Everyone loves to sink into the sweet bliss of a long luscious pigeon pose. Learning to ease in, lose the fight and surrender, breathing space into the back of the hip. Enjoying the moment when it finally lets’s go and allows you in. Like the moment before waking, wishing you could linger a little longer as you hear the teacher guiding you to your next pose.

But when is it safe and when can it be a dangerous pose? What could possibly be dangerous about a pigeon?

Injury-prone outer hip tendons called the gluteal tendons to attach firmly to the outer hip bones. These points of attachment can become vulnerable points of injury especially with deep and strong buttock stretches- which can contribute to the onset of gluteal tendinopathy. Commonly diagnosed in conjunction with hip bursitis, this condition can be long-lasting and tricky to manage. So what is gluteal tendinopathy, what are the symptoms and how can we treat and prevent this?

Tendinopathy is simply a term that is used to describe changes in the tendon likened to weakness, or wear and tear. We used to describe this as ‘tendonitis’, however, research has more recently revealed that chronic tendon pain is NOT an inflammatory process but instead a process of tendon overload which initially causes reactive changes to the tendon cells, that in turn can become signs of tendon weakness.

Tendons in the body are like thick strong ropes that attach muscles onto the bone. So the springy hamstring muscle turns into a thick strong tendon (rope) that connects onto the sitting bone. Much like the springy calf muscle turns into a thick strong Achilles tendon (rope) before attaching onto the heel bone.

Muscles are designed to be springy, to stretch and recoil. Tendons are designed to be thick and strong, firm places of attachment. In the presence of tendinopathy, the tendon can show signs of weakness, much like a frayed rope. If you imagine a frayed rope- you don’t want to overstretch or overload it, but take the pressure off and perhaps stitch some new fibers into it so it becomes strong again.

When the gluteal tendon is showing signs of tendinopathy, it will often be tender right at its attachment point which is on the outer hip bone (greater trochanter) of the hip. Pain can often be felt when lying on the side at nighttime, after activities such as walking or yoga. It is common for tendon related pain to occur after activity rather than during.

The nearby bursa can also become swollen in the presence of gluteal tendinopathy. A bursa is simply a small sack of fluid that protects bony prominences. We have them all over our body, including the tips of the shoulders, the elbows, the knees, and the heels. It can be a common symptom that when a tendon is irritated, the neighboring bursa can become swollen- this is known as ‘bursitis”.

A physiotherapist can test if you have tendinopathy and /or bursitis, as there can be many other reasons for outer hip or buttock pain!

So how do we manage gluteal tendinopathy?

Like a frayed rope, the first step is to avoid overloading or stretching it over the outer hip bone. Unfortunately, this means pigeon pose can be a significant overloading stretch and best avoided! Like to know how to modify your yoga practice if you have outer hip pain, bursitis or gluteal tendinopathy? Watch this FREE video here

The next step is to start a progressive strengthening program, including isometric exercises. These are very specific exercises that should be guided by your physiotherapist. Building up the nearby gluteals can also help!

The repair and recovery process for tendons can, unfortunately, be notoriously slow. All tissues in the body repair and rebuild at different rates. Skin heals very quickly- if I cut my skin it will usually be healed within a few days. Bones are slower- if I break a bone it will take generally 6 weeks of doing all of the right things (such as wearing a plaster cast) before it is healed. Tendons can be slower than bones. So if you do have signs of gluteal tendinopathy you will have to have patience with your recovery and do all of the right things to assist the process.

Like to know more about tendinopathy and what to do about it? Click here

The Yoga Physio is powered by Nichole Hamilton and her physiotherapy practice Synergy Physio. To learn more about her physiotherapy practice and her team at Synergy Physio click here

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