Understanding Gluteal Tendinopathy: Causes, Treatment, and Physiotherapy Solutions
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on MARCH 12, 2024
Gluteal tendinopathy is a common condition that affects the tendons of the gluteal muscles, which are crucial for hip stability and lower body movement. It is characterised by pain and tenderness in the lateral hip region and can significantly impact daily activities such as walking, climbing stairs, and even sitting for prolonged periods. The condition is often associated with overuse or biomechanical imbalances, leading to degeneration and inflammation of the tendons (Grimaldi & Fearon, 2015).
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Understanding the role of the gluteal muscles in maintaining hip stability and overall lower limb function is essential for appreciating the impact of gluteal tendinopathy. These muscles, particularly the gluteus medius and minimus, are key stabilisers of the hip joint during dynamic activities. When their function is compromised due to tendinopathy, it can lead to altered gait patterns, reduced mobility, and an increased risk of falls (Allison, Vicenzino, Wrigley, Grimaldi, Hodges & Bennell, 2016).
The prevalence of gluteal tendinopathy is higher among certain populations, such as middle-aged women and athletes involved in sports requiring repetitive hip movements (Fearon, Cook & Scarvell, 2013). Early diagnosis and appropriate management are crucial to prevent the progression of the condition and ensure optimal recovery.
Gluteal tendinopathy is a condition that can significantly impact an individual's mobility and quality of life. Understanding its causes, prevalence, and the role of the gluteal muscles in hip stability is essential for effective management and prevention of this condition.
Understanding Gluteal Tendinopathy
Gluteal tendinopathy is a condition characterised by pain and dysfunction in the tendons of the gluteal muscles, primarily the gluteus medius and gluteus minimus. These muscles play a crucial role in stabilising the hip joint and are essential for activities such as walking, running, and climbing stairs. The prevalence of gluteal tendinopathy is particularly high among middle-aged women and individuals engaged in activities that involve repetitive hip movements, such as certain sports (Fearon, Cook, & Scarvell, 2013; Grimaldi & Fearon, 2015).
The underlying pathology of gluteal tendinopathy involves degeneration and inflammation of the tendons. Over time, repetitive stress and biomechanical imbalances can lead to microtrauma and the breakdown of tendon fibres. This degenerative process is often accompanied by an inflammatory response, resulting in pain, tenderness, and reduced function in the affected area (Allison et al., 2016; Grimaldi & Fearon, 2015).
The impact of gluteal tendinopathy on the hip joint is significant. The condition can lead to altered movement patterns and reduced stability of the joint, increasing the risk of further injury and limiting an individual's ability to perform daily activities. Early diagnosis and appropriate management are essential to prevent the progression of the condition and ensure optimal recovery. Understanding its pathology and impact is crucial for effective management and prevention.
Causes and Risk Factors of Gluteal Tendinopathy
The development of gluteal tendinopathy can be attributed to a combination of factors, including overuse, biomechanical imbalances, and age-related changes in tendon structure. Overuse is a common cause, particularly in individuals who engage in activities that involve repetitive hip movements, such as running or cycling. These repetitive motions can lead to microtrauma and degeneration of the gluteal tendons over time (Grimaldi & Fearon, 2015).
Biomechanical factors also play a significant role in the development of gluteal tendinopathy. Abnormalities in gait, hip alignment, or muscle strength can create imbalances and increase stress on the gluteal tendons. For example, weakness in the hip abductor muscles can lead to increased loading of the gluteal tendons during weight-bearing activities (Allison et al., 2016).
Age-related changes in tendon structure can also contribute to the development of gluteal tendinopathy. As individuals age, tendons become less elastic and more susceptible to degeneration, making them more prone to injury (Fearon, Cook, & Scarvell, 2013).
Specific risk factors associated with gluteal tendinopathy includes:
Repetitive activities that involve hip flexion and extension
Poor biomechanics such as excessive hip adduction or internal rotation
Underlying hip conditions like osteoarthritis or hip dysplasia.
Women, particularly those in the middle-aged demographic, have been found to have a higher prevalence of gluteal tendinopathy, possibly due to differences in pelvic anatomy and hormone-related changes in tendon structure (Grimaldi & Fearon, 2015).
