FWIW and I’m an engineer not a medical professional… If you sit all day at work, don’t strength train regularly, and are 40+, then IMHO you either have or will likely develop weak glutes and weak posterior chain. And that can lead to other problems, in my case it was the knees. Humans weren’t made to sit. Getting old doesn’t have to suck. Be strong.
@IamDeablo Tendinopathy, or tendinosis, is degeneration of the tendon. To oversimplify matters, it has been damaged beyond its immediate recovery capabilities, then damaged again, partially healed, and the process is repeated. Each cycle weakens the tendon.
This only tends to resolve through strengthening of the tendon, which means loading it. @AntC is spot on here.
The general rehab pattern seems to be isometrics, then eccentric only, then heavy slow full repetitions, then finally explosive work. Generally exercises that compress the tendon should be avoided until at least stage 3. The exact protocol will vary according to the affected body part and needs to be prescribed by a physio or similar.
You should also be assessed by someone who can see if weakness elsewhere is disproportionately loading the affected tendon. For example, it’s common to get people with proximal biceps tendinosis (which presents as pain in the front of the shoulder, usually) to work on the muscles in the BACK of their shoulder and in the lower traps.
You may need to ease up or stop the initially aggravating activity for a while. There’s some evidence that shockwave therapy speeds things up but it doesn’t work on its own.
I’ve worked through bicep and patellar tendinopathy (both non cycling related) this way and am just getting over some (cycling related) high hamstring tendinopathy. The loading process works, though it takes 3-6 months if tendinosis is established.
You might also want to consider seeing a physio who specialises in cycling. If you’re in the UK, Dan Boyd (ex Movistar physio) is very good.
2 Likes
It’s a sit on the couch 3 or 4 out of 10 pain. It can get up to a 7/10 pain on hard climbs, etc.
Yeah been working on that for months. Glute bridges, bridges, clam shells, etc.
Took me a couple years and eventually rolled the clock back a couple decades. In some ways I’m stronger now than in my late 20s / early 30s which says more about the dedication to my career than anything.
That’s good. I’m in my best cardio shape too. I’d be so much further forward without the pain. I’ve tried the sit around and do nothing for months. It never really got better or worse. GP said that there wasn’t something structural to prevent getting back to exercise. The exercise hasn’t made it significantly worse.
I tend to think it’s a facia thing cause roll balls and massage guns help a bit.
Exactly the same here where in my case together with strength work I ‘cured’ my hip FAI
1 Like
Are you on a progressive, supervised program, and have you been assessed by a cycling-literate physio for imbalances and weaknesses elsewhere?
In addition to the exercises/stretches I’ve been doing, I’m going to be trying Rofling based on a recommendation on the forum to see if there is value there.
Hello with regards to the protocol that has proven effective to reduce your pain. Do yoh mind elaboring how many sets and times per week you are doing it? Thanks.
For me its varying and just down to how I feel. 2-3 times per week. One set at first if I’m out of practice, two sets when I’ve been doing it as a matter of routine.
This is a really interesting thread to read, with some very sensible posts - probably the most being to see a specialist physio as soon as possible in the process, and to possibly see more than one. I’ve been through an 18-month process of chronic hip flexor pain and groin pain following an increase in intensity/load linked with racing. For me, the most success has always been linked to strengthening. Mostly glutes, abductors and most recently adductors - the latter most recently to iron out the groin pain, all with very specific exercises, patience, setbacks and steady progress! The pain has all been linked to weaknesses elsewhere. Stretching has nearly always been self-prescribed and has probably done more harm than good (despite short term relief) - my physio has largely binned off stretching. Foam rolling and massage is nice, but again I dont think it can fix imbalance or weakness.
The process has revealed all sorts of interesting things, changes in gait and stance, posture, pedaling technique. Realising how pathetic my glutes/back/hamstrings have become over 40 years and why I’ve always been so crap at squats and deadlifts! Now seeing power on the increase again for the same perceived effort/HR, and (nearly) pain free.
I’m fairly certain I have adductor tendinopathy and sensibly loading them is really helping, I wonder if your situation could be the reverse, that imbalances elsewhere are causing an overloading of your glute med and subsequent tendinopathy? Anyway - good luck!
