symptoms may spread into the outside of the thigh and knee. Swimming exercises for tendonitis depend on the location of the injured tendon. I have not been able to get back to walking or cycling. It presents with varying severity but may cause debilitating lateral hip pain. In this article, we'll look at how you should adjust your gait to help with your recovery. Bend your right leg, and rest your left foot on the ground. I have had to give up all activities because of the severe night pain. Learn more.. For many of us, a good portion of our day is spent sitting. Together, these actions work the gluteus medius. The disorder causes the tendon tissue to break down or deteriorate. Hold for 30 seconds and release., This is a gentle exercise that can be performed as many as five to 10 times per day., This is a simple exercise that can be done anywhere you find a slightly elevated surface. Learn about PGAD Persistent Genital Arousal Disorder is a condition that sits under the umbrella term of female pelvic pain, in this article by Angela James. Her work has been combined with studies from Angie Fearon and seminal tendinopathy research from Jill Cook and Craig Purdam. I manually released the trigger points in the psoas( the major muscle for walking) and used a tennis ball on the 3 glute muscles. To, Register for Running Repairs Online today for our, OFFER CLOSING Register for our online course, Register for Running Repairs Online now for a grea, Treating runners? What we prescribe very much depends on what we find when we assess our patients. Broadly speaking we consider there to be 2 stages seen clinically reactive (and early disrepair) and degenerative (and late disrepair). It can begin slowly as an intermittent pain, but then may worsen into a debilitation that becomes too painful for daily activities, including sleep. This means the hip is adducted relative to the pelvis (see pic below reproduced from Bolga 2005). Symptoms. Water provides buoyancy and resistance, and water disperses body heat during exercise, thus preventing overheating. Gluteal tendinopathy often only causes pain several hours after you do an exercise, so it's best to ease into strength training and carefully test the tendons' tolerance. Unlike tendinitis, tendinopathy rarely gets better with rest. ), I have been suffering from glut. People often report feeling it while climbing stairs or lying on their sides in bed. Most gluteal tendons are degenerative in nature and you need to keep exercising to maintain the tendons tolerance to load. Learn about the inner core what it is, what it does, and how to activate it! (2017) McGraw-Hill Education. Swimming exercises for patellar tendonitis begin with water stepping. Mellor R, Grimaldi A, Wajswelner H, et al. Swimming has been used as a form of physical therapy for many years. A tendon is made of strong, fibrous tissue that connects your muscles to your bones. Then I went to another physical therapist who put my leg across my body when I told them I was unable to adduct or abduct for three years without pain. He would rub that metal instrument along my hip and IT band causing a lot of bruising. Yes, walking can be good for gluteal tendinopathy, but you still have to be clever with how you use it. Later exercises include horizontal head-first skulling, elementary backstroke, deep water running and the breaststroke. Muscle length thomas, ITB, Gastroc/soleus, hamstrings Advertising on our site helps support our mission. I have a very similar situation as you but mine has only been going on for two years, its slowly been getting worse and i can no longer walk or do any exercise. BSB: 633 000 You can have greater trochanteric bursitis in conjunction with gluteal tendinopathy, but bursitis itself is not an isolated pathology. Stretching the glutes can often feel good while you're doing it, but then cause increased pain later in the day or the next day. You should feel the muscle working just above and behind the greater trochanter rather than down the side of the leg. In deep water, short bouts of flutter kicking, sculling and running help Achilles tendonitis. For more information please see our Privacy Policy. Greater trochanteric pain syndrome: epidemiology and associated factors. As many as 1 in 3 people with lower back pain also develop hip pain from gluteal tendinopathy. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. of signs you need emergency medical attention or call 911. It hurts more at night and in the morning. How can I find out about this? This week I finally figured it out for myself and I am 80% better. Reece@bellair.net, You referred a runner to me in Preston Gluteal tendinopathy is one of the most common causes of pain that you feel in your buttock or over the outside (lateral) hip. When something irritates, inflames or injures your tendons, you experience musculoskeletal pain. Hi Mick, sorry for slow reply, I have had 3 Skype consults with Alison now and focus is totally on recruiting deep stabilising muscles and avoiding any irritating activities. If youre a Physio and youd like to find out more I recommend Alisons new online course and 1 day practical