[Burdy]

I hate that this is my first post here. I am a 46 y/o male and I had a V02 max test done on Memorial Day of this year, mainly for the purpose of establishing my HR zones, and while my actual VO2 Max was impressive, it was clear that I had aerobic deficiency. I bought Training the Uphill Athlete and started to put the program into play and had incredible success over the past 2.5 months, dropping my mid Z2 pace by over 2 min per mile.

Unfortunately, the part of the book I ignored was the part about doing “too much” too soon. Along with going from about 2.5 hrs of time on the feet over 4 days/week to around 5 hrs over 5 days/week including 1h of incline ruck walking with ~32lbs, I guess it was too much. I developed a lingering sore hip that eventually got to be noticeable enough to cut one of my runs short. After a trip to the doctor yesterday I was diagnosed with Gluteal Tendinopathy and am being sent to physical therapy. Looks like this is a bugger of a injury that could have quite a long road to “recovery” that may not ever be to 100% again, at least not technically.

I am curious if anyone has ever had or known someone who has recovered from this well enough to continue to run at a level near their baseline prior to the injury. Any help would be appreciated.

[Dr Andy Reed]

Good morning

Thanks for your question. I have a few additional questions, and if you wish to take this to a less public forum, Evoke does offer phone consultations and I would be happy to discuss this with you.
First off, you are correct that this was probably a case of ‘too much too soon. ‘ When tendons become sore, they have almost always been subject to excessive overload. Our cardiovascular system adapts rather quickly to training but our tendons, muscles, joints and ligaments take much longer, so it’s not uncommon to be ramping up the training load then wham, an injury hits.

My questions: 1) can you describe the symptoms? Usually the pain in this condition is over the outer aspect of the hip – at the bony prominence (greater trochanter). It’s often sore to lie on, and getting  up from sitting can cause pain.  2) Have you had any imaging? I find X-rays are useful to rule out other problems that can mimic gluteal tendinopathy. Ultrasound can also help with diagnosis.

Assuming the diagnosis is correct, then physical therapy is the first line treatment with exercises designed to progressively strengthen the hip abductors and rotators. Shockwave treatments can also be very helpful. The good news is that you can often continue to train through this – at a modified and reduced load – and you will certainly be in the gym.

Sometimes these do become persistent but I find this is much more common in older postmenopausal females.

Lastly, we do sometimes do injections but only if the problem becomes very severe or persistent.

Hope that’s helpful.

[Burdy]

Dr. Reed, thank you for the response. After attending physical therapy and PT having a different diagnosis than my GP, I decided to just spring for an MRI to be sure. Turns out both of them were wrong. I have trochanteric bursitis, which it seems to be a better outcome than gluteal tendinopathy. Similar symptoms and it seems like similar recovery/rehabilitation methods however.

The one issue that was revealed in my PT session, that could very well be a major contributing factor to his (in addition to the load) is that my left leg is significantly weaker than my right. I have a quite a strength imbalance there that I was unaware of. I am looking into the Evoke consultation as we speak as I would prefer to sort this out with someone very familiar with these issues.

[Dr Andy Reed]

You are right – very similar symptoms – and in fact the two conditions very commonly co-exist. In fact, a lot of people are told they have hip bursitis when in fact it’s Gluteal Tendinopathy. Hip weakness – particularly in the abductors – contributes, as when we walk or run, we need strong hip abduction during the stance phase to maintain a level hip position and prevent hip drop on the other side (adduction) which essentially compresses the trochanteric bursa up against the outside of the femur. With repeated compression the bursa becomes swollen and irritated. Your PT should be able to prescribe exercises to improve your hip strength. NSAIDs and/or injections can be helpful into the bursa if it is slow to settle.

[Burdy]

Submitting consultation request now.

[Author]

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