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Gluteal Tendinopathy

Gluteal tendinopathy

You rely on your gluteal tendons to perform simple activities like walking and climbing the stairs. While gluteal tendinopathy can be one of the most frustrating forms of tendon injury, it is a one of the most common forms of lateral hip pain.

In this article, we’ll provide you with all of the information you need to understand the condition and the most effective ways to treat it.

What is gluteal tendinopathy?

The gluteal tendons are the soft tissue fibres that connect your gluteal muscles to a bony prominence in the hip joint called the greater trochanter.

The three most common tendons to suffer from tendinopathy are the gluteus maximus, gluteus medius, and gluteus minimus tendons. They play a vital role in helping to absorb shock and stabilise the gluteal tendons and hip during movement in order to prevent lateral hip pain.

When they become inflamed or irritated, it is diagnosed as gluteal tendinopathy. Another clinical name for the condition is ‘Greater Trochanteric Pain Syndrome (GTPS).’

It affects 10-25% of the population and is 3 times more prevalent in women.

Symptoms of Gluteal Tendinopathy/ Greater Trochanteric Pain Syndrome

  • The outside of the hip joint is tender to touch. (Lateral Hip Pain)
  • Pain when in a side lying position on the affected side.
  • Night pain in the affected side
  • Morning stiffness in the tendon structure – specially after prolonged side lying position
  • Referred pain into the outside of the thigh or the knee.
  • Pain during weight-bearing activities such as walking, running, climbing stairs or performing a single-leg stance.
  • The relief when the buttock muscles are being stretched.
  • Lateral thigh pain when sitting for too long.
  • Buttock weakness
  • Pain with legs crossed and knees crossed.

Causes of gluteal tendinopathy/ Greater Trochanteric Pain Syndrome

Pain over the greater trochanter tends to build up slowly – that’s why so many people with the condition aren’t sure what caused it. It’s often associated with Trochanteric bursitis, and tends to be caused by overloading the structures of pelvis. Clinical trials have shown that people with Gluteal Tendinopathy have a different position of stance leg, compared to those who are pain free.

There are three main causes of trochanteric pain syndrome gtps include:

Biomechanics

To be able to perform routine activities such as walking, running, and climbing stairs, internal rotation and external rotation – we need strong gluteal muscles. If they are weak, the hips can fall out of line, induce excessive lateral pelvic tilt and put increased pressure through the gluteal tendons – causing lateral hip pain or the pain over greater trochanter. The normal femoral neck shaft angle is 125 to 135 degree, but it may decrease in these patients.

If the iliotibial band (ITB) is tight then it can compress the gluteal tendons during minimal hip adduction movements. The Iliotibial band passes over the bony prominence on the side of the hip known as Greater trochanter and plays an important role in hip adduction.

Also, if someone is limping from another injury such as Achilles tendinopathy then it can cause gluteal tendons pain.

Read the blog: Achilles Tendinopathy

Over-use

Everyone has their own load bearing capacity. When the compressive loads and tensile loading exceeds that, the affected area may become over=worked. You’ll find this more common during hip adduction. The role of the gluteal muscles is to absorb shock during weight-bearing activities, and if they’re over-worked, they can become tired, tight, and unable to absorb shock as efficiently.

This shock then gets transferred into the gluteal tendons, which leads to inflammation and irritation.

Alignment

The main reason gluteal tendinopathy and lateral hip pain is more common in women is due to hip width. Greater hip width increases the Q-angle. The greater the Q-angle, the greater the compressive forces on the outside of the hip. But, a misaligned pelvis can also force the gluteal tendons to function at an angle that they aren’t used to functioning at.

Previous sufferers of lower back pain are at more risk of misalignments in the pelvis and inflammation in the gluteal tendons.

Weak hip ligaments

The role of the ligaments in the hip is to stabilise the ball within the socket. If the ligaments are lax then the gluteal tendon has to work harder and as a result, can develop a lateral hip pain. Painful hip also known as greater trochanteric pain syndrome.

Trauma

Falling on your site can inflame the gluteal tendons, with the gluteus medius tendon being at most risk. This can cause gluteus medius tendinopathy, bursitis and other forms of hip pathology.

Excessive Hip Adduction

Studies show that changes in joint position, such as excessive hip adductions can increase the risk of gluteal tendinopathy. Hip adduction is the movement of the hip towards the midline. During hip adduction you’ll use the adductors muscles on inner thigh. These are different from the Gluteus medius muscles, and help move the hips away from the midline. The iliotibial bands play an important role in hip adduction, When the hip moves into adduction, the iliotibial band induces a tensile load and compressive force on the glute tendon, which causes lateral hip pain. Excessive hip adduction may also be associated with groin pain.

How to fix hip pain

Risk factors For Gluteal Tendinopathy/Greater Trochanteric Pain Syndrome

  • Athletes – especially runners that don’t stretch regularly.
  • Inactive people – this causes weakness in the buttock muscles which then effects the biomechanics of the hips.
  • Hip osteoarthritis – when cartilage in the hip starts to wear down it causes the joint to become unstable. The gluteal muscles and tendons during Hip Osteoarthritis (Hip OA) then have to work harder to stabilise the joint and as a result, can cause gluteal tendinopathy, hip pain and tendon pain.
  • Sleeping position – people who adopt a side-lying sleeping position at night are more likely to experience lateral hip pain.
  • Crossed Legs for long period of time

Diagnosis of Gluteal Tendinopathy/Greater Trochanteric Pain Syndrome gtps

Your doctor may initially start with a detailed history and overview of your symptoms. You’ll probably be asked about your habits, lifestyle, sitting and standing position and load management in the legs. If you spend a lot of time with hip adduction, and suffer with symptoms like single leg lateral hip pain (referred pain to thigh or knee on climbing stairs), you may be diagnosed with Greater trochanteric pain syndrome.

