Gluteal Tendinopathy

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Article by J. MillerZ. Russell

What is Gluteal Tendinopathy?

gluteal tendinopathy

Gluteal tendinopathy is the most common hip tendonitis (hip tendon injury). It is a common cause of Greater Trochanteric Pain Syndrome.

Your gluteal tendons are the tough fibres that connect your gluteal muscle to your hip bone. A tendon injury may seem to happen suddenly, but usually, it is the result of many tiny tears to the tendon that have happened over time.

Typically, tendon injuries occur in three areas:

  • musculotendinous junction (where the tendon joins the muscle)
  • mid-tendon (non-insertional tendinopathy)
  • tendon insertion (eg into bone)

Non-insertional tendinopathies tend to be caused by a cumulative microtrauma from repetitive overloading eg overtraining.

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually, it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means "inflammation of the tendon," but inflammation is actually only a very rare cause of tendon pain. But many doctors may still use the term tendinitis out of habit.

The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. Therefore tendinopathies do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

What Causes a Tendon Injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Your tendons are designed to withstand high, repetitive loading, however, on occasions, when the load being applied to the tendon is too great for the tendon to withstand, the tendon begins to become stressed.

When tendons become stressed, they sustain small micro tears, which encourage inflammatory chemicals and swelling, which can quickly heal if managed appropriately.

However, if the load is continually applied to the tendon, these lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a tendinopathy or tendinosis.

Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces generated during sport or an activity causes a tendinopathy. 

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent. Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good. Tissue is attempting to heal.
  • It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Poor Prognosis - Tendon cells are giving up!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

It is very important to have your tendinopathy professionally assessed to identify it’s injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist will ask questions about your past health, your symptoms and exercise regime. They'll then do a physical examination to confirm the diagnosis. If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

How is Tendinopathy Treated?

In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:

  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.
  • Have your biomechanics assessed by your physiotherapist.
  • Undertake an Eccentric Strengthen Program. This is vital!

Your gluteal (buttock) muscles control your hip joint movement. Gluteal tendinopathy is an injury to the gluteal tendon complex and is often associated with trochanteric bursitis.

What Causes a Gluteal Tendinopathy?

The most common onset of gluteal tendinopathy is due to poor hip and gluteal muscle control that leads to overstressing of the gluteal tendons, causing pain and hip-pelvis instability.

Continued hip instability can cause you to walk or run with poor control, which causes you hip bursa to become under friction load, leading to trochanteric bursitis.

What are the Symptoms of Gluteal Tendinopathy?

Gluteal tendinopathy usually causes lateral hip pain, muscular stiffness, and loss of strength in the hip muscles.

  • The pain may get worse when you use the tendon eg running or hopping.
  • You may have more hip pain and stiffness during the night or when you get up in the morning.
  • Pain is often worse when you lie on your affected hip.
  • The lateral hip may be tender, red, warm, or even swollen if there is inflammation of the hip bursa.

How is a Gluteal Tendinopathy Diagnosed?

In most cases, your doctor or physiotherapist will accurately suspect your gluteal tendinopathy diagnosis in their clinic.

If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

Gluteal Tendinopathy Treatment

  • In most cases, you can start treating your hip tendon injury at home using a RICE regime.
  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as second hourly, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle hip range-of-motion exercises and stretching to prevent stiffness.
  • Have your hip joint and muscle function professionally assessed by your physiotherapist.
  • Undertake a “Hip Core Stabilisation Program”. This is vital to prevent a recurrence.
  • Visualise and retrain your hip muscle control via Real-time Ultrasound.
  • Modify your return to sport under the advice of your physiotherapist.
  • Despite the common use of painkillers and anti-inflammatory medications the cause is related to hip control, so it is your control that should be retrained as a priority. Persisting tendon injuries are best managed by exercise under the guidance of your physiotherapist. 
  • Should your tendinopathy be slow to improve you have the option of a steroid injection under ultrasound guidance. For the best long-term results, you should continue to strengthen your hip rather than rely solely on the steroid effects. 
  • In severe cases, hip surgery may be required.

How to Return to Sport after Gluteal Tendinopathy

As soon as you are cleared by your physiotherapist you can return to your activity, but take it easy for a while.

  • Don't start at the same level as before your injury. Build back to your previous level slowly, and stop if it hurts.
  • Warm up before you exercise.
  • After the activity, apply ice to prevent pain and swelling.
  • Continue your hip stabilisation exercises.
  • If these steps don't help, you may require a re-visit to your physiotherapist. 
  • It may take weeks or months to fully rehabilitate a gluteal tendinopathy.
  • Be patient, and stick with your treatment. If you start using the injured tendon too soon, it can lead to more damage and further time delays.

If you have any concerns please seek the advice of your physiotherapist.

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Gluteal Tendinopathy Treatment Options

  • Early Injury Treatment
  • Avoid the HARM Factors
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Core Exercises
  • Closed Kinetic Chain Exercises
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Orthotics
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Brace or Support
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Gluteal Tendinopathy Products

    Hip Injuries

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    Related Hip Injuries

    General Information

    Hip Joint Pain

    Lateral Hip Pain

    Adductor-related Groin Pain

    Pubic-related Groin Pain

    Inguinal-related Groin Pain

    • Inguinal hernia
    • Sportsman's hernia

    Iliopsoas-related Groin Pain

    • Hip Flexor Strain

    Other Muscle-related Pain

    Systemic Diseases

    Referred Sources

    Hip Surgery


    FAQ's about Gluteal Tendinopathy

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
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  • What Causes Post-Exercise Muscular Pain?
  • Heat Packs. Why does heat feel so good?
  • How Do You Improve Your Balance?
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  • Running Recovery: 6 Helpful Tips
  • Sports Injury? What to do? When?
  • What are Growing Pains?
  • What are the Common Massage Therapy Techniques?
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  • What Can You Do To Help Arthritis?
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  • What to expect when you visit PhysioWorks?
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  • What's Your Core Stability Score?
  • Why do your Joints Click?
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    Last updated 08-Sep-2017 11:55 AM

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