Is walking good for gluteal tendinopathy? Yes! Walking can actually form a really important
part of your rehab program, but you can overdo it. So, in this video, we're going to look at:
Why does it hurt when you walk? Then, how can you get your tendons strong enough to actually walk?
And thirdly, what tips and things can help if you want to walk when you've got gluteal tendinopathy?
So, for those of you who don't know me, my name is Maryke. I'm one of the physiotherapists from
sports-injury-physio.com, where you can get online physiotherapy assessment as well as treatment for
your injuries – have a look at the description of this video if you want the link to our website.
Okay, so why do your tendons hurt or why do you get so much pain when you're trying to
walk with gluteal tendinopathy? Now, whenever we walk – or stand, for that matter – our muscles
in our legs have to work really hard. And the glutes, which are your buttock muscles,
they attach via the tendon – the gluteal tendon, which is the bit that gets injured
when you've got gluteal tendinopathy – onto your thighbone. Now, every time you give a step,
or when you’re just standing, the muscles produce force, and that force also gets translated through
the tendons. Now, whenever you injure a tendon, that tendon loses some of its strength. We talk
about ‘capacity’, so that means strength but also the endurance. So, not just the ability to sustain
the forces, but for how long it can do that. And depending on how irritated your tendon is or how
long you've had the injury for, the capacity of the tendon can come down quite a lot. So,
that means that it's just not strong enough and gets irritated whenever you want to do the
normal volumes of walking or standing you want to be doing. Now, it's important to understand
that just because your tendon is really, really painful does not mean that it is badly injured.
What we know is, there's a bit of a mismatch; even tendons with only a slight or small injury
can cause lots and lots of pain. So, just because it's really painful doesn't mean you have a super
weak tendon. In fact, gluteal tendons don't ever become that weak unless you neglect them for quite
a while. So, what can you do to help restore the strength of the tendon so that you can walk again?
Well, there's basically two main things to do. One is relative rest, and the second is that you have
to rebuild the strength through strength training. Now, let's talk about relative rest first.
Actually, I've made a … We've made lots of videos about gluteal tendinopathy and lateral hip pain;
I'll put a link here if you want to see more info about that. But ... in a nutshell,
relative rest is different from complete rest in that you don't just stop everything;
you try and figure out what the capacity of your tendon is at the moment, and a physio can
help you do that, but I'll also give some tips with regards to walking and that in a minute.
And then, you bring your activities down to a level that your tendons can actually cope with.
So, that would be, you look at your … all activities you do in the day. So, walking,
strength training, standing, anything that affects your gluteal tendons. So, that's relative
rest. And the aim of that is that you actually allow your tendons to settle down, because that
will then allow you to do the exercises you need to be doing to strengthen it up again.
If you keep on going and trying to push through the pain, it just becomes more and more sensitive,
and in the end, you can do less, and quite frankly, it just makes you miserable. Now, the
second component, strength training, that's super important because rest can calm the pain down,
but it doesn't actually strengthen the tendon. If you want to strengthen the tendon, you've got
to do specific exercises that act as a signal to the brain to come and rebuild that tendon.
You know how, when you go to the gym, you start seeing, ‘Oh, I've got muscle tone,
I can pick stronger things up.’ And that's because lifting the weights and doing the exercises
stimulate your muscles and your tendons to grow stronger. However, if you go on holiday or you've
got a three-month break or you're ill perhaps and you just lie on the couch and you can't do much,
you quickly see that muscle tone and everything just go away,
as, because the body's not going to waste energy when it thinks you're not needing something
to keep it strong. So that's why the strength training is a really important component. And yes,
walking can help to strengthen your tendons, but it can't be the only thing. You have to
use walking in ... What's the word now? … Together with the strength training program. We've done a
whole video on strength training for gluteal tendinopathy, and I’ll link to it also in the
comment, in the description of this video for you below. Good! So then, top tips for if you want to
be walking ... let me just get my thing here, that I know I'm not forgetting anything ... if you want
to be walking with gluteal tendinopathy. Now, Tip Number 1 is, you have to establish your baseline.
So, what ... How strong are your tendons at the moment? What's their capacity? How much walking
can you do? It's not rocket science; it's actually quite easy; it's a bit of trial-and-error. Now,
what we tend to do is, we want to see what distance or period of time you can walk for
that does not cause an increase in your pain either while you're walking or in the 24 hours
after you've walked. Now, it's absolute normal if you have gluteal tendinopathy,
you'll likely have discomfort most of the time. So, that doesn't mean you can't go for a walk.
What you're looking for, is an increase in your pain and a significant increase in your pain.
That would mean that, OK, the work you did was too much. So usually, what we say is,
we want you to not feel more than just a bit of discomfort, a bit of a ... tend to call it
a niggle that you feel while you're walking. And then, after you've walked, it's normal for it to
feel a little bit more uncomfortable. But it shouldn't be painful, so not more than a three
out of ten discomfort. And that discomfort should settle down within a couple of hours.
You shouldn't get up the next morning and think, ‘Oh, man! My hips are hurting now!’
Or, when you’re sleeping at night, think, ‘Oh man! They're so much more painful for than normal!’ But
again, remember, this is a change to your normal pain. So, if you usually have pain when you're
sleeping and you ... that evening after the walk, you try to sleep and it feels the same as it did
the previous night's uncomfortable and stuff, that doesn't mean the walk was bad for you,
because it's the same pain you usually get. So, it's the change in pain that we're looking for.