Gluteal Tendinopathy is usually confirmed using Magnetic resonance imaging or ultrasound. Also know as MRI, Magnetic resource imaging allows the doctor to analyse the supporting tissues and diagnose conditions like gluteal tendon, iliotibial band, gluteus medius, gluteus minimus tendons. However bone prominence and changes in hard tissues inn hip joint, lumbar spine or evaluation of lower beck shaft angle may not be as accurate.

A physiotherapist at a physical therapy clinic will perform several orthopaedic clinical tests which will provide an indication of whether there is a need for a scan. One of the tests might be a single-leg stance to see if it brings on the lateral hip pain. There’s also the external de rotation test, which is a good predictor of greater trochanter pain and gluteal tendon inflammation.

Treatment options For Gluteus Medius Tendinopathy

Treatments for Gluteus Medius Tendinopathy are designed to reduce compressive load and compressive forces, reduce hip adduction, pain, inflammation, improve the leg length discrepancy and correct the lower neck shaft angle. These include physical therapy, cortisone injections/ corticosteroid injection, isometric exercises, pelvic control exercises, strengthening of lateral hip muscles and prozolone therapy for the gluteal tendon/ glute tendon. Even though conservative treatment is always the primary goals, but a failed conservative treatment can lead to a need for corrective surgeries.

Prolotherapy For Gluteal Tendinopathy

The gluteal tendons have a poor blood supply, which is why they can struggle to heal with physiotherapy. It is the oxygen and nutrients in our blood supply that help to heal gluteal tendons and hip pain.

Prolotherapy involves the injection of nutrients into the gluteal tendons to provide a direct supply of what is needed to heal the tendon and provide lateral hip pain relief.

Alongside healing the tendon and improving the symptoms of gluteal tendinopathy, Prolotherapy also helps to strengthen the hip ligaments. As it is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

Corticosteroid injection For Gluteal Tendinopathy

Corticosteroid injection, which is also known as cortisone injection procedure is an anti-inflammatory medication which helps reduce inflammation. Corticosteroid injection is proven by randomized clinical trial to be effective for pain relief.

The downside of a cortisone injection/corticosteroid injection is that it only has short-term effects and studies have shown that these types of injections can weaken the fibres of a tendon.

Prevention of Gluteal Tendinopathy

  • Regular physical therapy including strengthening and stretching of the gluteal muscles and other muscles of the leg including the hamstring muscles.
  • If you are a keen runner, then it is worth having a running gait analysis once a year to check your hips are in proper alignment and the load management is balanced.
  • Massage into soft tissue structures such as the gluteal muscles and hamstring muscles will help to take the pressure off the tendons during weight-bearing activities. If you perform a lot of weight-bearing sports then a follow-up appointment is recommended once a month.
  • Put a pillow between your knees if you adopt a side-lying position at night.

Frequently asked questions About Gluteal Tendinopathy

How long does gluteal tendinopathy take to heal?

Randomised clinical trials have shown that sufferers of gluteal tendinopathy can benefit from physical therapy, but it can take anywhere from 8 weeks to a year to completely heal.

Is walking good for gluteal tendinopathy?

Walking is great for relieving symptoms of hip pain but only if the hips and pelvis are in the correct alignment. If not, then this can affect your walking gait and cause the gluteal muscles and tendons to work harder, resulting in gluteal tendinopathy.

If your buttock muscles are weak then this can also put pressure on your tendons.

Does gluteal tendinopathy go away?

Gluteal tendinopathy and associated hip pain can go away with the right treatment and advice.

Is Gluteal Tendinopathy degenerative?

Inflammation can weaken the fibres of a tendon to the point that it starts to wear down. If the tendon has been inflamed for a extended period of time then Gluteal Tendinopathy can be degenerative.

Is Tendinosis the same as gluteal tendinopathy?

Tendinosis is a degenerative form of tendon injury whereas gluteal Tendinopathy is an umbrella term for both tendinosis and tendonitis.

Are there any studies for the treatment of gluteal tendinopathy?

There have been several studies and randomised clinical trial for gluteal tendinopathy published by the following researchers: mellor, bennell, grimaldi a. Some of these clinical trials have been published by the BMJ.

Which exercises are recommended for Gluteal Tendinopathy?

Single leg squat and single leg bridge are two exercises often recommended for Gluteal Tendinopathy. Single leg squat and single leg bridge involve structures like gluteus medius tendon or gluteus minimus tendon. This in turn helps reduce tendon compression, tensile load and treat conditions like gluteal tendinopathy.

What is the differential diagnosis of Gluteal Tendinopathy?

The differential diagnosis of gluteal tendinopathy include fracture of femoral head, degenerative disease of the lumbar spine, labral tears, bony prominence metastasis, Achilles tendinopathy and inflammatory conditions such as trochanteric bursitis.

Do Gluteal Tendinopathy and Trochanteric bursitis often occur together?

The bursa is a fluid filled sac that sits underneath the gluteal tendon, and may be directly affected by any changes it. Gluteal tendinopathy can lead to a greater amount of compressive forces on the bursa and increased tensile loads may be a factor for its inflammation. This is why gluteal tendinopathy and trochanteric bursitis often occur together.

What are the triggering factors for greater trochanteric pain syndrome?

Pain in the greater trochanter may be triggered by external rotation or lateral tilt of the legs, as it activates the iliotibial band and imposes a greater tensile load on the gluteus medius and leads to its lengthening.

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