Thank you for taking the time to respond.
Do you have any recommendations on what I can do when I feel it start flaring up a little once I restart lifting?
I’ve been told various things may help such as deep tissue massage of the forearm, or stretching the forearm, triceps and lats. I haven’t been able to find much online. Or is it the case that once a little pain starts creeping in, enforcing a period of rest is best?
Rest (within reason) is good, but I’d only be resting from things you know to aggravate it
Strategies that can offer some short to medium term pain reduction include:
Your best bet will be to be very scientific in how you reintegrate pull training. I’d add only one exercise per workout at a time, so you can determine exactly how it affects your elbow
Thank you for all the responses. It is much appreciated!
Is this thread still active? @j4gga2
I seem to have acquired a gluteus medius strain from overzealous use of a pelvic thrust machine. Will give more details if this is an open offer.
Yep! Thread is still open
There are hip thrust machines at the gyms I use, and I had worked my way up to 700 pounds or so. But then stopped doing this exercise regularly.
Six weeks ago, I overdid things. I followed 700 pound rack pulls with about fifty 400 pound deadlift singles and some 400 pound hip thrusts. There was no acute pain.
But the next day I had pain over my greater trochanter. There was no palpable fluid as when I had elbow bursitis. I was limping and it hurt to lie on the affected side. Occasionally pain would shoot laterally down the affected leg to the knee, but not beyond. Climbing stairs became more difficult. There was no SI pain on palpating and I could put on shoes and socks as before. There were no difficulties with toileting nor saddle anesthesia.
Since I was stupid, and delayed pain is nothing new to me, I repeated some of these things a few days later. This time, doing pelvic thrusts with 200 pounds caused acute pain and reproduced previous pain exactly.
I thought I had strained my gluteus medius tendons by overdoing the thrusts, resulting in a “bursitis”/greater trochanter pain syndrome. I took naproxen twice daily with some relief. Standing on one leg became painful with Trendelenburg after ten seconds or so.
Several weeks later, there is still an occasional limp. I can stand on the affected leg for a minute but there is slight Trendelenburg. I can sleep on that side now and climb stairs better. I can do bodyweight pelvic bridges, and on one leg without pain. If I extend the opposite leg, sometimes it feels weak (but not painful) and sometimes it doesn’t. I can do 100 clamshells without immediate pain, but this makes the muscle feel weak afterwards. Since there has been no pain below the knee, I do not think it is due to piriformis. I have not had back or SI pain and have no history of hip or knee OA.
It is slowly getting better. But I have avoided leg workouts at the gym for over a month, which frustrates me. My questions:
Many thanks for your consideration. IT and groin pain only occur rarely. The pain on palpating the greater trochanter has mainly gone. But I still limp occasionally.
Hey mate - it does sound like a glute medius/minimum tendon issues, which used to be referred to as “greater trochanteric pain syndrome” (although this is now considered an outdated label)
In the presence of any tendon pathology - patellar, achilles, gluteal, triceps etc - you want to do two things:
Calm down symptoms, so that you can
Rebuild tissue strength and load tolerance in the affected muscle-tendon unit
In your case, dry needling can help calm down symptoms, but is optional. Active therapy is essential, as you will need to reload the glute med/min progressively to regain your normal function
Referring above, you need progressive loading of the glute med & min. These muscles are hip abductors (lift the leg out to the side), external rotators (turn the knees outwards), and pelvic stabilisers when standing on one leg.
To strengthen abduction in early-mid phase, I recommend the seated hip abduction machine, cable behind-leg hip abductions and side plank leg lifts.
To strengthen external rotation in early-mid phase, I recommend standing cable hip external rotation (ver 1 upright or ver 2 angled)
To strength the pelvic stabilising role in early-mid phase, I recommend glute-dominant step ups, single-leg rdl and Captain Morgans
You don’t need to use all of the above movements. Instead, aim to get two exposures to each of the movement “buckets” each week, with 3-4 sets per movement, per exposure.
Some key principles to remember are:
In the mean time, continue to hammer your quads, hamstrings, adductors and calves with isolated machine exercises. I would also reintroduce hip thrusts but start light and pause each rep for a 5 count at the top.
No. Refer to my above posts about being an asshole. Unfortunately, you were a bit of an asshole and went too hard too fast.
Unfortunately it would be inappropriate for me to provide a more specific diagnosis in this setting.
I’d get off the pain relief so you can accurately assess your response to training/rehab. Then, start light and progress slow.