Let me just see what I'm leaving out there? Yes. So, once you've established that baseline, you
now know, ‘Okay, my tendons are actually strong enough to cope with this volume of walking.’
And it can sometimes be very little; it can sometimes be like 10 minutes,
20 minutes. And it can be quite annoying if you’re somebody who is usually really active,
but it doesn't help to try and push past that, because your tendon will just become painful.
What we usually advise our patients is, start with something that's silly short. So, for instance,
if you're not sure and you think just all walking hurts, just test a five- to ten-minute slow walk
and see how your tendon reacts. If you look at that 24 hours afterwards, if it doesn't really
increase your pain by much, and it settles down, you're back to normal pain levels by the next day,
that walk was fine, and you can possibly even try a little bit more the next time you go out.
If, however, you think, ‘Hmmm, that wasn't quite good; I don't feel so well today,’
that means that walk was too much, and the next time you try it, you've got to do even less
to see, ‘Okay, what is my tendon’s true capacity?’ Or it may mean that actually your
tendon's not strong enough at this point to walk, and you first have to do some rehab for it. So,
those are the things to look out for. And to be honest, your physio should be helping
monitoring that and interpreting that for you. Then, the second thing is, keep it slow.
When we walk … We've spoken about the muscles working and the force through the tendons. Now,
if you want to walk faster, you've got to generate higher forces, which means higher force through
the tendons as well. Your tendon may have a certain capacity of strength to cope with slow
walking for X amount of time. But if you're going to increase that walking speed, it may mean that
you use the capacity all up within a very short period of time. So, really keep it slow until you
can do a good volume of walking or time on your feet and only then start increasing the speed.
The third one goes hand-in-hand with this, and it's about look at what terrain you're walking on,
because there's a big difference between walking on really soft sand or hilly terrain or uneven
terrain. All of those things will mean that there's greater forces going through the tendon.
So, the perfect place to walk at the beginning is on a firm surface and ... that's not too hilly
either. So, we're thinking of, in this case, tarmac may actually be a good idea. Or if you
have a dirt road that's nice and firm, those would be better surfaces than really soft sand
or anything that makes your leg wobble quite a lot. Then, fourth is, total time on feet matters.
And this is an important concept to understand, because this trips a lot of our patients up,
that they don't realize the other things they do in the day actually count towards
fatiguing those tendons. So, when we think of tendon capacity,
they have a certain capacity to cope with a certain amount of standing, walking, running,
depending on how badly yours is injured, in a day. And if you can picture this: Say for instance,
you have a certain routine in your daily life, that you're sitting for a certain number of hours,
you do a bit of walking, you do … and then you suddenly decide to go spring clean the house and
you have three days in a row where you're on your feet the whole time, up, down stairs, everything.
You now how knackered you feel? And things start hurting and you start thinking, "Ooof!" That's
because your muscles and everything had a certain capacity to cope with your activities you do in a
day, and by increasing those activities in the day, you've actually made them tired. Now, when
you have gluteal tendinopathy, anything where you weight bear will help to make those glute tendons
and glute muscles tired. So, we're looking at the total amount of time you spend on your feet,
just standing, as well as walking, as well as running, depending on whether you can run or not.
So, think about that. If you've got a day that you're already on your feet a lot,
that's not a good day to go do a walk for exercise as well, because you're more likely to overwork
the tendons on that day. If you have days where you don't spend so much time on your feet,
perhaps that's the better day to go for a walk as well. Same goes for your strength training. You
should look at how much you're already working the tendon through other things in the day
to decide what days are the best days for your strength training exercises.
And that kind of comes to the last point, which is Point 5,
where I want to say: respect recovery days. So remember, when we exercise, we get a bit of micro
damage in all our tendons, or body, everything. And then the body needs a period of time to
recover. Now, when your tendons are injured, they take a little bit longer to recover from exercise.
So, it's really important not to try and push your tendons and do your exercises and you're walking
several days in a row. Because then they're just not going to get enough time to recover,
and you may end up making your pain worse again. So, usually what we do for our patients
is, we structure and we teach them about high load days and low load days. So, a high load
day would be a day where you do a lot of walking or a lot of standing, perhaps your exercises;
those type of things are high load days. Low load days would be days where you
haven't really done much walking or you haven't really done much time on your feet, or perhaps
you are rather swimming or cycling that day, so you don't
work that tendon so hard. And that's also why we take quite a lot of time in our initial session
to figure out, 'What do our patients do in their normal life?' Because that's the bit
where people kind of neglect to look sometimes. We need to understand what days are you already
working your tendons to capacity just because of your job or other things you do. What days are the
best days for you to strength train, just because of kid or life or anything like that. And then we
can look at, OK, what days do we fit things like walking and things around that in as well, so that
in the end you've got a program which allows your tendons to recover between your high load sessions
and also fits in with the rest of your life. Because it doesn't help that it's a totally
unrealistic program when it comes to your normal day-to-day activities. Excellent! Hope you found
that useful. So remember, if you need more help with an injury, you're welcome to consult one
of us via video call; the link to our website is in the description of this video. Take care!