Dealing with Gluteal Tendinopathy; what it is and how to manage it
Gluteal tendinopathy is a common condition that affects the tendons on the outside of the hip, specifically the gluteus medius and gluteus minimus tendons. This condition most commonly affects females aged 40-60 years. The gluteal tendons play a crucial role in stabilising the hip joint, pelvis, providing support for the lower back and helping with lower limb movement and production of force. When the gluteal tendons become irritated, it can lead to severe pain and discomfort at the outside of the hip and buttock area. Ongoing pain can affect the individual’s lifestyle and ability to participate in sports and activities they love. Gluteal tendinopathy is often seen in individuals who participate in activities that require repetitive hip movements, such as walking, running, cycling, or jumping. Although it is described as tendon related pain, there occasionally can also be changes to the underlying bursa which sits below the tendon.
Signs & Symptoms
The location of gluteal tendon pain is felt at the outside of the hip over the bony prominence of the femur bone
Pain at the outside of the hip that can go down the leg toward the knee
Mild pain and limping when walking
Pain when getting up from prolonged sitting or standing
Difficulty lying onto the affected side
Difficulty ascending or descending stairs
Pain touching the affected area
Pain which worsens with stretching or massaging the affected area
What causes Gluteal Tendinopathy?
There are several factors that can contribute to the development of gluteal tendinopathy. One of the primary causes is overuse or repetitive stress on the tendons or a sudden increase in single leg loading activities such as running and walking. This can occur from weakness of the muscle, or from poor biomechanics during movement. Other factors that can increase the risk of developing gluteal tendinopathy include age-related degeneration of the tendons, hormonal imbalances, and certain medical conditions such as obesity or diabetes.
Ladies who have been through menopause have an increased prevalance of gluteal tendon pain. This is becase estrogen plays an important role in collagen replacement which makes up the tendon. When perimenopause starts and estrogen levels reduce, the cycle of normal tendon repair can take longer than previous which makes the tendon more sensitive to increasing loads rapidly and also means it can take a little longer to recover from tendon pain.
Symptoms and Diagnosis of Gluteal Tendinopathy
The symptoms of gluteal tendinopathy can vary from mild to severe and may include pain and tenderness over over the greater trochanter, the large bone that you can feel at the side of the hip, but may also extend down the outer thigh towards the knee. This pain is often worse with activities that involve hip movement, such as walking, running, or climbing stairs. In some cases, individuals may also experience stiffness or weakness in the hip joint.
To diagnose gluteal tendinopathy, your physiotherapist or healthcare practitioner will perform a physical examination. They may also order imaging tests, such as an MRI or ultrasound, to assess the extent of the tendon damage. It is important to accurately diagnose gluteal tendinopathy to determine the most appropriate treatment plan.
Physiotherapy for Gluteal Tendinopathy
Before commencing a hip strengthening program it is essential to have an assessment by a healthcare practitioner to determine the exact diagnosis. Pain at the hip can refer from the lumbar spine, sacroiliac joint or the hip joint itself so therefore gaining an appropriate diagnosis and treatment plan is important to ensure the exercises are effective for your condition. Following a formal assessment to determine contributing factors and analysis of biomechanics, your physiotherapist will develop an appropriate program and educate you about changes to make to sitting position, sleeping and walking techniques.
Prevention Techniques for Gluteal Tendinopathy
Preventing gluteal tendinopathy involves a combination of proper training techniques, biomechanical adjustments, and lifestyle modifications. It is important to gradually increase the intensity and duration of activities to allow the tendons to adapt and strengthen. Additionally, individuals should incorporate strength training exercises that target the gluteal muscles to improve their stability and support the tendons. It is also essential to maintain a healthy body weight and ensure adequate rest and recovery between physical activities.
Rehabilitation Exercises for Gluteal Tendinopathy
Rehabilitation exercises play a crucial role in the recovery process for individuals with gluteal tendinopathy. These exercises aim to improve the strength of the gluteal muscles, load tolerance of the tendon and provide stability of the pelvis and hip. A specific exercise program that aims to improve your movement patterns, gradually strengthen the muscles involved and improve the health of your hip tendons is essential. Massage, self trigger point releases, acupuncture or dry needling and heat may assist with short term symptomatic pain relief. However, research shows that a specific exercise program and being taught how to control loads across your tendons are key strategies in managing this condition for the longer term.
