I haven’t heard of this before. I recommend that you get in touch with our PT, Pete Dickinson. Click the blue chat balloon in the lower right-hand corner of posts in this forum to contact him.
January 13, 2020 at 8:11 am #36178tnstaafl2312Participant
I was wondering if anyone ever had to deal with glutes tendonitis?
I’ve been running two ultra last summer as well as i was following Luke Nelson’s Intro to ultras program.
Had to deal with medial glutes pain between the two races. I saw a physical therapist, droped the volume of training for a certain period and then came back to normal as the pain was gone after 3 weeks.
No pain after the second ultra either.
But then, got back from a rock climbing trip last november where i did lots of stemming routes and since then, i cant run for more than 40 minutes and i’m dealing glutes pain again….
Someon has been through something similar?!!
InactiveAnonymous on January 13, 2020 at 8:45 am #36182
While less common than in either the achilles or the elbow epicondyles, the hamstring attachments are a pretty common place for chronic tendonoses. The most obvious symptom is frequently that your butt hurts when you sit on it, I think cause the hamstring attaches right on the bone bump you sit on. I’m no kind of doctor, but if that were to be what it is, as with all chronic tendon injuries a slow, heavy, eccentric loading in a progressive pt program works magic. This paper describes a setup facing backwards on a treadmill to eccentrically load the hamstring (pictures towards the end).
Wow, not much fun to have your running so limited! As usual, there can be multiple causes for medial glut pain. One factor is your training load and progressions, this is where a coach comes in to keep your OES (OverEnthusiasmSyndrome) in check. Fascial tightness through the hamstring/hip/back region can conspire to create asymmetric loads through the region. Fascial rolling can be helpful in this instance. Nerve compression as they exit the spine can send pain to the medial glutes. This then gets into spine mobility, fascial mobility, force attenuation through footwear, and core strengthening for treatment. I see this in ultra runners….a lot! Feel free to use the chat button or email directly for more specifics.
I have some of this going on. It seems to take a long time to completely heal/stop. Two things:
1) If it hurts/aches when you sit on it (which you didn’t say, but has been suggested), it is probably not anything to do with the glutes, except that’s where the pain is referring, and much more likely to be the sacrotuberous ligament. Find pictures of that on Google and you’ll see where it runs. It’s important to know becayse otherwise you are going to be wasting tiem rolling and mobilising the glutes.
2) In my case, I think I sprained the ligament “catching” myself when I tripped coming down a trail descent. That taught me that it is a really important part of my balance/stability system centered on the hips/pelvis. So my rehab includes strengthening/mobilising the hips, putting in the raw materials needed for repair/regeneration (eg collagen and gelatin), and warming up the whole area with an infra-red heat pad BEFORE I do my warm-up 🙂
Good luck with your recovery!
I just recently recovered from upper hamstring tendinopathy (AKA, pain in the…er… glutes). And it was the result of OES as I was training for my first mountaineering course. I went to my chiropractor for it (he’s the best sports therapist I’ve been to — anything musculo-skeletal) after finally looking up what pain with sitting might be from.
I was told to strictly REST it until there was no pain. Essentially any time those tendons are in use and you feel them (very slight to intense pain) you just are doing more damage. It took me about 10 weeks. Really sucks. That’s actually what brought me to UA (via TFNA) — I don’t want to inflict an overuse injury on myself again.
I’m pretty sure the main cause was one-legged dead lifts I was doing. These are one of 2 exercises recommended in Freedom of the Hills, but I started with probably too much weight and definitely not enough recovery time between sessions. Once the tendons got irritated I continued to wreak havoc on them with lots of uphill running — again without regard to recovery days. The 8 hours sitting in the car up and back to the Sierras was excruciating — much worse than the climbing itself! If you have to sit, get something like a round neck pillow so your sit bones kind of hang over the edge. This injury is apparently most common in runners, especially training hills. 🙁
Oh my, I think I can add a bit to this as well as I’ve got some similar issues going on in the left gluteal area. Maybe some of what I’m going to say rings similar to what you guys are experiencing!
It’s no real “pain” in the sense that it hurts, it’s always more a discomfort, like something is tugging in that general area of glutes/upper hamstring tendons. It makes it uncomfortable (but again, not painful) to sit for long. I’ve reduced my running volume since as I can feel everything “tightening” post-run and it feels as though I am unable to properly engage the important muscles in my left glute while running (medius and maximus).
Funnily enough, running/power hiking uphill is when everything feels most normal. And I actually went on an unintended longer outing today of 10.6km and 720m of vertical gain and that didn’t make anything become more tight/uncomfortable than a shorter run would. Maybe the mandatory bouts of walking to keep HR down on the uphill helped.
