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Gluteus Medius Pain

Gluteus Medius Pain

Gluteus medius pain refers to the discomfort or pain that occurs when the gluteus medius is underworked or weak due to extended sitting sessions at a desk. Prolonged sitting puts severe strain on the gluteus medius muscle. The muscle loses its proper function and range of motion, resulting in the perpetuation of gluteus medius pain [1].

Gluteus medius pain also occurs due to repetitive microtrauma to the gluteus medius muscle from activities, such as overuse of workout equipment, running on soft surfaces, and repetitive movements that require hip abduction. The pain is commonly seen in athletes and runners due to rupture or tear of the gluteus medius muscle.

What Is The Gluteus Medius?

The gluteus medius is one of the three most functional hip muscles situated below the gluteus medius. The gluteus medius is located under the gluteus maximus (the primary buttock muscle). This muscle sits along the outer surface of your ilium. Roughly one-third of the gluteus medius is covered by the gluteus maximus muscle. The gluteus minimus muscle is the third component in this group. Gluteus medius sits along the lateral surface of the upper buttock between the gluteal aponeurosis and posterior and middle gluteal lines. It travels downward towards the side of the hip in a diagonal fashion [2].

The function of gluteal muscles:

  • The gluteus muscle acts as the chief mover of abduction at the hip joint.
  • It is important in activities like single-leg-weight-bearing, walking, and running because it doesn’t let the opposite pelvic side drop during these activities.
  • In assistance with the gluteus maximus and gluteus minimus, the gluteal muscles produce hip rotation to stabilize and balance the pelvis during gait. The anterior portion of the Gluteus medius assists in the medial rotation of the hip [3].

What Are The Causes Of Gluteus Medius Pain?

Athletes and runners involved in high-impact sports, like basketball or soccer, often experience poor flexibility of the gluteus medius muscle, which results in rupture or tear of the muscle. Gluteal muscle pain usually occurs due to the following causes:

  • Degenerative changes and traumatic injuries cause the complete or partial tear of the gluteus medius muscle.
  • Tight hip abductors that cause inhibition to the gluteus medius.
  • Sitting cross-legged for prolonged periods.
  • Inflammation or degeneration of the gluteus medius tendon.
  • Failure to stretch the hip flexors.
  • Standing with bodyweight shifted on one side, causing the pelvis to sway sideways.
  • Inflammation or degeneration of the gluteus medius muscle, known as hamstring tendinopathy (buttock pain) [4, 5].

What Are The Symptoms Associated With Gluteus Medius Pain?

Gluteus medius pain occurs in the lateral aspect of the hip, which may be aggravated with lying on the affected side of the hip, prolonged walking or sitting, climbing stairs, and running. Symptoms that a person with hip pain may experience are the following:

  • Tenderness on the affected side of the hip
  • Inability to properly bear weight on the affected limb.
  • Inflammation of the hip bursa.
  • Sciatica
  • Intense pain at night that interferes with sleep
  • Decreased hip range of motion
  • Limping while walking
  • Gluteus medius muscle dysfunction (lower extremities problem)

Sometimes, hip pain is mistaken for sciatica, bursitis, low back pain, or hamstring tendinopathy. If you experience any of the symptoms mentioned above of gluteus medius pain, consult an orthopaedic surgeon as soon as possible.

How Is Gluteus Medius Pain Diagnosed?

To diagnose hip pain, a detailed physical exam and medical history are necessary to determine the extent and exact location of the pain.

Physical Examination:

Physical examination of the patient includes:

  • Assessment of gait or walking pattern of the patient
  • Testing for muscle strength
  • Palpation of the affected muscle.

If a gluteus medius tear is causing the pain, it can be diagnosed with a positive Trendelenburg sign or a single-leg squat test.

X-ray Or Ultrasound:

The pathological changes in the gluteus medius muscle are viewed effectively with x-rays, and the integrity of the gluteal tendons can be evaluated with the help of ultrasound. Musculoskeletal ultrasound can identify different types of tendon tears, restricted range of motion, inflammation of the gluteus medius, and gluteus medius pain. MRI is also helpful for identifying pain in the gluteus medius [6].

