Physiotherapy

Gluteal Tendinopathy - What a pain in the bum!

Post by
Andre Luton

Gluteal Tendinopathy - What a pain in the bum!

Gluteal Tendinopathy is a common condition that can cause pain in the buttock and side of your hip. Sometimes, the pain can travel down the leg and it is often mistaken for sciatica, where a nerve can get irritated and cause sharp electric like nerve pain down the legs. Whilst the symptoms people feel with this condition can vary, most will report:

  • Pain on the outside of your upper leg, localised around the hip bone (Greater Trochanter) 
  • Pain that can travel down the side of the thigh, and into the lower leg, or into the lower back and the buttock
  • Pain when lying on the side, especially at night time
  • Pain when going uphill or upstairs
  • Pain when standing on one leg
Diagram of hip and buttock pain patterns that spread down the leg.
Gluteal tendinopathy can create hip and buttock pain that can spread down the legs.

What causes Gluteal Tendinopathy?

The glute muscles are actually made up of three main muscles, the gluteus maximus, gluteus medius, and gluteus minimus. The health of these tendons depends on regular forces and strain being applied to them, which is within their capacity to tolerate. When the gluteal tendons are exposed to excessive compressive forces, such as with trauma or overuse, this can irritate them causing inflammation and pain (tendinopathy). Some common scenarios this can happen is with:

  • A slip or fall directly landing on the side of the hip
  • Sudden increases in activity, such as going for longer walks than usual whilst on holidays or taking up running/a new sport
  • Low activity levels which lead to a gradual weakening and deterioration in the tendon
  • Gradual weight gain with inactivity, which over time places more strain on the tendons as the tendons weaken and deteriorate due to not enough use and loading
  • Constantly being in positions which place high compression on the tendon, like crossing your legs or standing with all the weight on one leg.

Diagram of muscles and tendons in the hip and buttock
The gluteus medius and minimus tendons are commonly involved in gluteal tendinopathy.

How do we diagnose Gluteal Tendinopathy? 

At Milsons Point Health, our Physiotherapists and Chiropractors all go through a detailed assessment to see if gluteal tendinopathy is present. This starts by asking to see if there has been any trauma, sudden increase in activity or weight, or de-conditioning of the tendons. Because there are so many things that can cause hip pain, ruling out other conditions is so important!

We then look to see how the back, hip, and knees are moving and test the strength of the muscles and see if there is any stiffness in the joints. It's very useful to test the strength of muscles using dynamometers, as this can accurately tell which are weak, and by how much, so we can give the right exercises to address them. We commonly find people are weaker on their non-affected side, and the tendinopathy might have actually developed because one side is doing all the work!

physiotherapist measuring leg strength using dynamometer
Using a dynamometer can help accurately measure which muscles are weak.

Medical imaging like x-rays, ultrasounds, and MRI scans can be used to confirm the diagnosis, but these are usually not necessary as the thorough assessment we use is enough to let us know if this condition is present or not. These scans do become more useful when things are not getting better, as they can reveal some less common things like tendon tears or calcifications in the tendon.

Managing Gluteal Tendinopathy

Treating gluteal tendinopathy starts by looking at your daily routine and reducing any excessive compression on the tendons. Positions that can create excessive compression are shown below and include sitting with your legs crossed, sitting with a foot under your bottom, standing with all your weight on one leg, sleeping on your side on a hard mattress, or sleeping on your side with the top leg flopping right over. Limiting these positions is a must to allow the tendons to recover.

Pictures of hip positions that can irritate hip pain
These positions can place a high amount of strain on the gluteal tendons.

Exercises for Gluteal Tendinopathy 

Rest alone will never really cure a tendinopathy as the tendons need to build back up their strength and endurance to handle the strain required of them. Progressive strengthening exercises which target the outside hip muscles have been shown to be effective in treating gluteal tendinopathy, by helping to promote new tendon fibre growth. This can be very useful, especially for those people who have tendons that have become de-conditioned from inactivity or long standing pain.

Our Physiotherapists, Chiropractors, and Exercise Physiologists in Milsons Point start with simple exercises initially, which progressively increase in difficulty and challenge over time. This might look like:

  • Stage 1: gentle isometric exercises where you are laying down and push against a heavy resistance band. This gently strains the tendon and can interestingly relieve pain in many people.
  • Stage 2: exercises that involve standing and placing weight on one leg, whilst keeping the side hip muscles on.
  • Stage 3: exercises that move the hip through its full range, such as laying on your side and lifting up your leg to the side.
  • Stage 4: exercises in weight bearing on one leg that move the hip through full range, such as lunging with a band for resistance.
  • Stage 5: exercises which start using the joint above and below (whole muscle chain) into twisting movements that mimic the everyday activities or sports movements.

Everyone moves in a different way, and the exercises we prescribe can range from simple for the older person just needing to climb stairs, to advanced for the elite athlete who needs to run and kick the ball really hard.

Other treatments that can help Gluteal Tendinopathy 

Whilst exercise is an important part in managing gluteal tendinopathy, these other treatments have also been shown to be helpful. All these other treatments are best used together with a suitable exercise program and strategies to minimise over straining the tendons in order to achieve the best long term result and prevention.

  • Manual therapy: this involves working on the muscles, ligaments, tendons and joints which can help address any muscle spasms or joint restrictions.
  • Dry needling: involves the use of small acupuncture needles to help relieve any muscles spasms and pain.
  • Shockwave therapy: involves using high energy sound waves that help reduce pain and promote healing in the tendons.
  • Corticosteroid injections: involves a steroid which helps settle and inflammation and reduce pain.

We can also use our doctors at Milsons Point Medical Centre to help organise a corticosteroid injection for you, or work closely with your doctor to see if one will be beneficial for your case.

How long does it take to get better?

Gluteal tendinopathy can take up to 12 weeks to fully resolve. With appropriate treatment, there is usually a good change in your symptoms around 6 weeks as your start to rebuild the strength and endurance of the muscles and tendons around your hip. Most people will get back to the things they want to do after 12 weeks, and have a good understanding on what they need to do to keep it that way through exercises and minimising any excessive strain on the tendons.

At Milsons Point Health, all our Physiotherapists and Chiropractors are all trained in assessing and treating gluteal tendinopathy. If you live in Milsons Point, Kirribilli, or North Sydney and are experiencing buttock or hip pain that might be gluteal tendinopathy, make a booking by calling us on 02 9023 9999 or booking an appointment online.

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