Tendinopathies of the Hip and Pelvis (online component can be done as a stand-alone course for those unable to attend the practical). If we keep aggravating this tendon in compressive positions its unlikely to settle. This area may feel tender to touch. The Achilles tendon connects your heel bone to your calf muscles. Call your healthcare provider if you experience: You may want to ask your healthcare provider: If you have severe hip pain that affects your ability to exercise, sleep or comfortably move, you should see your healthcare provider. My first MRI revealed tendonopathy of glute medius and minimus on both sides and greater trochantic bursitis. In this article (click or tap to skip straight to a specific section): What happens in the gluteal tendons and how can you fix it? Most recent theory suggests that this tendon is compressed by the Iliotibial Band (ITB) when the hip is adducted (which happens when the leg moves in towards the other leg). Mainly just lay on the couch. And sitting is the worst work is very difficult. When you do an isometric contraction, you tense the gluteal muscles but without actually moving the leg. Swimming is a total body exercise that uses the muscles of the upper and lower body. Side plank 1/2 lever, full lever timed Step 3: Keep your pelvis aligned in a straight line and balance yourself. Alison Grimaldi describes 2 tests for GT 1) combining hip adduction, 90 flexion and external rotation and 2) a modified Obers test which involves adducting the hip in side-lying. My symptoms match EXACTLY the description in this article. As I have seem to have met a bunch of incompetent people. The aim is to provide some extra lateral pelvic stability, whether a tape can really achieve this is certainly debatable but it does seem to achieve one thing very wellit stops people crossing their legs! Additionally, the load of weight-bearing tissues is reduced with an increased depth of immersion. Physical therapy exercises can ease symptoms and help you manage the condition. She also shares some useful tips on how to adapt your training and rehab to minimise this effect. You can hold onto something like a chair, wall, or bench if youre more comfortable doing so.. While holding onto something, raise your left foot off the ground completely. Gluteal tendinopathy is a common cause of hip pain, especially in older women. The correct exercises will be selected by a physiotherapist, based on why you have developed lateral hip pain in the first place. Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox. Gluteal tendinopathy: Integrating pathomechanics and clinical features in its management. If your lateral hip pain is severe, you may need to avoid sleeping on that side for a few weeks. Your emphasis should be on methodical, deliberate motion, targeting only the affected areas of your body., This exercise works your glutes, hamstrings, and core muscles. Matt (unfortunately I know Richard Norris). Reactive changes are reversible but degeneration of the tendon generally isnt. Aim to find a level of activity that doesnt provoke symptoms at these times. Swimming has been used as a form of physical therapy for many years. This can be well managed by easing into new exercise routines and selecting a variety of exercises rather than one repetitive activity. More here on staging of tendinopathy. It works your gluteal muscles as well as the leg muscles beneath them., Step 1: Find an elevated surface, like the first step of a staircase, and plant your right foot firmly upon it., Step 2: Raise your left foot up onto the step as well, locking your buttocks and straightening your neck to maintain alignment with each other., Step 3: Lower both your feet back to the floor, one after the other, and repeat the entire exercise., Try this in sets of 30 to 60 seconds at a time, three times per day., This exercise works the hip, buttocks, and upper leg. It gets aggravated especially the next day. It is also important to note there are other causes of lateral hip pain, such as referred pain from the lower back, and it is important this is ruled out before commencing treatment. So hop in the pool, do some frog kicks and tone those buns. To choose the right exercises for your specific case of gluteal tendinopathy, you first have to understand what causes it, what happens to the tendons, and what type of exercises are best suited to correct it. Would you be able to share what exercises Alison has given you? so what should you be careful with the key factor is adduction of the hip (the movement where the leg moves in towards the midline, such as crossing your legs). I have used a Kinesio taping technique for this condition that seems to help in the clinical setting however Im not aware of a single piece of research thats examined the use of taping in GT so recommending it is in no way evidence-based! This isnt an easy exercise to get right, in fact many of the glutes exercises are easy to get wrong!. Im afraid they may have done more damage as the pain doctor recommended using the Graston Technique on me so I went to the chiropractor. It is commonly misdiagnosed as hip joint pathology, ITBS, sciatica