11 of 12 Top Hip Papers – Gait and gluteal tendinopathy

PAPER 11: Kinematics and kinetics during walking in individuals with gluteal tendinopathy

Pain in walking is a substantial factor underlying the disability and loss of quality of life for those with gluteal tendinopathy. The wider reaching implications can be substantial – the impact of reduced activity levels on physical and mental health and for some, difficulty with walking impacts on their ability to perform their work duties. Investigating if there are differences in the way people with this condition walk, may help us understand why there is pain in walking and how we might address this issue.

Kim Allison did some wonderful work in her PhD studies on gluteal tendinopathy, finally providing important information on impairments in this population. Prior to this body of work there had been no studies to help us direct our treatment approach, not even a study on hip abductor strength! It had just been assumed that the problem was ITB tightness, although there had never been evidence to support this hypothesis. Kim’s work included assessments of muscle strength, and kinematic and EMG assessments of key functional tasks with which people with gluteal tendinopathy have meaningful levels of disability – walking, standing on one leg and stair climbing.

Here I have chosen her gait kinematics and kinetics paper as a showcase of this work and the contribution it has made to the evidence base for physical assessment and management of gluteal tendinopathy.

Key learnings about gait and gluteal tendinopathy:

• During stance phase of gait, those with gluteal tendinopathy demonstrated a significantly greater (9-33%) external hip adduction moment than painfree individuals
• This means that higher than normal internal loads are placed on the abductor mechanism to balance these forces
• Pelvic drop explained more of variability in hip adduction moment than any other factor in the gluteal tendinopathy group
• There were 2 main strategies used by those with glutes tendinopathy:
  • Large lateral pelvic drop + contralateral trunk lean (Uncompensated Trendelenburg)
  • Small lateral pelvic drop + ipsilateral trunk lean (Compensated Trendelenburg)
• Addressing excessive frontal plane deviations of the pelvis and/or trunk through movement training and optimisation of hip abductor muscle function may reduce pain and disability associated with gluteal tendinopathy.

If you'd like to learn more about gluteal tendinopathy, you might like to take a course, a workshop, or join Hip Academy for this and much more hip learning.