Gluteal tendinopathy AKA – Hip bursitis

A common injury we see presenting to the clinic is pain on the side of the hips – commonly referred to as hip bursitis over the years. The name has changed over time, from hip bursitis, trochanteric bursitis to now commonly referred to as gluteal tendinopathy. Our understanding of the tissues involved has also evolved, which I will go into further detail below.

Often the most common complaints is that it hurts to sleep on the involved side – and thus causes a lot of interrupted sleep. The bursa that sits on the side of the hip is often blamed, though this is now known to not be the main cause – rather it is a symptom. The main pathology is the tendon of the gluteal muscle – which sits on top of the bursa – it is weak. As a result, the tendon thickens and pain generators are active – causing the tendon to become sensitised.

Gluteal tendinopathy is more common in women than men, especially after menopause. It can also affect people who do activities that involve a lot of running, jumping, or twisting of the hips. Some of the symptoms of gluteal tendinopathy include:

  • Pain on the side of your hip that may radiate down your leg
  • Difficulty sleeping on the affected side
  • Difficulty walking, climbing stairs, or getting in and out of a car
  • Reduced range of motion of your hip joint

What causes It?

The main cause is overloading or too much compression of the tendon. This can happen when you:

  • Stretch your hip too much or too often – across your midline
  • Cross your legs when sitting or lying down
  • Stand with your hip tilted to one side
  • Wear shoes that are too high or too low

The interesting thing about gluteal tendinopathy is that you can do these things for years and you will have no symptoms. Although there could be a time when the tendon becomes fatigued – often due to an increase in activity over a short period of time and that can flare up the tendon.

How can it be treated?

The first thing we need to do is desensitise the tendon – that is stop irritating it! The number one thing to do is to stop stretching it! A lot of people think stretching the tendon will help, but this just irritates it. The next thing to do is stop the leg from crossing your midline – which means the tendon is not stretched or compressed.

Seeing a chiropractor can help by providing education and also:

  • Hands on treatment to mobilise and manipulate your joints and soft tissues
  • Exercise prescription to target your gluteal muscles and other supporting structures
  • Advice on how to progress your activity level safely and gradually

Gluteal tendinopathy can be a chronic and debilitating condition, but it does not have to be. With proper management and care, you can reduce your pain, improve your function, and enjoy life again.

Call 99975773 to book in to see one of our chiropractors so we can fix your gluteal tendinopathy today!

Mitchell Roberts – Chiropractor

Tennis Elbow

Over the past 2 years, I have seen an inrease in tennis elbow presentations to the clinic. This is likely the result of a number of people taking up tennis as a new sport during the lockdowns as it was one of the few sports you could still play, all be it – singles (Hence a lot of people who normally play doubles were now playing singles, therefore htting the ball twice as much as normal)

What is tennis elbow:
The injury is a tendinopathy, with the technical name being lateral epicondylopathy – or what used to be referred to as epicondylitis (-itis meaning inflammation, although studies have shown that there is actually no inflammation at the site of pain, hence we no longer use this name). It is located on the outside of the elbow.
At the cellular level, a breakdown of the tendon can be seen, where it joins onto the bone. Often what happens is the tendon adapts by thickening to try and be stronger. As a consequence, pain occurs as the tendon tries to adapt.

In simple terms – it is a breakdown of the tendon fibres where it attaches to the bone – because the tendon is not strong enough.

What can cause it:
It can be due to overuse, or an underuse of the tendon/muscle. The classic example is someone that has never played tennis before, suddenly starts playing tennis 4-5x a week and therefore the tendons in the forearm/elbow become fatigued very quickly, due to overuse as the tendon was not conditioned for the exercise. Thus, the big uptake in community tennis over the past 2 years has seen an increase in presentations to the clinic with elbow pain.

What symptoms does it produce:
Most people get a dull ache on the outside of their elbow, which is very frequent. The pain is worse when gripping items – such as a tennis racquet, opening doors or jars. It can at times cause pain at night in bed and often the patient can wake with a stiff elbow.

Location of tennis elbow pain
The area where the pain originates from

Treatment:
Tennis elbow is not an injury that resolves quickly. Unfortunately, it can sometimes take up to 6-12 months and can reoccur. The best way to reduce pain and prevent from occuring again is through strengthening exercises for the forearm extensor muscles. Manual therapy such as muscle releases and joint mobilisation can also be very beneficial in reducing pain in the short term.
Often we see is associated neck and shoulder pain, due to over compensation. The patient starts to avoid or change the way they move/use their forearm muscles / elbow and hence there becomes more strain on the neck and shoulders. This is why we often assess and work on shoulder and neck mobility as well during treatment.

