01/10/2025
Just published 🔥
Heavy Slow Resistance Training Combined with Patient Education in Patients with Gluteal Tendinopathy: A Feasibility Study
▶️ Gluteal tendinopathy (GT) is a common source of lateral hip pain, especially among middle-aged women, with prevalence rates up to 24% (Segal et al., 2007; Albers et al., 2016). It is associated with hip abductor weakness (Allison et al., 2016) and gluteal muscle atrophy (Woodley et al., 2008). Current best practice recommends exercise and patient education (EDU) as first-line treatments (Mellor et al., 2018; Kjeldsen et al., 2024). Education aims to reduce tendon compression through postural and movement modifications (Grimaldi & Fearon, 2015).
🏋️♀️ Heavy slow resistance training (HSR), a high-load, low-velocity form of resistance exercise, has shown positive effects in Achilles and patellar tendinopathies (Kongsgaard et al., 2009; Beyer et al., 2015), but has not been systematically examined in GT. The present feasibility study by Grigat et al. (2025, https://www.sciencedirect.com/science/article/pii/S2468781225001730) evaluated the safety, adherence, and clinical potential of HSR combined with EDU in patients with GT.
🏋️ Exercise Approach: Heavy Slow Resistance Training (HSR)
Format: 12-week supervised program, ~2.5 sessions per week (30 total).
Exercises: Hip thrust (or hyperextension), unilateral leg press, hip abduction, hip adduction, and hip flexion.
Progression: Linear load progression based on repetition maximum (12RM (week1-4) → 10RM (week 5-8) → 8RM blocks (week 9-12)).
Structure: 3 sets per exercise, last set to volitional muscle failure; load adjusted ±2–10% depending on performance (increased, when all assigned repetitions are completed and decreased, when ≥3 fewer repetitions than assigned are completed in the third set).
Warm-up: 10 min ergometer cycling (RPE 11–12).
Safety: Pain monitored using regression protocols—load, ROM, or sets were adjusted if pain exceeded tolerance.
📖 Education Approach (EDU)
Delivery: Written and oral education at baseline, reinforced during HSR sessions.
Content:
Avoiding tendon compression (e.g., crossing legs, lying on affected side).
Advice on posture, standing, and sitting to reduce hip adduction.
Sleep modification: pillow between knees.
Activity modifications: limit prolonged walking, stair climbing, and hip adduction stretches.
Purpose: Empower patients to self-manage load, reduce aggravating movements, and optimize tendon healing.
✅ Key Findings
Feasibility: High adherence (95% completed ≥80% sessions), minimal drop-outs (5%).
Safety: No serious adverse events, only mild transient discomfort (knee/groin).
Tolerance: Pain was well tolerated before, during, and after exercise (100% tolerability median).
Clinical Indicators: Moderate to large improvements in pain, VISA-G, self-efficacy, QoL, and hip strength.
📚 References
Albers, I. S., Zwerver, J., Diercks, R. L., Dekker, J. H., & van den Akker-Scheek, I. (2016). BMC Musculoskelet Disord, 17, 16.
Allison, K., Vicenzino, B., Wrigley, T. V., Grimaldi, A., Hodges, P. W., & Bennell, K. L. (2016). Med Sci Sports Exerc, 48(3), 346–352.
Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Am J Sports Med, 43(7), 1704–1711.
Grigat, J. M., Kjeldsen, T., Jørgensen, S. L., Mechlenburg, I., & Dalgas, U. (2025). Heavy slow resistance training combined with patient education in patients with gluteal tendinopathy: A feasibility study. Musculoskeletal Science and Practice, in press. https://www.sciencedirect.com/science/article/pii/S2468781225001730
Kjeldsen, T., Hvidt, K. J., Bohn, M. B., Mygind-Klavsen, B., Lind, M., Semciw, A. I., et al. (2024). Exercise compared to control or other conservative treatments in patients with Greater Trochanteric Pain Syndrome: A systematic review and meta-analysis. Physiotherapy, 123, 69–80.
Segal, N. A., Felson, D. T., Torner, J. C., Zhu, Y., Curtis, J. R., Niu, J., et al. (2007). Greater trochanteric pain syndrome: Epidemiology and associated factors. Arch Phys Med Rehabil, 88( 8 ), 988–992.
Kongsgaard, M., Kovanen, V., Aagaard, P., Doessing, S., Hansen, P., Laursen, A. H., et al. (2009). Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports, 19(6), 790–802.