Skitouring is also no problem and I don’t feel anything strange walking uphill and skiing down and there is no increase in “tightness” (that is just what I am going to call this overall feeling for the rest of the post) afterwards.
My hamstrings are also noticeably tighter. I can still easily bend over and have my hands almost flat on the ground (with straight knees) after warming up, but the hamstrings just do feel tighter.
The “tightness” is sometimes slightly radiating further down the leg, specifically lateral of the popliteal area where the biceps femoris tendon has its insertion. A little bit in the gastrocnemius, too.
I find that light stretching of the quadriceps + rolling it and being very friendly with the lacrosse ball (I’m rolling out sore spots – near the origo and insertion of the piriformis – on my glutes at least every other day) seems to help.
I’m suspecting more a case of sciatic impingement due to the piriformis being tight (because of the radiating feeling I sometimes have), but I might be mistaken. But if it is something along those lines, could it be the result of maybe a case of lower-body crossed syndrome?
Oh and one last thing: I started incorporating this hamstring exercise (forgot the name) where you kneel on the floor, upright (so no “sitting” on your feet with your bum) and someone holds your feet firmly against the ground (or you block them underneath a stair or a couch). You keep straight and start bending forward to lower yourself to the ground as slowly as possible. It’s super gnarly for the hamstrings as an eccentric exercise and I end up holding a slight forward bend for a few seconds before my muscle gives out. Anyway, been doing that and I do feel better overall almost “immediately” after doing it and the exercise itself produces no pain or discomfort whatsoever even though it puts stress on both the muscle and tendons of the hamstring.
Alright, long read, thanks for reading! 🙂
This is a great discussion. It illustrates the many regions and causes of pain in the posterior chain. The medial gluteus is just below the pelvic crest and a common region for inhibition from neural impingement coming from the spine. Sitting pain can be from tendinosis of the tendons attaching to the ischial tuberosities, and neural impingement of the sciatic/pudendal nerves as they traverses through some narrow regions in the area.
Nerves just don’t get impinged in specific spots, they also get held onto by soft tissue adhesions/restrictions. Rolling for fascial restrictions also helps nerve mobility. Everyone’s glutes/piriforis/quads/hamstrings have some densifications, roll them out!!
One to the most significant causes of pain in the area is improper progression of load. Get a coach!!
PeteInactiveAnonymous on January 29, 2020 at 10:19 am #37056
There are numerous esoteric suggestions being thrown around here for this uncommon “problem”. However, seeing the forest for the trees is critical first. The first thing I think about with this sort of complaint is a spinal source. Any kind of problem leading to spinal stenosis, be it herniated disc, spondylolisthesis or congenitally short pedicles needs to be ruled out prior to going down this worm hole of manual therapy. If I had a dollar for every patient I’ve seen with a “hamstring pull” or “piriformis syndrome” who ultimately had a big disc herniation or a grade 2-3 spondy, I’d be living comfortably in Cham. A thorough work up by a clinician with a broad lens would be helpful before investing a bunch of time barking up the wrong tree.InactiveAnonymous on January 29, 2020 at 3:08 pm #37081
Interesting. I have no experience in this area, but thanks for bringing this up. Good to know.
Yes, thank you Brian!
I sure hope my issues do not stem from herniated discs or so. I’m turning 27 in two weeks! I do have slight… scoliosis, is it? Or what is the term when you’ve got a bit of a C-shape in the spine, leaning forward? I got that “bend” roughly at the height of the angulus inferior of my scapulae. That would be too high to neurologically affect down in the hamstrings as those nerves originate from the lumbar spine. ANYWAY.
Piriformis in my case has actually been ruled out, looks like I need a ton of work done (and also need to put in a ton of work) in the abductor area, in the end it’s my gluteus medius that is hard as a rock – quadratus lumborum as well.
I mean really, down the line, I think that overall, in my case, it all comes down to “not the best biomechanics” – I’ve got a wider pelvis obvi, being a woman, so my abductors need to put in extra work to keep my pelvis level because gravity’s having a bigger mechanical advantage on me than on a man with a narrower pelvis. Alright there is that. I’ve also got pretty flat feet and a bit of overpronation going on and I’m sure that this is affecting what is happening upstream a bit as well. I mean, everything is interconnected! Which is why this is all so interesting (and why I am studying it, but I am just at the beginning so I really don’t have much smart input yet).
Anyway, good discussion thread! I am wondering though – as far as I am aware, whenever, say, older women complain of likely nerve-related issues (sciatica), doctors/therapists tend to relate it to a herniated disc issue right off the bat without considering such thing as the piriformis impinging it or something along those lines. Maybe that’s just because it’s a very different demographic from us athletic peeps, but it is quite interesting. My mom had issues with the sciatic nerve and it was indeed not a spinal issue for her.
Alright, enough rambling. Thanks for everyone’s input!
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