Signs and Symptoms of Gluteal Tendinopathy
Gluteal tendinopathy presents with a range of signs and symptoms that can impact an individual's daily activities and overall quality of life. The most common symptom is hip pain, which is often localised to the lateral aspect of the hip and can radiate down the thigh. This pain is typically aggravated by activities that involve hip movements, such as walking, climbing stairs, or transitioning from sitting to standing (Grimaldi & Fearon, 2015).
Tenderness over the greater trochanter, the bony prominence on the side of the hip, is another characteristic symptom of gluteal tendinopathy. This tenderness is often most noticeable when direct pressure is applied to the area, such as when lying on the affected side.
Difficulty with activities that involve hip movements is a common complaint among individuals with gluteal tendinopathy. This can include challenges with walking, climbing stairs, or sitting for prolonged periods. The pain and discomfort associated with these activities can lead to a reduction in physical activity levels and a decline in overall mobility (Allison et al., 2016).
Recognizing and addressing the early symptoms of gluteal tendinopathy is crucial to prevent the condition from worsening. Early intervention can help manage symptoms, improve hip function, and reduce the risk of further injury. It is important for individuals experiencing symptoms of gluteal tendinopathy to seek medical attention and undergo a thorough assessment to determine the appropriate course of treatment (Fearon, Cook, & Scarvell, 2013).
Prevention Strategies for Gluteal Tendinopathy
Preventing gluteal tendinopathy involves a combination of proper warm-up and stretching techniques, gradual progression of physical activity, and maintaining a healthy weight. A well-designed warm-up routine can help prepare the muscles and tendons for the demands of physical activity, reducing the risk of injury. Incorporating stretching exercises, particularly for the hip flexors and gluteal muscles, can improve flexibility and reduce tension in the tendons (Neumann, 2010).
Gradual progression of physical activity is essential to avoid overloading the tendons. Incrementally increasing the intensity and duration of exercise allows the tendons to adapt and strengthen over time. This approach is particularly important for individuals who are new to exercise or returning after an injury (Malliaras, Barton, Reeves, & Langberg, 2013).
Maintaining a healthy weight is another key factor in preventing gluteal tendinopathy. Excess weight can increase the load on the tendons, leading to increased stress and a higher risk of injury. Adopting a balanced diet and regular exercise regimen can help manage weight and reduce the impact on the tendons (Gaida, Ashe, Bass, & Cook, 2009).
Targeted strengthening exercises are crucial for reducing the risk of gluteal tendinopathy recurrence. Strengthening the hip abductor muscles, such as the gluteus medius and minimus, can improve hip stability and reduce the load on the tendons. Exercises such as side-lying leg lifts, clamshells, and single-leg squats can be effective in targeting these muscles (Allison et al., 2016).
Biomechanical corrections can also play a significant role in preventing gluteal tendinopathy. Addressing issues such as poor posture, abnormal gait patterns, or muscle imbalances can help reduce the stress on the tendons and improve overall function. Working with a physiotherapist or other healthcare professional to identify and correct biomechanical issues is recommended (Grimaldi & Fearon, 2015).
Preventing gluteal tendinopathy involves a combination of proper warm-up and stretching techniques, gradual progression of physical activity, maintaining a healthy weight, targeted strengthening exercises, and biomechanical corrections. Implementing these strategies can help reduce the risk of developing gluteal tendinopathy and promote overall hip health.
Treatment and Diagnostics for Gluteal Tendinopathy
The diagnostic process for gluteal tendinopathy typically begins with a thorough physical examination, where a healthcare professional assesses the hip for pain, tenderness, and range of motion. Specific tests, such as the single-leg stance test or the resisted external derotation test, may be used to provoke symptoms and confirm the diagnosis (Grimaldi & Fearon, 2015).
Imaging studies, such as ultrasound or magnetic resonance imaging (MRI), can provide further insight into the condition of the gluteal tendons. Ultrasound is often used to assess tendon thickness, integrity, and the presence of any tears or calcifications. MRI can provide a more detailed view of the tendons, as well as the surrounding tissues and structures (Fearon, Cook, & Scarvell, 2013).
Functional assessments, which evaluate the patient's ability to perform specific tasks or movements, can also be helpful in diagnosing gluteal tendinopathy. These assessments can identify any biomechanical issues or muscle weaknesses that may be contributing to the condition (Allison et al., 2016).
The treatment of gluteal tendinopathy typically involves a combination of conservative measures, such as activity modification, physiotherapy, and non-steroidal anti-inflammatory drugs (NSAIDs). Activity modification may include avoiding activities that exacerbate symptoms, while physiotherapy can focus on strengthening and stretching exercises to improve hip stability and function (Mellor et al., 2018).