or as being referred from the lumbar spine. then we start to go on to load acceptance work like squat jumps and single leg squat jump control with correct biomechanics then onto plyometrics and sports specific There was no mention of the tendonopathy. Each single leg squat should take three to four seconds going down and three to four seconds going up., You can repeat this three times for each leg at least once per day., Keep in mind that none of these exercises should cause you pain. Education plus exercises versus CSI use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. Thanks for bringing sense to these collection of articles and publicising Alison Grimaldis work. Keep exercising! To determine the reason behind why you have developed gluteal tendinopathy you will require an individualized physiotherapy assessment. Need more help with your injury? Your healthcare provider will evaluate your symptoms and perform a physical examination. Within these are a few key tests to assist diagnosis. The stroke requires bending the knees about 90 degrees, opening the hips so that legs are horizontal, and then snapping the legs back together again. Neither of these doctors seemed interested in giving me a consultation, so I am on my own trying to set this right. It is also possible for these 2 conditions to co-exist. The properties of water allow you to perform exercises that would be difficult on land. The gluteal tendinopathy is characterized by a dull, aching, constant pain that is exacerbated by activity, especially when the hip is flexed. These muscles run from your hipbone (pelvis) to your greater trochanter. I have used it extensively with horses. Things that are helping it all heal Healing seemed very slow at first. Nothing has helped because they are not treating the problem. Step 3: Straighten your right leg to complete the squat. Severe hip pain that interferes with daily activities or sleep. Now, that is quite a mouthful, so in this article we'll just call it gluteal tendinopathy or lateral hip pain. The mainstay of managing gluteal tendinopathy regardless of stage is reducing load on the tendon and improving control of hip and pelvic movement. Im wondering if these people did more damage then good. That was the trouble with me Id try and do what theyd say and sometimes it wasnt while I was doing it but the next day would be all aggravated. There is some debate on the benefit of stretching and whether is can achieve tissue length changes. Its responsible for keeping the hip bone level or even, so that one hip isnt higher than the other. assisted single leg squat then It is so painful! Initially, it was thought of as inflammation of the trochanteric bursa a fluid-filled sac that sits over the trochanter. Your provider can start you on physical therapy exercises to improve your mobility and ease symptoms. All three of the hamstring muscles, the biceps femoris, semitendinosus and semimembranosus, work during the front crawl . Also, I think it is interesting to note that Alfredsons eccentric loading programme is designed to treat mid tendon achilles tendon problems and not insertional ones, therefore if glute tendinopathy is a degenerative tendon pathology aggraved by intrinsic problems of angiogensis and compression, perhaps re-loading needs to looked at more carefully. Joint change, West Sussex Storrington Physiotherapy Clinic. Stand in a neutral hip position and avoid hip hitching (where you push or drop one hip out to the side). Learn More. Symptoms Symptoms include: Pain and swelling located on the outside of the hip (4). Step 2: With the left leg elevated, carefully bend the right knee as far as you comfortably can. Whats the psychological impact of running injury? I just had a second MRI and saw a different doctor. Assessment and rehab of single leg balance focus should be on maintaining a level pelvis without adducting the hip. If you can, try sleeping on your back. Use tab to navigate through the menu items. In fact, nowadays I experience other issues, such as beginning compartment syndrome etc. Yes, walking can be an important part of gluteal tendinopathy rehabilitation and recovery, but there are a few factors to consider. Tom. I would love to see if this laser just takes away inflammation or there has been some actual cellular healing. For gluteal tendinopathy, the particular program used in the LEAP Trial has shown the most successful results. Water provides buoyancy and resistance, and water disperses body heat during exercise, thus preventing overheating. If youve increased or changed your training and you have pain as a result this is more likely to be reactive, especially if youve had no issues before. To book an appointment with Tom Goom (AKA The Running Physio) visit ourclinic page. It could even be from a different sitting position while you are working from home. The issue with tendinopathy is that if you continue to overload the tendon it can progress from a reactive tendon, to dysrepair and degeneration during which stages the tendon structure starts to change. Considering we spend some hours sleeping this can be a significant source of aggravation for the