Gluteal Tendinopathy – By Nicholas Musso
What is Gluteal Tendinopathy?
The gluteal tendons are the fibres that connect the gluteal muscles to your hip. Gluteal tendinopathy is an injury or pathology of these tendons, most commonly it is a result of repeatedly overloading the tendon. While pain may come on suddenly, tendinopathies actually develop over a period of time, and pain will most often come at a later point. Because of this, tendinopathies are considered to be overuse injuries rather than acute injuries and are usually managed differently. For further general information on tendons and tendinopathy please refer to the “What is a tendon and tendinopathy” blog.
What are the symptoms?
Gluteal tendinopathy usually causes pain and tenderness on the outside of the hip, as well as loss of full movement and reduction in strength in the hip muscles. Pain can be local to the hip or spread further down the outside of the leg.
You may also get pain during certain activities which place more load on the tendon, these include:
- Climbing stairs
- Standing on one leg
- Crossing your legs
- Standing up from a chair
- Lying on your side (particularly at night time)
Your pain may also increase with more demanding tasks such as jumping and hopping. Your physiotherapist will also be vigilant for determining there may be other causes for your hip pain.
What are the risk factors?
Gluteal Tendinopathy is primarily seen in post-menopausal women, with some researchers suggesting that 25% of women after the age of 55 will experience it at some point due to changes in anatomy and bioechanics. However, anyone can develop gluteal tendinopathy, it is not an age or gender-specific injury.
If you have had a previous injury (e.g. to the knee or ankle), the muscles surrounding those areas may not be working optimally even though the injury itself has healed. This can lead to increased stress being placed on physical structures further up or down the body (such as the gluteal tendon) which is overloaded and gradually increases in symptoms.
It is not uncommon to see people present with Gluteal Tendinopathy following a large increase in the amount of exercise being completed without being prepared for the increase in load i.e. mid-way through a sporting preseason, or in late January with a New-Years resolution spike in exercise. Runners who train on hills are particularly at risk.
How is it diagnosed?
A physiotherapist will be able to complete a comprehensive assessment of your problem area including taking a detailed history, previous medical and injury history, as well as a full physical assessment to determine the diagnosis and true cause of your problem.
It is unlikely that you will require a scan, as researchers have found that there is a poor link between findings on scans and pain symptoms. However, in rarer cases, your doctor or therapist may request an ultrasound or MRI scan if they suspect that your problem will require longer-term management.
What are my treatment options?
Physiotherapy will include a variety of treatment options, however the most important treatment is exercise therapy. This may seem counterintuitive as it is excessive loading that caused these symptoms, however load is also the answer! More specifically, it is putting the right amount of load through the tendon and gradually increasing the capacity of the tendon that is essential for promoting proper repair. While this is the primary treatment for promoting long-lasting improvement, physiotherapy treatment will also be focused on relieving the painful symptoms. There are a variety of techniques that may be suitable for you, including:
- Medical management as prescribed your GP or pharmacist
- Shockwave therapy
- Rest from activity if required
- Modification of current activity (i.e. load management)
- Managing lifestyle factors that may be contributing to your pain such as climbing stairs,
- Stretches (stretches may not always be useful and may sometimes increase your pain, these will be prescribed as the therapist deems suitable)
Blog by Nicholas Musso (Physiotherapist)