What can you do right now to reduce the pain:
An isometric exercise is the easiest and simplest way to get the muscle working and strong again. In the picture below, the elbow is supported on a table and while holding a weight (1-2kg, it does not have to be heavy) with a soft grip, extend the wrist upward and hold it for about 20-30 seconds. Often you will feel some mild pain, which is ok. Perform 3 sets of this daily, especially before doing exercise where you will use the elbow.
Once you get strong with the isometric exercises, you can progress to exercises with movement.

Isometric wrist exercise for tennis elbow
The wrist extended, holding for 20-30 seconds

If you are suffering from what you believe to be tennis elbow, call us on 99975773 at Mona Vale Chiropractic Centre to book and appointment and we can assist you with the treatment and rehab of your elbow.

Mitchell Roberts – Chiropractor

Exercise: Dynamic Warmup and Mobilisation

The terms ‘stretching’ and ‘warmup’ are often used interchangeably, however they are not necessarily the same thing. Stretching and warming up both serve their own purpose in any exercise regime. In my previous blog, I highlighted the importance of stretching and clarified that stretching should be done after exercise and physical activity. Before exercise, mobilising the joints and performing a dynamic warm up is where you should start.

When in doubt just remember MES:

According to former NSW State of Origin player David Williams:

“Warming up the muscles and mobilising your joints before any strenuous physical activity or exercise, is vital for the body to move through its full range efficiently and effectively whilst greatly lowering the risk of injury.”

David Williams aka Wolfman
Click image for animation

Dynamic Warmup

A mobilisation technique or ‘dynamic warmup’ involves easing your joints into full range of motion. This prepares the muscles for movement and wakes up the body’s nervous system. By mimicking movements that you are about to perform in your work out, you are gradually increasing flexibility and blood flow to the areas that will be moving in your sport or activity.

Focus on major muscle groups and the muscles used most in your activity. For example, if you are about to go for a run, you should focus on mobilising your hips, knees, and ankles. If you are a swimmer, you should mobilise your upper back, neck, and shoulders.

Click image for animation

Things to Remember

When doing a dynamic warm up, remember to focus on symmetry. Always do equal amounts of movement on both sides of the body.

Start at a low level of movement and then slowly increase intensity until your joints and muscles feel ready to go.

Remember that some joints will have more range of motion than others. Injuries, ageing, and even genes can restrict some of our joints, so don’t try and force a joint past its natural range.

Sources

Williams, D., 2021. Performance Coach [Interview] (28th June 2021).

Taylor, K.-L., Sheppard, J. M., Lee, H. & Plummer, N., 2009. Negative effect of static stretching restored when combined with a sport specific warm-up component. Journal of Science and Medicine in Sport, 12(6), pp. 657-661.

Published by Sydney LaVine June 29 2021

Exercise: Stretching Before or After?

“Should I stretch before or after I exercise? Or both?”

This is a frequent question asked by my clients when we are talking about movement and exercise.

My job as a massage therapist is to assist my clients with sore muscles, sports injuries, and stress management. Regardless of what ailment a client presents with, we always discuss what they are doing for daily exercise. In this day and age, we all know that habitual exercise is crucial for our health and well being. Reasons to be physically active everyday include:

  • Feeling more energized
  • Burning more calories when at rest
  • Improving overall appearance
  • Ability to withstand stress
  • Improved sleep
  • Speed up recovery from injury or surgery
  • Decrease the risk of illness and injury
  • Keeping focused
  • Building up cardiovascular endurance
  • Improving flexibility and range of motion

The ability to perform daily exercise, requires our joints to be healthy enough to cope with consistent movement. Maintaining our flexibility, joint range of motion, and joint health comes down to the wonderful combination of exercise and stretching. Stretching our muscles has been proven to:

  • Improve your joint range of motion
  • Maintain joint health
  • Improve athletic performance
  • Decrease risk of injury (1)

Now that we have a better understanding of why stretching and daily exercise are so important, when should we stretch?