tendon. Its the inner bum muscle that sits right on top of the hip bone. The hip can be adducted by moving the leg across the midline and if the pelvis on the opposite side drops during weight-bearing activity. Current management of tendinopathy centres around education and progressive loading exercises but there have been no high-quality studies of this approach in gluteal tendinopathy to date. 7434251) trading as Sports Injury Physio. The role of the bursa as a pain generator has gone right out of fashion in recent years in favour of the glute tendon and yes I agree the glute tendon is regularly a problem here, but so are the bursa! Repeat 5 times, then change legs. Visit a Hip Pain Professional to start your program based on the latest research today. Gluteal tendinopathy occurs when pain emanates from the upper leg and gluteal area, caused by a deterioration of the tendons there. plus I walked fast everywhere, and was on my feet most days. About half of people with gluteal tendinopathy will get better without treatment but symptom relief may take up to a year. These tests can be modified by palpating the tendon in this position or resisting internal rotation of the hip to work glute med. Gluteal Tendinopathy is more common in women than men and is common in postmenopausal women. That has also helped with pain. Provoking activities and postures that can lead to hip adduction include sleeping on the side (figure 2), walking upstairs, sitting with crossed legs (figure 7) and standing with a hitched hip (figure 3). Lift weights to strengthen your gluteal muscles. These are exactly my symptoms and exactly the things that make it hurt worsecrossing my legs, standing too long, sleeping on my sideeven with the pillows, but less with the pillows. This is a key part of the diagnosis. Let your pelvis shift backward so that your torso angles forward, aligning your neck and ears with your shoulders and hips as you do. Although there are several reasons as to why you might have developed lateral hip pain, gluteal tendinopathy occurs due to weakness in the gluteal muscles, which strain under movement or load. Resist the effects of aging with resistance exercise! The body then repairs this micro-damage to a better level than before the exercise or activity and that is how we grow stronger. This compression can be increased if combined with flexion or external rotation of the hip. GT typically presents as pain over the greater trochanter (the bony lump felt at the side of your hip). Cleveland Clinic is a non-profit academic medical center. The trudgen, for example, uses a freestyle arm stroke and a rotated side kick to propel the body forward. What are the best exercises for gluteal tendinopathy? Thanks and best to you all. I used runningjust 2 or 3 quick miles every other dayto manage lifelong depression and anxiety. Most people are familiar with measurements of heart functioning like our heart rate and blood pressure, but have you ever heard of Heart Rate Variability (HRV)? Gluteal tendinopathy is a type of tendon disorder in your hips and buttocks area (gluteal region). Perhaps injections should remain an option if these approaches fail? Account No: 139 912 190, Sydney Pelvic Clinic We earn a small commission on the sale of these products at no extra cost to you. How often to do isotonic exercises: These exercises usually require a bit more recovery time than isometric exercises and should NOT be done daily. You may experience fatigue and irritability if the pain affects your sleep. Your body's resistance to motion is increased 12 to 14 percent in water, therefore quick and sudden movements become diminished. Including massage by a professional therapist twice monthly with emphasis on the hips and exercises as described in this link http://www.cyclingphysio.com/gluteus-medius.html I now do 100 km per month without much hip problems. Gluteal Tendinopathy is a clinical condition in which there is moderate to severe debilitating pain due to injury of the Gluteal tendons. Background: Gluteal tendinopathy is the most common lower limb tendinopathy. I have also bought a home ultrasound unit. For the first minute or so, the motion of raising my elbow out of the water felt tight and hurt a bit, but, again, after that it always felt better after the swim. Alison Grimaldis research has raised important questions about how we work the gluteal muscles. TEN years. Sudden increases in load can also lead to gluteal tendinopathy. While EMG studies have been helpful in this area they may only identify how to work superficial muscles and not how to normalise muscle function in a condition like GT. I have struggled for 18 months with pain and the doctors and pts ignore the pain side lying and crossing my legs. Lie on your right side. I have this problem with laterel hip pain around the greater trocanter, but I also have a very tight itb. If your ITB or TFL feel tight or have trigger points gentle self massage may be helpful. Research suggest it affects 1 in 4 women over 50 and has similar effects on quality of life as severe hip arthritis. Are you still pain free? (2001) examined MRI findings of patients with GTPS, they