Treatment Options For Glutes Pain:

The normal function of the gluteus medius muscle can be restored with many treatment options. The following are some treatment options for relieving gluteus medius pain:

1. RICE Therapy: RICE therapy is mostly used for instantly relieving gluteus medius pain. It involves:

  • Rest
  • Ice
  • Compression
  • Elevation

Deep tissue massage, physical therapy by a certified physiotherapist, and stretching exercises strengthen hip muscles and promote mobility while relieving low back pain too. Assistive devices, such as crutches and a cane can also be used to facilitate pain-free ambulation. Placing a pillow between the legs can also prevent the overstretching of the glutes muscle.

2. NSAIDs: Pain and inflammation of the gluteus muscle can be relieved by steroid injections and non-steroidal anti-inflammatory drugs (NSAIDs). Steroid injections are administered by using ultrasound, and the steroid is injected by a long needle near the injury site so that the steroid can work directly at the site of inflammation.

3. Surgery: Surgery is recommended when a patient has gluteus medius pain due to a wholly torn glutes muscle. The surgical procedure involves reattaching the torn tendon onto the greater trochanter (femur) with stitches. Surgery helps relieve pain by restoring the function and strength of the gluteus medius muscle [7].

A woman strecthing with gluteus medius pain

What Are The Complications Of Untreated Gluteus Medius Pain?

Gluteus medius pain should be not taken lightly as it indicates that you have a problem that requires medical attention. If ignored or left untreated, glutes pain can cause severe health complications, including:

  • Chronic lower back pain due to changes in the gait
  • Knee osteoarthritis
  • Ankle tendon, ligament, or cartilage injuries, including arthritis
  • Knee instability due to the dysfunction of the iliotibial band.
  • Hip osteoarthritis
  • Full-thickness tear of the gluteus medius
  • Gluteus medius tendinopathy (dead butt syndrome).

The Bottom Line:

Gluteus medius pain occurs as a result of prolonged sitting or sudden bursts of repetitive activities like running or climbing. Gluteus medius is an important hip muscle that not only levels the hips but also stabilizes and balances the pelvis during activities when you balance on a single leg. Exercising, stretching, and following the RICE protocol can help relieve gluteus medius pain. Steroids injections and NSAIDs can also help. Warming up before activities, being aware of surroundings, avoiding falls and injuries, and having good footwear are some tips to avoid gluteus medius pain.

A woman with gluteus medius pain

References:

  1. Kokubo R, Kim K. Gluteus Medius Muscle Pain BT – Entrapment Neuropathy of the Lumbar Spine and Lower Limbs. In: Isu T, Kim K, editors., Singapore: Springer Singapore; 2021, p. 27–33. https://doi.org/10.1007/978-981-33-6204-8_4.
  2. Presswood L, Cronin J, Keogh JWL, Whatman C. Gluteus Medius: Applied Anatomy, Dysfunction, Assessment, and Progressive Strengthening. Strength Cond J 2008;30.
  3. Reiman MP, Bolgla LA, Loudon JK. A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiother Theory Pract 2012;28:257–68. https://doi.org/10.3109/09593985.2011.604981.
  4. Godshaw B, Wong M, Ojard C, Williams G, Suri M, Jones D. Acute Traumatic Tear of the Gluteus Medius and Gluteus Minimus in a Marathon Runner. Ochsner J 2019;19:405–9. https://doi.org/10.31486/toj.18.0090.
  5. Aepli-Schneider N, Treumann T, Müller U, Schmid L. [Degenerative rupture of the hip abductors. Missed diagnosis with therapy-resistant trochanteric pain of the hips and positive Trendelenburg sign in elderly patients]. Z Rheumatol 2012;71:68–74. https://doi.org/10.1007/S00393-011-0919-Y.
  6. LaPorte C, Vasaris M, Gossett L, Boykin R, Menge T. Gluteus medius tears of the hip: a comprehensive approach. Phys Sportsmed 2019;47:15–20. https://doi.org/10.1080/00913847.2018.1527172.
  7. Meghpara MB, Bheem R, Haden M, Rosinsky PJ, Shapira J, Maldonado DR, et al. Differences in Clinical Presentations and Surgical Outcomes of Gluteus Medius Tears Between Men and Women. Am J Sports Med 2020;48:3594–602. https://doi.org/10.1177/0363546520966335.

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