Therefore this kind of stretching is the worst thing you can do to your tendon. If you want to develop tendon problems. Keep doing that. Hi guys, rehab safely! Mr. Physio here in Australia. Today I am going to talk about Gluteal tendinopathy According to studies. This problem affects 25% of women at some point of their life and not surprisingly it affects female 3 times more than male so even if you don’t have any problem at the moment, there is a 25% of chance You would have this symptom at some point of your life. If you are a woman. Unfortunately. I’ll tell you why so please watch till the end and share it with any woman. You care about As always. Let’s have a look at the structure first. Gluteal tendinopathy is a problem of Gluteus Medius and Minimus tendons. Anatomically the Gluteus Medius tendon inserts onto the outer and back side of the greater trochanter and the Gluteus Minimus onto the front side of the thigh bone(called Femur). They normally keep the head of the thigh bone onto the hip joint and also stabilize the pelvis. but if they’re weak, the problem starts. I’ve been telling you in all my tendon videos that most tendon problems occur around a bony area This study also supports my statement by saying if these muscles are weak, it can cause compression of these tendons against the bone. so the pain can be reproduced with passive elongation, passive stretch of this involved tendons so when you stretch out these muscles. There will be compression against the bone and stretching the tendon at the same time. So when you cross your legs or sleep on your side, you compress your tendons against a bone which your tendons don’t like at all. The reason why this affects female more than male is also to do with women having a wider pelvis, and a relatively narrow stance causing stretching and compression of these tendons on the outer side of their hips. Women have wider pelvis and relatively narrow stance, so this angle is quite sharper, and that will put a prolonged stretch on these muscles if your muscles are being stretched out. They will get weak. normally these muscles are stabilizing your pelvis. but if they get weak your hip will drop on the other side here and that will stretch out these muscles more and the vicious cycle starts. Therefore this kind of stretching is the worst thing you can do to your tendon. If you want to develop tendon problems, Keep doing that Instead, I will show you some exercises based on this study, which found education plus exercise is better than injection or wait-and-see approach before that we will loosen up some muscles with a tennis ball first one is adductors. if these muscles are tight, They will bring your leg inwards putting a lot of stretch on the outer side. Sit down with the ball into the muscles on the inside of the thigh and just press down and roll side to side. from here above the knee and going all the way up Just right below that area. You can do it on a chair or bed, and we’re going to massage abductors a little bit. So this is the head of the thigh bone and the muscles attached like this From here(bone), maybe 5-7cm up and just push against the wall. Just roll side to side. It has to be very gentle pressure. If it’s too painful. You just stay on it. You don’t wanna push into that bony area because you are gonna compress the tendon again then again. If it’s too painful. You can skip this part. It is also very important to address IT band and TFL Which will be in the next video and we are gonna do some exercises. the first one is hip hitch (Left side=affected side). hold onto the wall and slowly hitch right hip up even if you are lifting the right side, your left side should be activated so I’m feeling around there (left hip) so you can lift up 5 centimetres up. You can start with 5 seconds 10 seconds. And build up to 45 seconds 5 times a day once you can do that, hitch up and (just toe tap) you can do hip swing as well. hitch up and swing your leg back and forth or making circles. again 45 seconds 5 times and next level is hip shift. put legs about hip-width apart or a little bit more and toes a bit pointing out. it’s not facing forwards a little bit out to the side like that and try to push out, so I’m doing this against the ground and squeeze your buttock. then push your legs apart against the ground and you should feel side hip activation From there, you are going to shift your hip side-to-side this way and that way I’m doing this at the moment and that way as well basically you stand nice and tall with your knees straight and push your legs apart and activate that muscle(gluteus medius/minimus) and you are going to move your hip side to side. and squeeze your hip as well or you can rotate your body while pushing your legs out to the side keep pushing and rotating your body side to side so when I move to the right my left abductors get shortened and when I move to the left this will get lengthened This is really hard you can do with one foot up on a footstool. I didn’t put the footstool against the wall, but he should be against the wall so that it doesn’t get pushed away the most advanced exercise for gluteal tendinopathy is single leg wall squat (Link below) also you need to work on quadriceps eccentric control according to many studies, Lack of quadriceps eccentric control is a contributing factor for gluteal tendinopathy. so when you walk, as you hit the ground, your knee is slightly bent. At that short moment, your quadriceps has to stop your knee from going too far forward like this Otherwise your knee goes forward and inwards. that will put a stress on your hip and check yourself. a lot of people bring their knee inwards when they go up stairs and going down as well but this kind of small, faulty movement can put a lot of stress on the hip and knee ankle as well. so that ability to prevent the knee going forward and inwards has to be improved so we will start with partial squats. Have your legs wider than your pelvis and just push your legs apart as we did just now. I’m doing that action, so my knee is a little bit out to the side and just squat down maybe up to there and come back up so your muscles are being lengthened while controlling your knee and once you can do that, You can actually go all the way down to sit down on a chair stand up and knees out going down in about 3 seconds when you do that, you should bring your hip all the way back. So that you can keep your knees behind the toe lines You shouldn’t bring your knees in like that, alright? so you should bring your bum all the way back. It should be nice and controlled at the end rather than collapsing after that you need to combine those muscle activation in one action to improve the connection between those muscles. After that you can do this exercise on a step, going down/up touch the ground and up the most important thing is try to keep your knee a bit out to the side. it shouldn’t go in like that. (Again!) That will put a lot of stretch on the hip, going down and come back up. You can actually start with toe touching and sole of the foot (touching) This is probably one of the most advanced exercises for gluteal tendinopathy after this exercise. You can practice step ups with your knee out and plus it’ll be good to do some calf raises (double calf raises->single calf raises) and it is also important to avoid aggravating activities, like going upstairs with your knee in, lying on the affected side. And sitting in a low chair. So when you sit down, your knees should be below your hip level and a recent study has found it is also related to hormone changes after menopause, so I will keep you updated if they have found anything fantastic, so again! gluteal tendinopathy is also associated with compression and stretching like other tendon issues. That’s why you want to avoid activities that can cause compression and stretching. Instead, You want to do a gradual loading program so that your tendon can be stronger. I hope this video helps. I will see you next time. Rehab safely!