Gluteal tendon pain can be tricky. I’d suggest anywhere from the 2-4 month range is reasonable.
I really appreciate your detailed advice and sensible recommendations. And the clear and concise videos of the exercises you recommend.
I know giving advice over the Interwebz is not always easy to do. I will do what you recommend and seek personal attention if things do not show steady improvement.
Once again, many thanks.
My pleasure!
My success in the gym is largely because of my natural hammerhead tendencies. This has also been the cause of the occasional problem, of course.
I have taken your advice and rotated many of the recommended exercises. I no longer need naproxen. I still am probably going too far too fast.
For example, I went back on the glute bridge machine after four weeks without doing anything leg specific, which was hard. However, time relieved many symptoms (pain at night, lateral radiation to knee, medial radiation.to groin, pain on palpating greater trochanter, pain standing on one leg).
I started on the glute bridge machine by adding 20 pounds and doing five second holds at top and bottom, and could not really feel like I was moving any weight. I worked up to sets of five reps (same hold) adding 90, 180 and 270 pounds (to the base weight of 20 pounds) and it still felt easy with a decent range of motion. I decided not to further increase, but did five sets of three at 290 with long holds at top and bottom. No immediate issues.
I think part of the problem was the glute machine at a different gym is much more poorly designed, and places the stresses very differently. I am avoiding this specific machine in the future; but not glute bridges.
I also did cable exercises, the machine where you kick back your legs (full rom but only 50 pounds), five 380 pound deadlifts (working up), quad machine curls for 300 pounds, and ham machine curls with 220 pounds. Plus clamshells and bodyweight glute bridge holds.
This seemed okay. I then got on a treadmill and did a light jog for two minutes. This was the hardest of all of them - I could immediately feel (with minimal pain) the medius muscle after seconds of jogging. But was essentially fine the next two days.
What gives the best burn with lots of TUT seems to be bodyweight glute bridges. If I hold that for five minutes, I do feel substantial burn and get lots of local painless crepitus as well from the tendon.
I am not going to try to quickly increase these numbers - I’ve read 10% a week is ambitious. (But also a good reason not to start too low). But I am also not the same as someone naïve to strength training. I feel nothing if I go too low, and a 300 pound bridge is perhaps 40% of my potential. Rather than increase weight, I will increase holding time. If it causes more problems, I will back off immediately. Using the more isolating machines after a long break felt very, very good.
Again, many thanks.
Awesome stuff. I love seeing experts and hard workers collaborate for tangible results
It also helped to “climb the steps like a cowboy”. I am amazed how probably everyone immediately knows what this means, even when the action it describes is quite complicated.
This makes sense. The glute medius has to work very hard in running due to the rate of loading.
I think, in this case, you’ve gone too far chasing the TUT burn and sacrificed actual load. Muscles and tendons need at least 30% 1RM to remodel. If you can hold 5min, this definitely isn’t the case. Also, glute bridges load glute max and adductor magnus. Unfortunately glute min+med recieve very little load during hip extension.
I think my emphasis on burn + TUT may have encouraged you to underload yourself, and for that I apologise. We still want to be training, and training hard at that, but just following common-sense rules of steady progression.
This statement definitely makes me think you’ve got the right idea, but please let me be clear: rehab should be fucking hard. The expertise is learning what can you do that pushes your body to adapt, without interrupting the healing process.
I am not underloading myself in the gym — I could do somewhat more but it’s like “The Price Is Right” (or Australian equivalent) where it simply is not worth going too high. But chasing the burn with long bridges on off days perhaps is not accomplishing much.
Perfect
Thibs generally believes any lift that can be held for more than one minute has too low a load. He would probably exclude loaded carries and things done to strengthen tendons, though.
I have found different heights of wood choppers to be somewhat effective for the rotational component.
I agree, and would actually go so far to lower that threshold to 45s based on our most recent evidence on muscle hypertrophy and tendon training
That’s good to hear? Are you referring to the rotational component of core training, or hip external rotation?
The cable exercises you posted from the Glute Lab are much more specific to gluteus medius external rotation. They seem to be helping.
But since I have been limiting general exercises involving the legs, I have been doing more upper body stuff. Rotational wood choppers, from above the head to the knees while twisting, would not seem to involve the hips that much. I was surprised to find they do more than I thought. Just as I was surprised to find that doing heavy Kroc rows made my biceps bigger. It’s a reflection of my own ignorance.
Love it! I’m a big fan of rotational/multi-planar work, yet I also seem to “skip it” regularly