Studies show that corticosteroid injections can provide moderate short term pain relief for four weeks, long term therapeutic benefit was shown to usually last no longer than 3 to 6 months. Research shows that a targeted exercise program over eight weeks had greater improvements and effects on pain scores when compared to corticosteroid injection alone.
Evidence for exercise
Specific exercises targeted at gradually loading the tendon, beginning with low load and progressing over the course of 1-3 months, have been shown to help with long term pain. An exercise therapy program aims to reduce hip pain and improve the tendon’s tensile load–bearing capacity. Exercises may include low load muscle activations, banded exercises, progressing to more functional exercises involving lower limb alignment and finally strengthening with higher loads.
Recovery and Long-Term Management of Gluteal Tendinopathy
The recovery process for gluteal tendinopathy can vary from person to person, depending on the degree of tendon pathology, any associated pain and bursal involvement and the individual's response to treatment. As the gluteal tendons don’t have a great blood supply when compared to muscle, they can be slow to heal. It is important to follow the prescribed treatment plan and engage in regular physical therapy exercises to promote healing and prevent future recurrences. It is also essential to make lifestyle modifications, such as maintaining a healthy body weight and avoiding activities that exacerbate symptoms. Long-term management of gluteal tendinopathy may involve regular reviews with a healthcare professional to monitor progress and address any ongoing concerns.
What can I do about my hip pain? Tips to help you BOUNCE BACK:
Sleeping position is an important factor for offloading painful tissues. Try putting a pillow between your knees when sleeping at night. If sleeping on your back, try putting a pillow under your knees.
If you have pain after lying on your side, add extra padding on top of the mattress
Try sitting on a pillow to lift the hips higher than the knees - great for the car
Avoid sitting with your knees crossed
If walking for exercise, try to avoid excessive hills or inclines and stick to flat surfaces
Avoid long striding 'power walking', try to take shorter steps
Incorporating a daily routine of gentle muscle strengthening exercises will aid in improving your hip health, decreasing pain and reducing the risk of reinjury
Get early advice from a physiotherapist experienced with hip and pelvic pain
Don’t stop moving; but get guidance about which type of exercise is better suited for your hip pain
Gluteal tendinopathy is a common condition that can cause pain and discomfort in the hip and buttock area. By understanding the causes, symptoms, and treatment options for gluteal tendinopathy, individuals can take proactive steps to prevent and manage this condition. Whether through prevention techniques, rehabilitation exercises, or alternative therapies, there are various approaches to help individuals recover and improve their quality of life. It is important to work closely with a healthcare professional to develop a personalised treatment plan that addresses the individual's unique needs and goals. Remember, early intervention and proper management are key to achieving optimal outcomes in gluteal tendinopathy.
Help for your Hip Pain
Are you or someone you know suffering from ongoing hip pain that’s stopping you from doing the things you love?
With experience in the management of hip pain associated with osteoarthritis, impingement, tendinopathy, bursitis and hypermobility, at Back to Bounce Sports Physiotherapy we thoroughly assess and guide you through your rehabilitation plan to help you get back to doing the activities you love.
At Back to Bounce, our mission is to help people get moving, achieve their goals, and BOUNCE BACK to their BEST
We are a passionate team of physiotherapists who love supporting our community on every step of their rehabilitation journey with expert knowledge, care, guidance, and support. If you need help, or need further information, you can call our clinic on (07) 5378 1571 or book online for an appointment here.
References
Ladurner A, Fitzpatrick J, O'Donnell JM. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation. Orthop J Sports Med. 2021 Jul 29;9(7):23259671211016850. doi: 10.1177/23259671211016850. PMID: 34377713; PMCID: PMC8330465.
Mellor R, Grimaldi A, Wajswelner H, Hodges P, Abbott JH, Bennell K, Vicenzino B. Exercise and load modification versus corticosteroid injection versus 'wait and see' for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskelet Disord. 2016 Apr 30;17:196. doi: 10.1186/s12891-016-1043-6. PMID: 27139495; PMCID: PMC4852446.
Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163–8. doi: 10.1136/bjsports-2011-090414.
Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management J Orthop Sports Phys Ther 2015;45(11):910-922. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5829
