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Gluteal Tendinopathy

Gluteal tendinopathy can be one of the most frustrating forms of tendon injury due to our reliance on the gluteal tendons in helping us perform simple activities such as walking and climbing stairs.

It is one of the most common forms of hip pain.

In this article, we will provide all the information you need to understand what the condition is and the most effective way 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 hip during movement.

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

Up until recently, the condition was referred to as ‘Trochanteric Bursitis.’ It affects 10-25% of the population and is 3 times more prevalent in women.

Symptoms of gluteal tendinopathy

  • The outside of the hip joint is tender to touch.
  • Pain when in a side-lying position on the affected side.
  • 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.
  • Pain when sitting for too long.
  • Buttock weakness

Causes of gluteal tendinopathy

Gluteal tendinopathy tends to build up slowly, so many people with the condition are unaware of what caused it. There are three main causes:

Biomechanics

To be able to perform routine activities such as walking, running, and climbing stairs, we need strong gluteal muscles. If they are weak, then the hips will fall out of line and put increased pressure through the gluteal tendons.

If the iliotibial band (ITB) is tight then it can compress the gluteal tendons during hip adduction movements.

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

Over-use

One of the roles of the gluteal muscles is to absorb shock during weight-bearing activities. If over-worked, they can become tired, tight, and unable to absorb shock efficiently.

This shock then gets transferred into the gluteal tendons, which leads to them becoming inflamed and irritated.

Alignment

The main reason why gluteal tendinopathy is more common in females is due to the width of their hips. This increases what is clinically known as the Q-angle. The greater the Q-angle, the greater the compressive forces on the outside of the hip.

A misalignment of the pelvis can also force the gluteal tendons to function at an angle that they aren’t used to functioning at.

Previous episodes of lower back pain are the most common cause of misalignments in the pelvis.

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 into greater trochanteric pain syndrome.

Trauma

If someone has fallen on their side then it can inflame the tendons. The most likely tendon to inflame during a fall is the gluteus medius tendon. This can cause gluteus medius tendinopathy and also bursitis.

Risk factors

  • 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 then have to work harder to stabilise the joint and as a result, can cause gluteal tendinopathy and hip pain.
  • Sleeping position – people who adopt a side-lying sleeping position at night.

Diagnosis of gluteal tendinopathy

A physiotherapist at a physical therapy clinic will initially perform several orthopaedic clinical tests which will provide an indication of whether there is a need for a scan.

One of the tests will involve asking the patient to perform a single-leg stance to see if it brings on the hip pain.

The condition can be diagnosed with either an ultrasound scan or MRI scan (magnetic resonance imaging), which can also see if there are any tears or an inflamed bursa.

Treatment options

Prolozone Therapy

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 tendon injuries.

Prolozone Therapy involves the injection of oxygen and nutrients into the tendon to provide a direct supply of what is needed to heal the tendon and provide pain relief.

Alongside healing the tendon, the treatment 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.

Physiotherapy

A physiotherapist at a sports medicine clinic will prescribe an exercise program to help to strengthen the gluteal muscles in an attempt to take the pressure off the tendons.

The most effective exercises for tendinopathy are isometric abductor exercises.

The program will also include exercises to help support neighbouring structures such as the iliotibial band (ITB).

Corticosteroid injection

Also known as a cortisone injection, the procedure involves the injection of anti-inflammatory medication to help reduce inflammation.

Unfortunately, a corticosteroid injection only has short-term effects and studies have shown that these types of injections weaken the fibres of a tendon.

Prevention

  • Regular 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

How long does gluteal tendinopathy take to heal?

If someone experiences benefit from physical therapy then it can take between 8 weeks to a whole year for gluteal tendinopathy to heal properly.

Is walking good for gluteal tendinopathy?

Walking is only good for gluteal tendinopathy if the hips and pelvis are in the correct alignment. If they aren’t then this can affect an individual’s walking gait and cause the gluteal muscles and tendons to work harder.

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

Does gluteal tendinopathy go away?

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

Is Tendinopathy degenerative?

Tendinopathy can be degenerative if the tendon has been inflamed for a certain amount of time. Inflammation can weaken the fibres of a tendon to the point that it starts to wear down.

Is Tendinosis the same as tendinopathy?

Tendinosis is a degenerative form of tendon injury whereas 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 clinical trials published by the following researchers: mellor, bennell, grimaldi a. Some of these have been published by the BMJ.

 

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