Glute med tendinopathy and greater trochanteric bursitis

Been dealing with left hip pain for what it seems like forever (~8 years now). I feel like it all started after a relatively minor MVA I was involved in where by left knee was driven into the dashboard. It was minor enough at the time that I didn’t even go to the hospital. I full admit this could all be recall bias however. Regardless, this issue has plagued me for a long time, and prevents me from training regularly.

To be exact, the pain is latent and always kind of there, lifting/exercise is not the culprit, rather training exacerbates the issue. If I just try to train through it it affects my daily living causing a noticeable limp. I tried a number of different treatments, paying through the nose for Graston for some time years ago (temporary relief), and also ART few years later (which I don’t recall giving me any relief, besides my wallet). I’m not proud of my choices but I was desperate to find a solution. Eventually I got an MRI in 2012 fearing it was a labral tear. MRI ruled that out and gave me the diagnosis of “mild bilateral trochanteric bursitis/glute medius tendinopathy. No left labral tear identified on high resolution imaging. Sacroiliac joints are normal.”

Basically squatting is the main provocative movement, mainly the repetitive flexion/extension at the hip. If my training excluded squatting I would probably have no issue. I’ve tried low bar, high, bar, playing with toe angles and stance width. NSAIDs are only temporary, and don’t allow training either. I tried hip abduction exercises focusing on the eccentric portion, I tried icing, I tried heat. None of it seems to matter.

I can also reproduce discomfort over the trochanter if I internally rotate the hip, both with the hip flexed or in neutral position. The discomfort sort of feels like a progressively increasing tightening/pressure over the outside of the hip. If I add adduction to the IR it gets even worse, also causing discomfort in the anterior hip crease feels like its about the location of the iliopsoas.

I have a fairly active job, I became a paramedic/firefighter ~6 months ago. I want to train regularly, not only to be better at my job but also would like to get back to competing (former olympic, but would like to try PL as well). I have a garage gym that has been sporadically used since I built it, partially due to laziness, partially to becoming a father 18 months ago, but I’d be lying if I said that the thought of the hip hasn’t crept into my head numerous times. I used to think that volume of work involving repetitive hip/flexion extension was the problem, but the intensity also plays a part. Sad thing is that over time the intensity that causes cessation of training is decreasing. I tried restarting regular training last week, I’m three training sessions in and the hip feels so uncomfortable and painful that I know if I don’t stop squatting I’ll be limping soon, and that’s not an option. The last high bar squat session was a measly 220x4 @ RPE 8.

I need advice on how to manage and rehab this issue, how to adjust my training, and for someone to tell me I will be able to squat regularly again (I’ve considered never squatting again).

Hey @tnumrych , sorry to hear about the ongoing issue.

I think you’d really benefit from a consult with us: Contact Us | Barbell Medicine

Based on the information you’ve provided thus far, I see no reason why you can’t squat but the dosage is of importance. You mentioned getting back to training, how long of a layoff did you have?

I think it’s great you are trying to squat again, however perhaps 220# x 4 at RPE 8 is a bit too much starting out. You can try to drop the RPE and up the repetitions while adding in a tempo 3.0.3 with the squat (3 second lowering to bottom position and 3 seconds standing-up). What’s the game-plan with the 3 days / week of training?

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Hey Micheal, thanks for the reply. This most recent lay off was probably about a year. But the previous attempt didn’t last long, so truthfully it’s probably been a few years from the last regular training that lasted more than a few weeks. If I can dig up my old log I can provide a better answer.
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220x4 @ RPE 8 was the third session in. I heard Jordan mention an off-the-cuff BB medicine program in one of the Q&As and thought that the reduced volume when compared to SSLP could be good, so I wrote the prescription down and tried it. 220 felt like I had two left in the tank/RPE 8, so I thought I was following the prescription.

The plan is 3x per week, I want to hit the big lifts but I’m catastrophizing over the squatting. As I said above I thought trying the BB medicine novice LP would have been good. Since the flare up I’ve done the usual PT prescribed isolation exercises in hopes they may help (reverse clamshells) but not much else.

I also have the added pressure of making sure I’m ready for the demands of the firefighting academy in July (as you can imagine it’s a lot of bodyweight circuit style nonsense PT plus the all-day firefighting activities following) and the inevitable birth of my twins.

I considered the consult and filled out the form, Charlie got back to me, but at this stage the cost is prohibitive for me.

Thanks for the insight. Yeah - overall sounds like you came back and attempted a bit more than you’ve previously adapted to after the year layoff. I think if you take some time to find appropriate dosage of movement like discussed in my previous comment then over-reaching will be minimized and you can effectively get back to squatting while improving your confidence in the lift along the way.

Check out this article by @Charlie_Dickson to get you on the right track: https://www.barbellmedicine.com/reco…e-the-process/

As a caveat to this process - long layoffs like you are describing are often associated with increased symptoms for tendinopathies. You need to try and remain active but finding the appropriate dosage of training is a necessary part of the process. Also - symptoms will be a part of this process but shouldn’t severely increase during or after training (individualistic). If symptoms do severely increase for you, it’s nothing to panic about but means that alterations need to be made to loading. You can get through this but it will take some time and patience. Keep us posted.