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98 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 9 technique MYOSKELETAL ALIGNMENT TECHNIQUES Healing the Hip's Rotator Cuff Assessing Hip Bursitis and Tendinopathy By Erik Dalton, PhD 1 rotator cuff bursitis, where the subacromial bursa becomes battered and inflamed as a result of underlying rotator cuff tendinopathy. 1 He and others have called the gluteus medius and minimus tendons the rotator cuff of the hip. Here, we'll explore the myoskeletal approach to pain that affects the hip's rotator cuff. Lateral hip pain includes at least three possible injury sites, so I'll use the term greater trochanteric pain syndrome (GTPS) to describe this commonly seen condition. TESTING FOR GTPS I've found GTPS typically results from direct impact to the lateral hip, instability due to aging, prolonged single-leg weight bearing, or IT band irritation from repetitive movements. In these cases, the client typically complains of dull lateral hip pain, often radiating into the thigh. It's not uncommon for clients to report increased hip pain at night or upon standing after sitting for an extended period of time. During assessment, direct palpatory trochanter pressure, single-leg weight bearing for 30 seconds, or the resisted hip abduction test shown in Image 2 may aggravate the client's pain. Together, these evaluations can help determine whether the client is suffering from trochanteric bursitis, gluteus medius tendinosis, or both. However, the hip de-rotation test demonstrated in Image 3 is still my favorite exam for reproducing hip symptoms in those with GTPS. The femoroacetabular joint is one of the largest, strongest, and most flexible joints in the body. As we walk, our hips give us power and stability, and when jumping, these ball- and-socket joints are able to withstand enormous impact. However, the hips and their supporting structures are often compromised due to aging, overuse, and traumatic events that cause the brain to reactively guard the area with spasm or pain. For decades, lateral hip pain has been blamed on injury to the fluid-filled bursa sacs covering the greater trochanter, thus the name trochanteric bursitis. Today, many manual therapists have come to realize certain cases of hip bursitis are actually due to wear and tear of the gluteus medius and minimus tendons, the iliotibial (IT) band, or both (Image 1). Hip pain and instability due to gluteus medius, gluteus minimus, and IT band tendinosis may cause the client to walk or run with poor control, which creates friction and irritation of the trochanteric bursa. Researcher Thomas Bunker and his team were the first to compare this condition to Inflamed bursa, gluteus medius tendinopathy, and IT band compression. POSTUROFUNCTIONAL ASSESSMENTS Performing a three-minute posturofunctional movement exam is another wonderful way to differentiate hip bursitis from underlying gluteus medius tendinopathy. The most important aspect to observe is the client's seated and standing posture. Those with hip irritation tend to stand with the ipsilateral femoroacetabular joint slightly flexed. When seated, they slouch and lean to the uninvolved side. This posture takes pressure off the trochanteric bursa as the painful hip rests in a slightly less flexed position. Faulty movement patterns observed during gait alert us to areas where the brain and body may not be communicating well. A classic example exists in those who present with a Trendelenburg gait (Image 4). This peculiar movement pattern is triggered Gluteus medius IT band Inflamed bursa