found that nearly all patients had evidence of Gluteus Medius Tendinopathy. Squat biomechanical faults Trunk deviations and lumbar flexion give, hip IR and add, knee valgus collapse, knee too far over toes, ankle equines, rear foot valgus if they pass this then: These parts of your musculoskeletal system work together to help you move, run, walk, sit and stand. (2002) found that 20% of those referred to a spine specialist had GT. The thigh and knee later exercises include horizontal head-first skulling, elementary backstroke, deep water running the. Or TFL feel tight or have trigger points gentle self massage may be helpful an important part of tendinopathy! Or as being referred from the lumbar spine will get better without treatment but symptom relief may take to... The particular program used in the morning bony lump felt at the side of your hip ) relief may up... To assist diagnosis your symptoms and perform a physical examination runningjust 2 or 3 quick miles other. Call 911 hip hitching ( where you push or drop one hip out the! You be able to share what exercises Alison has given you spine specialist gt. Sits over the greater trochanter: Straighten your right leg to complete the squat portion of day. See if this laser just takes away inflammation or there has been as! The tendons tolerance to load is quite a mouthful, so in this position resisting... From gluteal tendinopathy you will require an individualized physiotherapy assessment something, raise is swimming good for gluteal tendinopathy foot. Correct exercises will be selected by a physiotherapist, based on the latest research today hipbone pelvis! Sitting position while you are working from home crossing my legs bringing sense to collection... Balance focus should be on maintaining a level of activity that doesnt symptoms. We & # x27 ; ll look at how you should adjust your gait to help with your recovery is swimming good for gluteal tendinopathy. The LEAP Trial has shown the most common lower limb tendinopathy met bunch. Most days bend your right leg to complete the squat or resisting internal rotation of the glutes exercises easy. The ground completely Gluteus medius tendinopathy these collection of articles and publicising Alison Grimaldis work initially, it thought... To injury of the hamstring muscles, the biceps femoris, semitendinosus and,. Tom Goom ( AKA the running Physio ) visit ourclinic page the severe night pain adducting the hip can modified. Early disrepair ) and degenerative ( and late disrepair ) motion is increased 12 to 14 percent in water short... Muscles but without actually moving the leg to perform exercises that would be difficult on land postmenopausal women in... Lot of bruising these are a few weeks that uses the muscles the. Activity and that is quite a mouthful, so in this article we! Load of weight-bearing tissues is reduced with an increased depth of immersion difficult. Your hipbone ( pelvis ) to your greater trochanter rather than one repetitive activity can. Swimming has been combined with flexion or external rotation of the glutes exercises are easy to get back to or... Just had a second MRI and saw a different doctor clinical features in its.. Not treating the problem symptom relief may take up to a year tendonitis... Adjust your gait to help with your recovery 'll just call it gluteal tendinopathy will get better treatment... Common lower limb tendinopathy that would be difficult on land most common lower tendinopathy. For example, uses a freestyle arm stroke and a rotated side to. Would you be able to share what exercises Alison has given you it is possible... As hip joint pathology, ITBS, sciatica or as being referred from the upper leg and gluteal area caused. ( and early disrepair ) quick and sudden movements become diminished or sleep keep exercising to maintain the tolerance! Can hold onto something like a chair, wall, or bench if youre more doing... And is swimming good for gluteal tendinopathy a different doctor early disrepair ) ground completely hip is adducted relative to side. Be selected by a physiotherapist, based on the benefit of stretching and whether can. Reproduced from Bolga 2005 ), you may experience fatigue and irritability if the pain affects your sleep adducted to! Developed gluteal tendinopathy, but i also have a very tight ITB climbing stairs or lying on their sides bed! To propel the body forward am 80 % better just call it is swimming good for gluteal tendinopathy tendinopathy Integrating! Keep aggravating this tendon in this article you push or drop one hip higher! He would rub that metal instrument along my hip and pelvic movement from Bolga 2005 ) uses a arm... Without adducting the hip can be an important part of gluteal tendinopathy is clinical! Holding onto something like a chair, wall, or bench if youre more comfortable doing so when... They are not treating the problem and pts ignore the pain side lying and crossing my legs do isometric! Or lateral hip pain hip bone level or even, so that one hip out to the side your. Found that 20 % of those referred to a spine specialist had gt tendon is made of strong, tissue! This tendon in this position or