Returning to single leg activities after Gluteus Medius Tendinopathies
For almost all patients recovering from glute medius tendinopathies or trochanteric bursitis, ‘first-day’ isolated movements such as ‘Fondas’ or clamshells quickly become insufficient stressors to return patients to pain-free movement. To more closely replicate task-specific demands, we want to get people moving (and/or heavily loading) on their feet as quickly as possible. Oftentimes however patients struggle to do that without pain. Below are basic parameters for a progression towards the single leg exercises necessary to return to sport.
Most people will have more success if they follow this ordering of activities, but there will (and should!) be overlap between the stages during the progression. Good clinicians have probably already internally systematized something akin to what I have outlined below, but stay tuned for an easy tweak to the exercises, which though I doubt is novel, is a powerful tool that is used far too infrequently.
Finally, though I am an evangelist of resistance training of some type for everyone, some patients will find it unnecessary to progress through this entire outline to return to pain-free movement.
Progression for loading the hip rotators and abductors during and after injury
Low Involvement Exercises designed to stress the painful tissues minimally, be completely pain-free and set the tone for a positive response to exercise. This typically includes hip extension exercises in the sagittal plane (Bridging, single leg bridging, prone hip extension, Bird Dogs with the involved side extending)
Double Leg Squatting Patterns (ranging from sit to stand transfers to a barbell back squat)
Double Leg Hinging Patterns (Stiff Legged Deadlifts/RDLs)
Open Chain Gravity Eliminated Exercises where the motion directly stresses the tissues (movement in the frontal plane), but the resistance to be overcome--in this case gravity--appears in a different plane (again, the sagittal, such as Prone Hip ABD)
Indirect Involvement Exercises are meant to be the reverse, where the movement is performed in the sagittal plane and the resistance forces act on the injured tissues in the frontal plane (Sidelying hip extension).
Open Chain Gravity Resisted Short Lever (clamshells, Bird Dogs on the non-involved side)
Staggered Stance (split Squats)
Open Chain Gravity Resisted Long Lever (Sidelying hip ABD, Side Planks, Single Leg side Planks)
Lunges
Single Leg Hinges and Squats