist, I had pain in my upper thoracic back and forearm for years but has been fixed by treating trigger points in the scalene muscles in the neck.

Good luck though

I am dealing with this right now.

I think in my case it was aggravated with a running workout i did last week. But I always feel funny at the start of brick runs.

Unfortunately, mine is a 2 year continuous ache with flare ups that are worse, so stay on that one. The medical system hasn’t been much help.

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