1 Like
This is a reasonably conservative treatment I would definitely try and has level one studies to support the evidence. Make sure you get the right PRP that is Leucocyte rich though and also that they guide it with a ultrasound to get the correct area .
How is your recovery going? I was diagnosed (via MRI and physio) about 4 months ago with tendinopathy in my glute medius and minimus, as well as mild trochanteric bursitis. Also have a great bike fit. I had been running 20km a week and cycling 150-200km plus strength training but had to peel things way back, especially running. My rehab has primarily consisted of strengthening my glute max, because my physio looked ay my hip extension firing pattern and saw I was relying too much on my hamstrings (super common).
My physio said a couple of really useful things at the start of my rehab journey.
-
the way through this is to stop firstly stop aggravating the area and to progressively load it as others have said. If you introduce too little load, you won’t see pain relief or strength gains, and if you overload it, you will move towards more lasting injury. The key is finding your ‘sweet spot’ (ha).
-
crossing yours legs in any way, in either direction, is a no-go, as anything that increases your Q-angle is sure to increase the strain on your tendon. Same goes for stretching. Stretching appears to provide immediate relief but actually slows down your overall recovery. Absolutely no glute stretching.
-
no hop, skip, jumping motions or - if you run- running uphill, or for too long, or too quickly. On the bike, no fast cadence drills during rehab (i found this one the hardest).
-
The way to exercise with the correct amount of load means:
- less than 4/10 in pain while exercising
- less than 1 hour of pain or stiffness (in the area) following the cessation of the exercise
- no significant increase in pain or stiffness the morning after.
Tendinopathy can be really tricky and frustrating. I was going really well and yesterday I had to sit down for 6 hours at a wedding and it hugely flared up my pain. For me, personally, I can’t sit down for too long (I spend barely any time in my work life seated, which works well for me).
I hope you find some of this information useful. I actually came onto the forum this morning after my flare up and searched gluteal tendinopathy and your post came up. I’m not a physio but in a former life I was a qualified personal trainer and now I work in medical imaging (with masters’ degree - just to say that I have an anatomy background), and see a lot of people every day for interventional radiology procedures who tell me their injury stories - from sciatic problems to trochanteric and subacromial bursitis.
Interesting points here, isn’t it funny how maladaptive one’s lower leg firing patterns can become over time? Your experience resonates with me. Changes in my overall posture that have come secondary to my rehabilitation have been significant. Hope your strengthening process is continuing to go well.
OP here.
So my journey has been a long one. Here is a update.
I’ve unfortunately had to take extensive time off the bike (6-7 weeks) to be pain free in the hip. I’ve been very stubborn, but it has to be.
I went to see a physio specializing in cycling. Last week.
I should mention that I also have back pain issues, but I have had those all my life (a bit of a curved spine).
After his assessment he, like others has said that my glutes aren’t firing correctly. This is resulting in the pain in my back (taking on work it’s not meant to) and my hip pain.
He said that compliance to treatment is highest when he doesn’t give too many exercises. So he gave me 3.
#1. Snow angels with a band. Laying on my stomach, I engage the core and the raise my legs a few inches off the ground then pull my legs apart and hold for 5 - 10 seconds isometrically. 3 sets of 10. He says this is the most critical exercise to do daily.
#2. One leg bridges. 3 x 10 daily.
#3. Dead bugs 3 x 10 daily.
It’s too early to tell if it will help. I know for a fact that if I just got back on the bike I’d be in pain in a few days so I definitely need this therapeutic phase.
The one other thing he’s said is, due to my desk job and cycling, I am sitting too much and recommended that I look at standing options (like standing desks, etc.)
Hope this helps others.
5 Likes
Sitting is the silent killer.
Hey, how’s your hip going? I’ve had a flare up this month and i thought back to this thread
Would strongly recommend googling the LEAP Exercises out of Queensland - should be able to google it if this link doesnt work. The supplementary appendix is useful if you can find it as it has a really good protocol to follow.
Thanks for this link! I love science