Greater Trochanteric Pain Syndrome (GTPS) causes discomfort on the outer side of your hip. While previously it was believed that GTPS was caused by inflammation of fluid-filled sacs called bursae in your hip joint, research now indicates it may more often result from injury to the tendons attaching gluteus medius and minimus muscles to the top of your femur bone.
1. Gluteus Maximus Stretch
The gluteus maximus is one of the largest muscles in your body and plays an essential role in hip extension and abduction, stabilization of pelvis during stooping, connecting with the iliotibial band for steadiness of head of femur on lateral tibial plateau, stabilization during stooping as well as steadying head of femur with its head on it via its connection point iliotibial band connection, stabilization.
Gluteal tendinopathy (commonly referred to as greater trochanteric pain syndrome, or GTPS) is a condition affecting the tendons and muscles on the outside of your hip that often manifests itself as hip pain when getting out of a chair or climbing stairs. While no single factor causes GTPS, often small changes over time lead to this condition becoming apparent.
GTPS symptoms typically include hip and/or knee pain when stooping or walking up stairs, and standing on one leg. It is essential to determine the source of your discomfort as tight gluteal tendons could make stretching and relaxing during movement more challenging than necessary.
Exercising exercises that target the gluteus medius and minimus muscle groups can assist with stretching of hip flexors, including the seated figure four stretch and sideways step-up exercise.
For the seated figure four stretch, lie on your back with both legs bent, then pull your left knee toward your chest while keeping the other leg flat on the floor. Hold this position for 30 seconds before switching sides and repeat.
The sideways step-up exercise targets hip flexors. You can perform it by placing your feet shoulder-width apart and slowly taking backward steps of 5- to 6-inch steps until reaching an equilibrium point – your goal should be 15 repetitions in succession.
2. Gluteus Medius Stretch
Tight glute medius muscles can contribute to back pain after squatting or balance issues when standing on one leg, and strengthening this hip muscle can be used to either prevent or address these issues. Strengthening this hip muscle is a great exercise for people who have undergone surgery or suffered an injury as it helps build overall gluteal strength and balance.
The gluteus medius muscle is responsible for abducting legs to one side, also assisting with medial-lateral rotation of knee joints, making this muscle an invaluable ally in single leg squats, jumping sports or any activity requiring jumping or running. Strengthening it may provide additional advantages in single leg squats or sports that involve jumping.
To perform this clamshell stretch, lie on your side with most of your weight balanced over one leg. Move your top leg back and forth until a stretch occurs on the outer hip – hold for 20 to 30 seconds then repeat on other side.
Add resistance bands or increase the height of the step you are using to increase the difficulty. Add dumbbells or barbells across your shoulders for even more challenge!
Another variation of the figure four stretch, this exercise can help strengthen and activate your gluteus medius muscles without needing to bend forward or press against a wall. You can do it while sitting on the floor by crossing one ankle over the other; or while lying down on a yoga mat with a massage ball between your knees. Moving the ball can target different areas of the hip for maximum benefit from this workout.
3. Gluteus Maximus Extension
The gluteus maximus is a large muscle located on the outside of each hip that plays two primary roles in hip movement: extension (straightening leg back from body in sagittal plane) and flexion, or moving leg forward and out to side from bent position; it also helps regulate knee movement.
The greater trochanter is a bony outgrowth on the outside of the hip joint that features four facets that connect tendons from gluteus medius (GMed), gluteus minimus (GMin), and tensor fascia lata (TFL) muscles to these facets, often known as the “rotator cuff of the hip”. Their tendon attachment points also wrap into an ITB band for protection.
Studies have demonstrated that when the gluteus maximus does not fire optimally, this can put undue stress on the ITB and ultimately result in hip pain. To strengthen and activate the gluteus maximus and optimize function, bodyweight exercises that target this muscle such as Side-Lying Hip Abduction are beneficial in strengthening and activating it – one such example being Side-Lying Hip Abduction.
This exercise requires no equipment and can be completed both at home or the gym. Start by lying on your side while keeping your head up and core strong; use your glute muscles to lift your top leg toward the ceiling using only your gluteus minimus muscles; this exercise works your inner thighs, quads, and gluteus minimus simultaneously for an excellent lower body exercise that’s gentle on knees.
Studies conducted recently aimed at tracking EMG activities of gluteus maximus and semitendinosus muscles were recorded as subjects performed four modalities of an active prone hip extension exercise with four positions for knee extension: Knee extension only (KE), without knee extension (KF), knee flexion only (LHR) or lateral hip rotation with knee flexion and KF (LHR-KE). Results demonstrated that exercises performed with FE and LHR exercises increased gluteus maximus activation while decreasing semitendinosus activity significantly.
4. Gluteus Medius Flexion
The gluteal region (commonly referred to as buttocks) includes numerous muscles that protect and drive your hips, such as gluteus medius and minimus. If you experience pain on the outer side of your hip, it is likely due to injury or irritation of these muscles and associated tendons – this condition is known as greater trochanteric pain syndrome, or GTPS; it often arises as a result of overusing standing movements like walking, running or sitting for extended periods.
One of the most widely practiced exercises to strengthen gluteus medius (GMPS) is the Clam or Clamshell Exercise, which involves lying on one’s side with various degrees of hip flexion. This routine has become an indispensable component of many Pilates classes as well as being prescribed by fitness and health professionals as an effective means to strengthen this muscle group.
Exercise for people living with GTPS because it causes compression of gluteal tendons around the greater trochanter. This occurs because an overlap occurs between upper portions of gluteus maximus and gluteus medius; as a result, an external rotation torque is created, while abduction torque occurs with each lower section ovelapping with each other resulting in additional compression at the greater trochanter. Furthermore, its insertion point into the iliotibial band is further away than it normally would be from greater trochanter for an increased lever arm when performing internal and external rotation of hip internal/external rotation exercises.
Selkowitz and colleagues found that hip flexion caused lower gluteus medius activation to increase, yet when performing internal and external rotation exercises on hip flexors the upper gluteus medius has an even higher lever arm than its counterpart flexors to produce far greater force than their lower counterparts could.
5. Gluteus Medius Extension with Gluteus Maximus Stretch
Although an integral component of hip movement and knee support, the gluteus medius often goes overlooked. Although this essential muscle is involved with everyday activities like squatting, hip hinging and running – it also plays a vital role in maintaining derriere shape!
As there are plenty of effective gluteus medius exercises to keep it healthy and strong, one effective combination involves the low side plank with a lateral leg lift – the latter specifically activates your gluteus medius as well as other core muscles. To do it properly, start in plank position with elbow under shoulder stacking feet on top of one another then engage your core and squeeze glutes before slowly lifting top leg until stretch in upper hip is felt – hold position for 30 seconds then switch legs.
Gluteus medius pain is an often-recurring problem caused by repetitive movements, poor posture and sedentary lifestyles. Thankfully, there are some simple exercises you can perform from the comfort of your own home to reduce discomfort and prevent future injuries to help alleviate pain and avoid future incidents.
If you are experiencing any of the symptoms associated with greater trochanteric pain syndrome, reach out to us to schedule a consultation with one of our expert physiotherapists in Toronto. Together we can create a tailor-made treatment plan and get back on the path toward recovery!
