Gluteus Medius Tendinopathy Case Study - Marisol Reyes Fuentes B.Phty, M.Musc Phty, APAM - Square One Physio
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Gluteus Medius Tendinopathy
Case Study
Marisol Reyes Fuentes
B.Phty, M.Musc Phty, APAM
APA Musculoskeletal Physiotherapist
Certified APPI Pilates Instructor
Member Hip Pain Professionals
Acknowledgement of Country Today I wish to acknowledge the Traditional Owners of the land on which we are meeting. I would like to pay my respects to their Elders, past, present and emerging, and any Elders who may be here with us today. We envision a society that is free of institutional racism, and where justice and healing has occurred through acknowledgement and acceptance of the wrongs of the past and their intergenerational effects. Reconciliation APA
The patient • 62 y.o. female, complains of left glute and hip pain, 20 years history of hip pain flared up after low back pain episode 3 weeks ago • Does Yoga 1-2/week, and long walks (5km-10km) on weekends • Agg: Sleeping on L side, walking and climbing stairs with pain 6/10 VAS, putting pants on when standing on one leg • Occupation: office based, but used to work in a restaurant
Let’s role play
• Find a partner to role play: physio and patient
• Subjective (5min)
• Physio: Write the 3 most relevant questions that you would ask for GMT
• Patient: Write the 3 most relevant questions to rule out hip OAObjective (10min)
• Physio: Perform appropriate Dg tests and explain what are you looking for
• Patient:
• Explain relevant GMed anatomy/function and patho-anatomical mechanism of GMT
• Answer the questions:
WHAT IS WRONG WITH ME?,
WHY DID THIS HAPPENED TO ME?
HOW DO I FIX IT?
HOW LONG IS IT GOING TO TAKE?
• Use visual cues: drawings, iPad, wall chart, MB videoManagement
• Physio:
• Teach GMed tendon decompression strategies RELEVANT to THIS patient
• Prescribe home program including isometrics and early management exercises
• Justify and explain what are you aiming to achieve
• How would you modify your approach if pain is above 3/10 VAS
• Patient: Be a difficult patient! Ask lots of questions. WHY? WHY? WHY?CHANGE ROLES!
Now the patient is the physio
• Physio:
• Your patient is doing super well, she has been in rehab for 3 months, pain is minimal and occasional, but still
struggles with long distance walks (>10km), and stair climbing. Her goal is to do the 6 foot track over a period
of 3 days in 6 weeks carrying a 10km backpack
• Create and teach a 4-5 exercise home program that will prepare her for it (be specific)
• Patient:
• Your patient has joined our Clinical Pilates classes, choose and teach 6 Pilates exercises that are relevant at
this stage of the rehabSix Foot Track The Six Foot Track was originally a bridle trail from Katoomba to the Jenolan Caves, and is now a walking trail of 44.3 kilometers. Elevation change: 1,600 m (5,200 ft) approx Trail difficulty: Medium Highest point: Black Range, 1,200 m (3,900 ft) approx Lowest point: Coxs River, 400 m (1,300 ft) approx Location: New South Wales, Australia
Q&A
• Is imaging relevant for this patient. If so, what kind and which area?
• Is cortisone injection indicated for this patient? Why?
• How would you help her to develop walking endurance for the 6 foot track?
• Have you considered the extra weight she will be carrying during the hike in your
program?
• Is there anything she needs to be doing during the hike for her GMT?Great work team!
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