Understanding hip, buttock, and thigh pain that is often worse at night

January 26, 2017

While there can be many reasons and causes for pain in any area of the body by far the most common problem for pain, in the hip/buttock/thigh area, is Glut Med Tendinopathy.  Compression Syndromes are often worse at night and during some activities like walking up steps.

People who have Glut Med Tendinopathy often complain of one or more of the following…pain in the hip at night when lying on the problem side, turning over in bed hurts, walking…up-stairs or hills makes the pain worse. The night or morning after exercise is often more painful, getting out of chairs may hurt for a few steps or standing for too long brings on pain in many cases. If there is leg pain then it often radiates down the side of the leg up to 15cm below the knee.  Many women suffer with this condition, often in silence, with serious consequences because it starts to impact many aspects of life. Being female makes you more susceptible to Glut med Tendinopathy because of the pelvic angle, lady-like gait rather than the wider male gait, a history of carrying children around on the hip and hormonal changes.

This particular musculoskeletal problem has not been well understood until recent years.  There has been collective evidence studying imaging over the last two decades that has raised questions.  In recent years Dr. Alison Grimaldi enlightened the medical world as to Glut Med Tendinopathy, its causes, symptoms and best intervention for recovery. Her PhD study of pelvis and hip stability made a significant leap forward to successful intervention. The results from Dr. Grimaldi’s research were made available in medical journals by the year 2008. 

Tyack Health practitioners were treated to a personal in depth presentation by Dr. Grimaldi on her most informative PhD study. Employing this knowledge as a team has helped many suffers with this debilitating life limiting complaint, experience full recovery.  As is often the case if Glut Med Tendinopathy is not addressed, poor function in the muscles of the buttock lead to other musculoskeletal failures and issues.

How can a professional help?  The practitioners at Tyack Health address Glut Med Tendinopathy first with an assessment which includes asking exactly where the pain is, palpating to find if there is a tendon tension/pain/swelling type of feeling deep at the side of the hip. The trained practitioner then assesses which movement brings on pain along with other specific tests to confirm or find differentials to the diagnosis of Glut Med Tendinopathy  If the assessment indicates that complications have begun to develop such as asymmetry or imbalances in structure or function the chiropractor or physiotherapist will address these with therapy to create favourable tissue tension to stabilize painful structures. Glut Med Tendinopathy responds well to the team approach developed at Tyack Health. A combination of Chiropractic, physiotherapy, massage and rehab exercises achieve the best long term outcomes.  Education on lifestyle modifications as defined by Dr. Grimaldi is an essential aspect of team approach.   

Glut Med Tendinopathy may be most painful at night, particularly lying on the side or when initiating rolling over. Similar pain may occur with going from sitting to standing. A medical quality memory-foam overlay is recommended on the bed to minimize compression.  Eccentric exercises are some of the most beneficial and best done with practitioner supervision. Latter they can be carried on with the help of a partner at home.

What causes Glut Med Tendinopath? Back and hip pain is a very common problem affecting most people at some time in their life. These strains occur from simple daily activities, times of rapid hormonal change, repetitive work tasks, sports or trauma due to injuries and/or accidents. For some others it is more a case of micro-trauma from prolonged postures and sedentary lifestyles that create poor function in muscle and joints.  Activities that involve twisting, bending or asymmetric movement patterns make the joints and spine especially prone to stresses.  Recent studies and research have highlighted that Glut Med Tendinopathy is the cause of pain in a much higher percentage of back/hip/leg pain cases than previously understood. Radiological and surgical studies have now shown that the primary pathology in the majority of cases of lateral hip/thigh pain is Glut Med Tendinopathy. Other studies addressing the prevalence suggest that degenerative tears in the gluteus medius or minimus tendons occurs in 20% of patients with osteoarthritis of the hip; 20-35% of patients with low back pain also have Glut Med Tendinopathy often with referral down the lateral thigh. Pain from Glut Med Tendinopathy is often misdiagnosed as low back problems. Low back and pelvic problems often develop as secondary conditions to Glut Med Tendinopathy. If long term relief is to be achieved the primary cause must be addressed. 

