ITBand Pain That Won’t Go Away? It Could Be Gluteal Tendinopathy

You’ve stretched. You’ve foam rolled. You’ve iced. Maybe you've even tried single leg bridges only to regret your life decisions afterwards.

So why does your ‘IT band pain’ still flare up every time you run?

It's because you're making a MASSIVE MISTAKE.

It's NOT your ITB.

Do these stories sound similar to yours?

"I've had outer hip pain for almost a year. Tried everything - strength exercises, stretching, taking a break. Nothing helped."

"But this past weekend, I pushed for a PR in my 5K... but now I'm having a hard time stabilizing on my right hip. It's fine when I'm sitting and when I get walking, but standing up and getting going is pretty painful, and stabilizing my right leg to lift my left leg up to put on pants/underwear/socks is pretty tough. And I notice the pain when I pop my right hip out putting the weight on my left leg."

"I get pain from running, on top side of the hip. The longer I run, the more pain for longer there is. It's a dull muscle ache...It's somewhere in the neighborhood of gluteus medius or minimus. I can't seem to localize it by palpating, but I feel it fairly intensely if I jut my hip out. The doctor says to stop running, and just do elliptical. The massage therapist says it's sciatica. It's not."

What all these stories and yours have in common: Gluteal Tendinopathy.

Here's how you know...

Gluteal Tendinopathy symptoms feel like:

• localized lateral (outer) hip pain with a notable absence of anterior (front) groin discomfort

• Painful area is specific to Lateral + posterior glute (meaning the side of the hip and into the bum cheek itself)

• Gluteal tendinopathy pain can radiate down to the outside of the thigh occasionally, but goes only as far as the knee, NEVER beyond.

• There are no neuro symptoms, meaning NO numbness, tingling, stabbing, shooting/zingers (ruling out sciatica!)

• Can feel worse with single leg strength exercises like lunges or single leg squats like bulgarian split squats

You can start to see how these symptoms can easily get confused with ITB issues.

But here's how you know the difference.

If your pain is gluteal tendinopathy, it probably bothers you the most:

• when you're coming back from an offseason and you begin ramping up your mileage a little too quickly

• when you add more intensity or increasing mileage volume from your base level

• When you add in more up hill work

Still not sure? Try these 3 tests.

If either of these reproduce your pain, consider these tests positive.

• Able to reproduce your pain palpating just above greater trochanter

• Self FABER test: lying or seated

• single leg stance on hurt leg with pain in standing and/or hopping on that leg

Ready to learn how to fix it? Let's jump in.

Gluteal Tendinopathy: the REAL reason for your Outer Hip Pain

Warm-Up Circuit:

3 sets each // LIGHT & medium weights

Frog bridge with Arm Pull

• 3 x10 reps OR 2 sets of 10 reps (holding each rep for 5-10 secs)

Bridge on Box Progression with Overhead Pull Over

Legs backs of calves resting on box // Heels on box // Box under your ankles with knees straight

• 3 x 8-12 reps X medium weight

Strength Circuit:

3-4 sets each // medium-heavy weights

B Squat with "break the floor apart"

• 8 reps X medium-heavy weights (minimal to no pain)

B deadlift with "break the floor apart"

• 8 reps Reps X medium-heavy weights (minimal to no pain)

Got Outer Hip Pain from Running? Fix It for Good.

Frog bridge with Arm pull into Mat pushing into heels

• Bear with me; I will explain everything.

• The Reason: we start with a frog bridge first because it activates both butt cheeks in one exercise, especially when you cue yourself to dig your heels as best you can into the floor. This is meant to be a relatively symptom free warm up

• What's with the arms? I like exercises that work smarter, not harder. By pulling and driving both elbows into the floor, you activate your posterior chain (all the muscles on the back side of your body) and encourage your body to work as one team, rather than one muscle group in isolation.

  
  

Bridge on box progression Overhead Pull Over

• No, you do not need to all 3 versions. But I've given them to you for a reason.

• Please realize, individual one-on-one attention is the best way to tailor these exercises to your body. But I also don't want to leave you in a lurch. I have 3 different leg positions you can try that graduate from easiest to hardest. You should only be working with a max of 4/10 pain.

• But all of these versions encourage your glutes to activate and strengthen in an isometric capacity, meaning they're working against a set load: your body weight

• I like the addition of the pull over because it encourages more core activation, posterior chain engagement, and it's another easy way for you progress the exercise by adding more weight,

  
  

Squat with "break the floor apart"

• I freaking love the cue "break the floor apart with your feet". I use it every time I lift.

• Here's what you're gonna do: choose your double-leg squat of choice. Before you even think about descending into your squat, I want you push the outside borders of your feet into the floor i.e. think about trying to split the ground beneath you in two.

• This is a fantastic isometric that "jump starts" and activates your glutes, helping to decrease any pain and allow you to begin strength training so you can without symptoms.

Deadlift with "break the floor apart"

• yup, same cue; different application.

• The Catch Here: you really need to be performing a regular deadlift here (sorry, RDL).

• It's ok if you need to start a little lighter with this deadlift. It's ok if it feels kinda clunky. The point is, you use the "breaking the floor" cue to isometrically engage both glutes, teach them how to work together, then load them by hinging in your deadlift. Yes, it can feel like a lot to set up, but loading up and progressing with heavier and heavier weights is how you strengthen not only muscles, but tendons, making them stronger and injury proof.

  
  

WRAPPING UP

I saved the good stuff for the end...the anatomy.

Anatomy 101 Lesson: did you know that there 3 layers of glute muscles?

Your glute max, glute medius, and glute minimus.

Your glute medius tendon, which comes from that glute medius muscle, is one of the thickest and largest tendons in your body.

This dynamic duo supports your entire body weight when you're standing on one leg and works to keep your hips/pelvis level while walking and running.

That's a LOT of work as it is, but not MAGNIFY that by remembering, running is high impact.

Your glute medius and it's tendon have to help keep your pelvis stable, support all of your body weight while standing on one leg, AND handle the impact of your body slamming back down to earth because of gravity.

What happens to this tendon that results in pain and injury,..

is that over time the ITB can compress the glute med tendon between itself and the femur repeatedly.

This painful compression is most noted in positions that create a great deal of hip flexion, like sitting in a low chair or running for long periods of time, or when you bring the injured leg across the midline of your body, like crossing one leg over the other.

How does this relate to running?

If you're adding in more hill work that what's normal, you're performing harder work and introducing greater amounts of hip flexion that your glute medius and it's tendon might not be prepared for.

Overload and overwork occurs without appropriate strength training and rest...and ta da! Outer hip pain from gluteal tendinopathy masquerading as ITB.

Can you start to see how important those exercises are that we talked about above?

By strengthening your glutes and tendon first in bilateral leg positions (meaning using both legs), we give your glute and tendon a chance to calm down, to get out of that painful state.

But what I don't want you to miss, is that once these 2-legged exercises become easy and pain free, single leg strength is IMPERATIVE.

Running is a single activity.

It's essentially single leg squats over and over for miles on end.

So don't forget: the exercises I've given you in the blog post are to give you a place to start, but they're not a reason to stay away from Bulgarian split squats ;)

If you're looking for more running specific strength exercises to help you stay injury and get faster so you can chase down more PTs, check out my FREE strength guide for runners HERE.

And until next time, running fit fam...

Dare to Train Differently,

Marie Whitt, PT, DPT //@dr.whitt.fit