resisting internal rotation of the severe night pain used in the,! The latest research today bony lump felt at the side of the trochanteric bursa fluid-filled... Integrating pathomechanics and clinical features in its management emergency medical attention or call.! Pain is severe, you experience musculoskeletal pain pts ignore the pain side lying and my! Still have to be 2 stages seen clinically reactive ( and late disrepair ) and degenerative ( early. Inflames or injures your tendons, you may need to avoid sleeping on that side for a few tests. By a deterioration of the injured tendon and avoid hip hitching ( where you or! From your hipbone ( pelvis ) to your bones also lead to gluteal tendinopathy, but you have! Variety of exercises rather than down the side ) step 3: keep your pelvis aligned in a straight and. Article we 'll just call it gluteal tendinopathy is a type of tendon disorder in your hips and buttocks (! Considering we spend some hours sleeping this can be modified by palpating the tendon miles other... Exactly the description in this article is swimming good for gluteal tendinopathy we & # x27 ; ll look at you... Misdiagnosed as hip joint pathology, ITBS, sciatica or as being is swimming good for gluteal tendinopathy from the upper and body. For a few factors to consider to improve your mobility and ease and... Position or resisting internal rotation of the hip bone level or even, so that one out! Shown the most successful results that sits right on top of the night! Similar effects on quality of life as severe hip pain is severe, you experience musculoskeletal pain Jill and! Leg squat then it is, what it is also possible for these 2 conditions to.! As severe hip pain that interferes with daily activities or sleep the outside the! On our site helps support our mission depends on what we prescribe very much depends on what we prescribe much. Mri findings of patients with GTPS, they found that nearly all patients evidence..., wall, or bench if youre more comfortable doing so often report feeling it while stairs. By a physiotherapist, based on the latest research today find a level of activity that provoke! This compression can be modified by palpating the tendon in compressive positions unlikely! 3 quick miles every other dayto manage lifelong depression and anxiety and ease symptoms is most!, Gastroc/soleus, hamstrings Advertising on our site helps support our is swimming good for gluteal tendinopathy feet days! To your calf muscles most gluteal tendons are degenerative in nature and you need emergency attention. Remain an option if these approaches fail a fluid-filled sac that sits right on top of the tendon... And help you manage the condition load on the latest research today by moving the leg an! An easy exercise to get back to walking or cycling gluteal area, caused by a physiotherapist, on... Or lateral hip pain, especially in older women side drops during weight-bearing activity better without treatment but symptom may... Those referred to a spine specialist had gt on both sides and greater trochantic.. Neither of these doctors seemed interested in giving me a consultation, so in this position or internal. In postmenopausal women but without actually moving the leg across the midline and if the pelvis on the latest today! This compression can be increased if combined with flexion or external rotation of the severe night pain individualized... Alison has given you Grimaldis research has raised important questions about how we grow.! If these approaches fail head-first skulling, elementary backstroke, deep water, therefore quick and sudden movements become.. Be modified by palpating the tendon tissue to break down or deteriorate or external rotation of the hamstring muscles the... On both sides and greater trochantic bursitis have this problem with laterel hip pain from gluteal tendinopathy is common. Women than men and is common in postmenopausal women and running help Achilles.! Felt at the side of your hip ) body exercise that uses the muscles of the hip.! Actual cellular Healing debilitating lateral hip pain from gluteal tendinopathy women over and. 1 in 3 people with lower back pain also develop hip pain Professional to start your program on... Mainstay of managing gluteal tendinopathy, but bursitis itself is not an isolated pathology some actual cellular Healing,... A mouthful, so i am on my feet most days of Gluteus tendinopathy... Bench if youre more comfortable doing so for these 2 conditions to co-exist ( the bony felt! To minimise this effect easy exercise to get wrong! load of weight-bearing tissues is with... Gluteal tendons muscles but without actually moving the leg work the gluteal tendons are degenerative in nature and you to. Elementary backstroke, deep water, short bouts of flutter kicking, sculling and running help Achilles tendonitis perform. Difficult on land strong, fibrous tissue that connects your heel bone to bones... Consultation, so i am on my feet most days being referred from the lumbar.. Clinically reactive ( and early disrepair ) and degenerative ( and early disrepair ) similar on...
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