When Glut Med Tendinopathy is not well managed it can lead to years of inappropriate or ineffective treatment. Glut Med Tendinopathy is much more common in females with a ratio of 3:4.males to females. The group with the highest incident of Glut Med Tendinopathy are professionals who stand for long periods such as teachers, those going through rapid hormonal change especially women, young athletes, runners and those who do step training.

Imaging has shown that in the early stages of this condition the muscle can hypertrophy or become more swollen and at other stages there can be wasting in these same muscle. As we have all heard "the foot bone is connected to the knee bone, the knee bone is connected to the thigh bone and so on. Keeping it all functioning with clear, efficient communication between the soft tissues, nerves, vessels and bones is one of the body's ultimate challenges. 

Why is Glut Med Tendinopathy called a compression syndrome?  You might be surprised to learn that muscles can get pinched. When Dr Grimaldi's research demonstrated that muscles at the side of the hip/thigh were getting compressed it came as a surprise. The side of the leg has large attachments to the bone, at the line where the hip joint bends when you flex your hip to put on footwear.  The Gluteus Medius attaches to a bony protrusion over which is the attachment tendon for a long fibrous muscle group called the iliotibial band. When this band gets too tight it actually compresses or pinches the gluteus medius tendon. Because the gluteus medius has a major role in helping us stand upright, this creates a problematic situation and leads to considerable pain and handicap or even tears if decompression isn't addressed.  The professional intervention programme proceeds with well timed management, there is much greater tendon load when exercises are speeded up.  Intervention can fail if progression from one stage to the next is too rapid..  

Today, more than ever, large numbers of people are running, stepping, exercising at gyms and on home equipment which is a good thing for fitness but if the mechanics are not right, exercises can become problematic where the buttock and hip attachments join. 

People at risk maybe those who love to keep fit and exercise, sit at work stations, drive motor vehicles, carry small children and other loads.  If you  simply love life and want a body that works well at all stages even through to later years you are best to have physical health check ups so conditions such as Glut Med Tendinopathy can be picked up early and prevented.  'Prevention is better than cure when there is no cure'  is a famous saying by one of the worlds leading spinal experts. While there are answers for Glut Med Tendinopathy especially before tears occur, scaring and tears become lifelong problems.

In summary; success or failure in the long term is dependent on best management of the condition.  This includes education about compression syndromes, specific rehab exercises at the right time without moving to the next stage before the condition has stabilized in the present stage.  The person with Glut Med Tendinopathy will need to be committed to lifestyle modifications. There is evidence that Glut Med Tendinopathy is one of the most prevalent physical conditions leading to disability. When Glut Med Tendinopathy is unaddressed disability involving low back, buttock, hip, thigh, knee and shin often occurs long term and may predispose to tears in the glut med tendon.

There is good and bad news for those who suffer the condition.  The good news is it will go away and disability can be prevented by employing evidence based management.  The bad news is it will take time and commitment to recovery, usually about twelve months until tolerance levels are stabilized.

Why is it so hard to treat?   There is clinical evidence that failure to achieve long term relief in cases of Glut Med Tendinopathy has several crucial factors; inadequate education as to the cause and what this compression syndrome involves, ecological factors and how to avoid them with lifestyle modification and  too  rapid advance in the exercise programme especially with single leg tasks.   A graduated specific exercise programme is vital to address muscle imbalances in this condition.   Trained practitioners offer sufferers of this condition instruction to modify activities until the tolerance level is improved with therapy and rehab. 

The multidisciplinary approach employed at Tyack Health involving, assessment, education, treatment and rehabilitation has been effective in stabilizing hundreds of cases of Glut Med Tendinopathy.  This comprehensive approach was developed at Tyack Health in 2009 after the ground breaking research of Dr. Alison Grimaldi was published. Prior to this, the condition was often treated as low back pain, trochanteric bursitis or sciatica with various procedures that varied from injection to surgery.   The good news is long term relief can be achieved by addressing this problem in a complete, whole way and when this knowledge is shared with the rest of the family or friends they can be saved from the condition. Dr Grimaldi’s Phd study high-lights the major role these amazing Glut Med muscles do to support the body to be upright.   Walking on the flat, cycling, swimming with a free style kick are activities that these muscles mostly tolerate well. In summary Glut Med Tendinopathy is one of the most prevalent syndromes that lead to disability. The good news is we can prevent such disability and while medical research is adding years to our life good physical management adds life to our years.