Gluteal Tendinopathy

Gluteal Tendinopathy

Article by J.Miller, Z.Russell

Gluteal Tendinopathy

Hip Tendinopathy / Hip Tendonitis

What is Gluteal Tendinopathy?

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

Gluteal tendinopathy is an injury to one or all gluteal or buttock tendons in isolation, characterised by the gluteal muscles’ pain and dysfunction to support daily activities. Gluteal tendinopathy can also be associated with trochanteric bursitis.

Your gluteal muscles are a group of three muscles that make up the buttocks: the gluteus maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium and sacrum and insert on the femur. They are responsible for the hip movement and supporting the body in weight-bearing (running and walking).

Gluteal tendinopathy describes its various aliases: gluteus maximus tendinopathy, gluteus medius tendinopathy or gluteus minimus tendinopathy.

What Causes a Gluteal Tendinopathy?

gluteal tendinopathy

Reduced hip and gluteal muscle strength and control is the most common cause of gluteal tendinopathy. The result is pain and further muscle weakness, resulting in hip-pelvis instability, which further perpetuates the cycle. This weakness and functional instability lead to increased load on the gluteal tendons.

Hip instability can cause you to walk or run with poor control., which may increase the compressive load to your trochanteric (hip) bursa. This bursa pressure raises your risk of developing concomitant trochanteric bursitis.

Who Suffers from Gluteal Tendinopathy?

Gluteal tendinopathy is most common in postmenopausal women, with 20 – 25 % of women suffering from the condition. There is also a 10 – 15 % prevalence in the general population, usually young active individuals, and it is generally associated with running, dancing and skiing.

What are the Symptoms of Gluteal Tendinopathy?

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

  • The pain may get worse when you use the tendon, e.g. running or hopping or ascending stairs.
  • You may have more 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 bursa.

How is a Gluteal Tendinopathy Diagnosed?

Gluteal tendinopathy can be diagnosed clinically by your PhysioWorks Physiotherapist, based upon presenting signs and symptoms, clinical history, and pain response to loading tests. In most cases, you will not require diagnostic imaging.

Your physiotherapist may suggest ultrasound or MRI that gains further insight into your clinical presentation, given that there is a confluence of multiple pain generating structures in the region. It is important to note that tendon pathology on MRI is a risk factor for developing lateral hip pain. Clinical assessment is required to determine the relevance of imaging findings on your presentation. Your physiotherapist may liaise with your GP to obtain imaging and guide you on what may be specifically required.

What Causes Gluteal Tendinopathy?

The gluteal tendons’ role is to transfer the gluteal muscle forces to the hip and pelvis for everyday movement and activity. Your tendons withstand repetitive loading. However, once the tendon becomes painful, the more times you are required to perform the provoking action, the tendon’s ability to cope decreases. The tendon’s efficiency is impaired and causes micro stresses in the tendon to make the tendon stronger. When this process occurs, the tendon can recover if managed appropriately.

When accumulated tendon loads exceed the repair rate, this process is progressive and causes pain and dysfunction. The result is gluteal tendinopathy.

Risk Factors for Gluteal Tendinopathy

Many factors can contribute to the development of gluteal tendinopathy. Your physiotherapist is the best person to discuss these factors with you. The successful management of gluteal tendinopathy has become highly specialised over recent years. Your physiotherapist will help you to identify all the causes of your gluteal tendinopathy.

Researchers have identified the following factors with increased risk:

  • Increased load through increased training loads or new accustomed capacity.
  • Weak gluteal musculature
  • An altered gait (walking pattern)
  • Lumbar spine pain
  • General health conditions – diabetes, thyroid function

Gluteal Tendinopathy Treatment

In most cases, conservative management will be able to facilitate your recovery from Gluteal Tendinopathy.

  • However, relative rest keeps moving, avoiding positions of compression – such as crossing your legs or propping on one hip.
  • Apply ice or cold packs for 20 minutes at a time, as often as two times an hour, for the first 72 hours. Keep using ice as long as it helps with your pain. 
  • Have your hip joint and muscle function assessed by your hip physiotherapist.
  • Undertake Gluteal Tendinopathy Exercises, possibly combined with a Hip Core Stabilisation Program, 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.

Gluteal Tendinopathy Exercises

Persisting tendon injuries are best managed by exercise under the guidance of your physiotherapist. Despite the frequent use of painkillers and anti-inflammatory medications, the cause is related to hip muscle strength and control, so exercise therapy should be a priority as part of your management. Your hip physiotherapist will prescribe the most appropriate gluteal tendinopathy exercises for your rehabilitation phase.  They will also customise your gluteal tendinopathy exercises specific to your individual goals and needs. Every sport differs in the demands placed upon your gluteal tendons, so your hip physiotherapist will adapt your exercise to best suit your ultimate needs and requirements.

How to Return to Sport after Gluteal Tendinopathy

Your physiotherapist will gradually progress your rehabilitation program. Based on your current level of function and desired goals, they will prescribe an initial batch of gluteal tendinopathy exercises and then monitor your progress with the following:

  • Pain levels
  • Strength Testing
  • Functional activities related to your goals
    • Walking
    • Running
    • Jumping
  • Outcome Measures – specifically VISA – G Score

It is common for gluteal tendinopathy rehabilitation to take a minimum of 6 – 12 weeks. Tendinopathy is one condition where the longer you have suffered the injury, the longer it takes typically to reverse the tendinopathy symptoms and resume your function. Be patient and proactive. Stick with your treatment and the advice of your tendinopathy physiotherapist. 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 PhysioWorks physiotherapist.

Hip Pain Treatment

A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.

Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence,  or improve your athletic performance.

The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.

However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.

You should consult a healthcare practitioner who has a particular interest in hip pain and injury management to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all impact, especially at the high athletic performance end. A quality practitioner will educate you on your condition and combine it with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.

Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.

For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapists experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.

Hip Pain Treatment Options

Your hip physiotherapist may consider an extensive range of treatment options, including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and hip joint control exercises as they deem appropriate for your specific functional and sporting needs. Please consult with them for advice.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.