Hi, I'm Ali! I'm one of the physios from sports-injury-physio.com. This is the fifth
episode in our greater trochanteric pain syndrome series, and what we're going to
be talking about today is whether stretches are a good idea or really not a good idea.
In our last two, when I've talked about standing and sitting tips and also lying and sleeping tips,
we've talked about how, if the body gets into a position where we're compressing that
tendon more against the bone, so, either tendons getting nearer to that bone, either, for example
lying on it or your leg coming into that abducted position or in sitting, and standing,
when you're more leaning on to one side, you might feel like you're putting more
compression through that tendon. So, what I mean by that is, where your bottom muscles come around
and attach onto the greater trichanter … the bony bit on the side where they attach … When we do
those positions, we're bringing that tendon closer to that bone, creating a compression
force. If that tendon or the bursa that sits underneath it is irritated, it's then going to
be acting like it's being pressed on like a bruise would be pressed on, and it can create more pain.
Now, this is exactly what's happening when we're stretching. If we go back in time and we look at
when we were talking about this being not greater trochanteric pain syndrome and knowing less
about it and called it hip bursitis, one of our common exercise treatments we would give people
is stretching. And we would try and stretch your tensor fasciae latae, we try and stretch your ITB,
and we try and stretch your glute muscles. So, your glute muscles are your bottom muscles,
your tensor fasciae latae or TFL is this top part, and the ITB runs all the way down here.
Now, what we do know is, when your leg drops into that stretching position,
this IT band – so ilio, that's this part here, tibial, that's that part there – so these two
bones, the ilium and the tibia are where the band runs through ... this band that is over the top of
those gluteal tendons and can compress it and push into it. So, it goes even closer to that bone.
So, that's why the theory was ‘Well, let's stretch this out and get this longer and see whether this
can help.’ But in fact, all of those stretches we're doing, we're putting it in the position
where it compressed and therefore it was more likely to aggravate. So, what I'm trying to get at
is: Please avoid glute stretches and TFL and ITB stretches whilst you are in a rehab process. Now,
compression is a completely normal force that I would expect your body to be able to withstand,
and therefore these sorts of movements are something that we may come back to
later in rehab and get you used to doing again. But, if for the first port call means that we're
releasing that pressure that's being put on that area, so you're stopping pressing on that bruise,
then things will make it feel better. So, typical glute stretches that you might wanna have seen
would be the figure four stretch, it may have been bringing your knee in towards your shoulder,
and you may also have seen the one … and I'm going to just move you up a bit so you can see
me in standing … which is quite common in gyms, when they call it the ITB stretch, where you put
your legs behind and lean to the other side. In all of these, can you see how this takes that leg
into this across the body position or it's trying to stretch this outside part here?
Now, incidentally there's also been a lot of findings in the studies to show that you
can't actually stretch your ITB band, because that IT band is non-contractile and therefore
there's very little point in holding those stretches in the first place. So, if you are
considering doing some exercises for your greater trochanteric pain syndrome or outside hip pain,
we'll come on towards some useful stretch ... useful exercises should be in another
video, but please avoid these stretches for the time being. Thanks very much. Bye!