Is walking good for gluteal tendinopathy?

Yes, walking can be an important part of your rehab and recovery from gluteal tendinopathy, but there are some factors to consider. If you overdo it, it can actually make things worse. In this article we’ll look at how you should adapt your walking to aid your recovery. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.

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In this article:

1. Why walking can cause pain

2. How can you get your tendons strong enough for walking?

3. Tips for walking with gluteal tendinopathy

4. How we can help

We also made a video about this:

Why walking can cause pain

When we walk, our gluteal (or buttock) muscles have to absorb and generate quite a lot of force. These forces are also transferred through the tendons that attach our glute muscles (glute max, glute med, and glute min) to the hip bone.

When you have gluteal tendinopathy, your gluteal tendons lose some of their strength. This means that they no longer have the capacity (endurance and strength) to cope with all the force created during your normal daily walking.

Depending on how irritated or sore your tendons are, even short walks may cause them to become painful. It’s important to understand that experiencing lots of pain does not mean you have a really badly injured tendon. Even mildly injured tendons can be very painful.

How can you get your tendons strong enough for walking?

You have to use a combination of relative rest and strength training.

Relative rest is different from complete rest. Relative rest means that you remain active, but you reduce the volume (how far you walk) and/or intensity (speed, hills, and so on) of your activities to levels that do not aggravate your pain. In other words, you reduce your activity levels so that your current (injured) tendon capacity is sufficient to cope with it. This then allows the tendon to calm down so that you can get on with your rehab.

Strength training is the most effective way of stimulating your tendons to regain the strength and endurance they need to cope with all the activities you want to be doing in a day. We’ve discussed what exercises work best for gluteal tendinopathy in a previous article. Walking can also be used to restore tendon capacity, but this has to be alongside your strength training programme, not as the only activity.

Tips for walking with gluteal tendinopathy

1. Establish your current walking baseline/capacity

What distance can you currently walk without causing a significant increase in your pain, either during the walk or in the 24 hours after? This distance is known as your baseline and represents what your tendons are currently able to cope with.

It’s OK to have a little bit of discomfort for a short while after your walk, but it should settle down fully within the next 24 hours. If it was very painful, kept you awake at night, or you struggle significantly more for a few days after the walk, then that distance and/or intensity were too much.

It may require a bit of trial-and-error to figure this out. We usually advise our patients to start with a very short distance. If it doesn’t increase the pain, they can then up the distance by a bit. But if it causes the pain to flare up, it is usually not as severe as if they had gone for a long walk, and they now know to walk even less the next time.

2. Keep it slow

Fast walking creates larger forces on the gluteal tendons and means that they will reach their maximum capacity sooner than when you walk slowly. So, keep it at a stroll or even a saunter to start with.

3. Avoid hills and uneven terrain

Hills, soft sand, and uneven terrain will also cause your glutes to work harder and can cause flare-ups during the early stages of rehab.

4. Total time on your feet matters

Your gluteal tendons work even when you’re just standing still. So, when you plan your walks or activities, consider the total time that you’ll be spending on your feet that day. For example, if you’re going to spend quite some time on your feet while baking or cooking, it may not be a good idea to also go for a walk that day, as the total load (standing + walking) may exceed your tendon’s current capacity.

This is why we take extra time during our assessments to get a good understanding of all the activities and tasks our patients do in a typical day. We then use that information to create an optimal schedule so that they can fit in their strength training and walking around their regular life without causing tendon overload.

5. Respect recovery days

Injured tendons take a bit longer to recover from exercise. This is why it’s usually not a good idea to push your tendons to their limit on several subsequent days. It is often best to alternate what we call “high load” and “low load” days.

High load days for gluteal tendons are days when you do your exercises (although we also split these into high and low load) or when you do more walking and standing. Low load days may be days where you don’t spend a lot of time on your feet or go swimming or cycling instead of walking.

Your physio should help you to figure out the optimal schedule for you. This is not an exact science and also takes a bit of trial-and-error. This is why we ask our patients for regular feedback to ensure that we adapt their programmes in a timely manner if needed.

6. Don’t rush it!

It’s normal to experience a small increase in discomfort when you start new exercises or walking. It is really important to get fully used to that load and to allow your body enough time to adapt to it before increasing your walking distance or intensity. And when you do increase it, do it by small amounts, e.g., 5 or 10 minutes rather than 20 or 30 minutes. However, this advice may vary depending on the specific case.

How we can help

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References:

1. Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon)

2. Grimaldi, A. and A. Fearon (2015). "Gluteal tendinopathy: integrating pathomechanics and clinical features in its management" Journal of Orthopaedic & Sports Physical Therapy 45(11): 910-922.

3. Grimaldi, A., et al. (2015). "Gluteal tendinopathy: a review of mechanisms, assessment and management" Sports Medicine 45(8): 1107-1119.

4. Mellor, R., et al. (2018). "Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial" British Journal of Sports Medicine 52(22): 1464-1472.