Stretching should not be considered a warmup. By stretching cold muscles, you increase the risk of injuring yourself. Instead, consider performing mobilisation techniques, which I will cover in my next blog. Stretch after your workout when your muscles are warm. Remember to focus on the main muscle groups that were used during your workout session. (2)

Research shows that stretching before a workout does not reduce muscle soreness in the days after. Other results show that lengthening the muscle and holding the stretch immediately before a sprint may slightly worsen performance. Consider skipping stretching before any intense activity, such as sprinting or track and field activities. Pre-event stretching may decrease performance and create weakness in the hamstring strength. (3)

Gentle stretching at the end of any exercise also gives you a great chance to catch your breath, be still, and reflect on the hard work you just achieved!

June 20th 2021

By: Sydney LaVine

Sources

  1. Harvard Health. (2019, August 26). Retrieved from Harvard Health Publishing: https://www.health.harvard.edu/newsletter_article/why-we-should-exercise-and-why-we-dont

2. Stretching is not a warm up! Find out why. (n.d.). Retrieved 6 19, 2021, from https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931

3. Taylor, K.-L., Sheppard, J. M., Lee, H., & Plummer, N. (2009). Negative effect of static stretching restored when combined with a sport specific warm-up component. Journal of Science and Medicine in Sport, 12(6), 657-661. Retrieved 6 19, 2021, from https://sciencedirect.com/science/article/pii/s1440244008000790


We are open

As a primary health provider we are open during the latest Covid19 outbreak. We ask that you wear a mask and you must register using the QR code when you enter the clinic. You are allowed to attend an appointment if you are coming from outside the northern zone of the Northern Beaches

WE are OPEN NORMAL HOURS

During the Covid19 crisis, as Primary Health Providers, Mona Vale Chiropractic Centre is open as normal. We understand that this is an incredibly challenging time for all of our patients. We are here to support you in any way that we can. We are following all government recommendations in keeping our clinic environment to the highest health standards.

3 exercises to prevent low back pain

These 3 exercises are termed ‘the Big 3’ by spinal researcher Dr Stuart Mcgill. The exercises are performed in a neutral back position – a spine sparing position and it helps to build muscular fitness along with stability and control throughout the spinal column. Spinal stability is what creates a strong core.

You do not have to be in pain to perform these exercises. These are actually best used as a preventative method to prevent back pain! Although if you are in pain, they are still a great way to help you get your core switching on again.

Some things to note:

·   The exercises must be performed daily

·   The best time is mid-morning or dinner time. Not upon waking – as this is when the spinal discs are at their fullest and therefore less room to move

·   Reps and sets are important to what you can tolerate. There is no point trying to push through excruciating pain. Find your level and then progress

·   Try and ensure that all 3 exercises are performed in a pain free posture for your spine.

1. Bird dog

Position yourself on all fours. Raise your right hand forward while simultaneously extending your left leg back, until both are parallel. Bring both arm and leg back into the resting position and then repeat with the opposite arm and leg. This is one rep.

Make sure your pelvis has minimal rotation while performing this exercise. The value of this exercise is coordinating upper back, lower back and hip movement all together.

Perform 1 set of 8, followed by another set of 6, with a final set of 4.

2. The side plank

Lie on your side, resting on your bent forearm, with your legs straight out

Lift your hips off the floor and hold for 10 seconds. You should feel your abdominal muscles and obliques (side) working. This exercise also works the quadratus lumborum (QL), a major spine muscle that plays a role in spine flexion and rotation. This exercise gets the  QL and oblique muscles working together in coordination.

Perform 3-4 holds per side of 10 seconds each. Repeat for 3 sets, but with each set, reduce the reps by 1.

3.      The curl up

The Mcgill curl up is not like your traditional curl up. There is no movement from lumbar spine.

Start by lying on the ground, with 1 leg bent up and the other leg straight (the painful side should be the one with the straight leg). Place both hands under the small of your back, this will ensure minimal movement through the lower back.

Lift your head off the ground by a few inches and then hold it there for a count of 10. The goal is to perform this without any movement in the lower back. If you feel your lower back rounding, then your head or shoulders are too high off the ground.

During this, you should feel your abdominal muscles brace – this is the spinal stability

Repeat another 5 times for a total of 6 reps. The recommended volume is 1 set of 6, followed by another set of 4 and the final set of 2. You do not need to hold the curl up for more than 10 seconds, rather to progress you can increase the reps.

Conclusion

I recommend using these exercises every day as the best preventive measure to avoid lower back pain. If you do have back pain, they are also great to perform as they can be done in a pain free position. The key is being consistent, once a day and before any exercise.

Mitchell Roberts – Chiropractor