Physiotherapy clinic in Tambaram Are you Lookin...

Physiotherapy clinic in Tambaram Are you Looking for Physiotherapy Treatment in Tambaram, Sunshine Super Speciality Physiotherapy Clinic, We Provide Electrotherapy, Exercise and Manual Therapy, Orthopedic, Neuro, Cardio, Pediatric, Sports and Geriatric Rehabilitation, Post Operative Physiotherapy Treatment, Fracture Rehabilitation, pain free movement. Hip pain! Where about? What causes? How to assess? How to treat, manage? How to educate? Yes, I know. There's a lot to ask and take in. I will talk about gluteal tendinopathy, bursitis! ++ Lateral hip pain Yes. When it comes to lateral hip pain, what first comes through your mind? Yes! Gluteal tendinopathy. I would say that I see 5 to 6 patients with gluteal tendinopathy, bursitis per week at the clinic. Anyways, let me get into this topic. What is it? This is thought to be the primary care of lateral hip pain. Pain over the greater trochanter that may extend down the lateral thigh. when people complain about lateral hip pain and point at the greater trochanter, it can be pretty much gluteal tendinopathy. Of course, you have to implement a proper subjective assessment. Research: one of the diagnoses for lateral hip pain is "location of the pain". Yes! if your patient describes where the lateral hip pain is, that may be "gluteal tendinopathy or bursitis" The location of the pain is an important assessment tool. Pathoanatomy? thickening, thinning and tears in the gluteus medius and minimus tendons observed Changes in the bursal structure observed. this condition has traditionally been referred to as trochanteric bursitis. However, gluteus medius, minimus tendinopathy, accepted as the most prevalent pathology. Research: 877 individuals with greater trochanteric pain showed a low incidence of bursal change, with only 20 Percentage bursal thickening on ultrasound. If bursal thickening, usually trochanteric bursa, sub gluteus maximus bursa. Does it matter if it is gluteal tendinopathy or bursitis? not really cuz they are caused by the same thing. KEEP READING DOWN Patho Mechanics? increased compressive and tensile load across the gluteal tendon. Mostly, a combination of tensile and compressive overload is a major contributing factor. Risk factors? I always spend more time educating my patients with lateral hip pain about the risk factors. It is because of their bad habits. As you subjectively assess them, you can pick their bad habits that can cause their hip pain. What are they? 1) hip adduction, internal rotation positioning - yoga stretching -crossing legs - standing one leg - lying on the affected side - low couch - a lot of stairs - overtraining - running, splinting, jumping Why? Once increasing hip adduction and internal rotation, it will cause massive compression to the gluteal bursa and tendon over the greater trochanter. What else seems to be a problem? 1) commonly females over 40 don't get me wrong! male athletes get this problem often once they go back to training after the off-season. it will overload their gluteal tendon. Anyways, why are females more common? it may be due to the pelvic morphology. this is a controversial topic but let me explain why? Think of female pelvis. It is bigger than a male's pelvis. this may increase hip adduction when walking standing. this is a conflict topic but I don't really care about this one. It is a structural problem. You can't do anything about this. So, think of what you can change in terms of gluteal tendon load tolerance, avoiding the risk factors, adjusting training, etc. Plus, gluteus medius in females has a smaller insertion on the femur across which to dissipate tensile load and a shorter moment arm, resulting in reduced mechanical efficiency. Less efficient gluteus medius more regularly use increased hip adduction to provide a mechanical advantage for their abductors likely associated with length-tension associated relationships. Diagnosis! alright! my "go to" physical assessment tools. 1) location of pain 2) passive hip adduction and internal rotation in supine. - this will challenge compression over the greater trochanter. 3) resistance to hip internal rotation hip ad abd in supine 4) single leg stance test for 30 seconds - looking for a pelvic drop, possibly producing pain. - Research: this test does not indicate gluteal medius weakness. Then, why am I using this? i am not looking for the specific gluteal medius weakness. 1st, everything is connected. You cannot isolate one muscle for sure. This test is more likely global rather than the weakness of gluteal medius. and once seeing the pelvic drop, you know it is increasing the load to the gluteal tendon. 5) Lx ROM. why? research: gluteal dysfunction associated with LBP and SIJP. Treating the tendon related pain has been shown to improve the function of people with LBP. So, They may be related. Som if a patient has LBP, SIJD, P, have a look at their hip. 6) Neurodynamic test! 7) palpation!!! very important - if sore, yes! suspect that there may be gluteal tendinopathy! 8) US or MRI - However, imaging tests solely cannot be relied on. Why? signs of local soft tissue pathology at the greater trochanter are common in imaging of those without lateral hip pain. they may be necessary when diagnosis is not clear. Treatment! 1) education on risk factors 2) Taping - prevent hip add, internal rotation! 3) Isometric exercise in supine or sidelying 4) Isometric isotonic exercises in supine, sidelying, standing 5) isometric isotonic eccentric exercises 6) movement retraining! SUNSHINE ® SUPER SPECIALITY PHYSIOTHERAPY CLINIC - #DrParthiban #Sunshinephysioclinic.in #Physiotherapyclinicintambaram #Physiotherapyclinicnearme DR.M.P. PARTHIBAN.M.P.T (Ortho), Chief Orthopedic Physiotherapist, Call for Appointments: - 9345122177 East Tambaram, CHENNAI