For cases that do not respond to conservative treatment, more invasive interventions may be considered. Corticosteroid injections can provide temporary relief from pain and inflammation, but their long-term effectiveness is debated. Surgery, such as tendon repair or bursectomy, may be considered for refractory cases or when there is significant structural damage to the tendons (Grimaldi & Fearon, 2015).
The diagnosis of gluteal tendinopathy involves a combination of physical examination, imaging studies, and functional assessments. Treatment options range from conservative measures like activity modification and physiotherapy to more invasive interventions like corticosteroid injections or surgery for cases that do not respond to initial treatment.
Physiotherapy's Role in Treating Gluteal Tendinopathy
Physiotherapy plays an integral role in the management and rehabilitation of gluteal tendinopathy. It focuses on reducing pain, improving strength and flexibility, and optimising biomechanics to enable individuals to return to their functional activities with confidence.
Physiotherapists develop personalised treatment plans tailored to the specific needs and goals of each patient. These plans often include a combination of manual therapy, exercise therapy, and education. Manual therapy techniques, such as soft tissue massage or joint mobilisation, can help alleviate pain and improve tissue extensibility. Exercise therapy is crucial for strengthening the muscles around the hip, particularly the gluteal muscles, and for improving flexibility and range of motion (Grimaldi & Fearon, 2015).
Education is another key component of physiotherapy for gluteal tendinopathy. Physiotherapists provide patients with information about their condition, advice on activity modification, and strategies for pain management. This empowers individuals to take an active role in their recovery and helps prevent recurrence of the condition (Mellor et al., 2018).
The effectiveness of physiotherapy interventions in treating gluteal tendinopathy is well-documented. Research has shown that a combination of exercise therapy and education can lead to significant improvements in pain, function, and quality of life for individuals with gluteal tendinopathy (Allison et al., 2016; Mellor et al., 2018).
Physiotherapy is a vital component of the treatment and rehabilitation process for gluteal tendinopathy. Personalised treatment plans, incorporating manual therapy, exercise therapy, and education, are effective in reducing pain, improving function, and empowering individuals to manage their condition and return to their daily activities.
Conclusion
Gluteal tendinopathy is a common condition that affects the tendons of the gluteal muscles, leading to hip pain and functional limitations. Early intervention and comprehensive care are crucial for effectively managing and rehabilitating this condition. Key points to remember include:
Gluteal tendinopathy is characterised by pain, tenderness, and difficulty with activities involving hip movements.
The condition can be caused by overuse, biomechanical factors, and age-related changes in tendon structure.
Prevention strategies include proper warm-up and stretching, gradual progression of physical activity, and targeted strengthening exercises.
Diagnosis involves physical examination, imaging studies, and functional assessments.
Treatment options range from conservative measures like activity modification and physiotherapy to more invasive interventions for refractory cases.
Physiotherapy plays a vital role in reducing pain, improving strength and flexibility, and optimising biomechanics.
It is important for individuals experiencing symptoms of gluteal tendinopathy to seek professional guidance from physiotherapists for assessment, treatment, and rehabilitation. With the right approach, it is possible to manage the condition effectively and return to functional activities with confidence.
Taking proactive steps towards hip health and overall well-being is essential. With early intervention, comprehensive care, and the support of healthcare professionals, individuals can overcome gluteal tendinopathy and lead active, fulfilling lives.
References:
Allison, K., Vicenzino, B., Wrigley, T. V., Grimaldi, A., Hodges, P. W., & Bennell, K. L. (2016). Hip abductor muscle weakness in individuals with gluteal tendinopathy. Medicine and Science in Sports and Exercise, 48(3), 346-352.
Fearon, A. M., Cook, J. L., & Scarvell, J. M. (2013). Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clinical Orthopaedics and Related Research, 471(7), 2259-2266.
Gaida, J. E., Ashe, M. C., Bass, S. L., & Cook, J. L. (2009). Is adiposity an under-recognized risk factor for tendinopathy? A systematic review. Arthritis Care & Research, 61(6), 840-849.
Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 910-922.
Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine, 43(4), 267-286.
Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., ... & Vicenzino, B. (2018). Education plus exercise versus corticosteroid injection use versus a wait-and-see approach on global outcome and pain from gluteal tendinopathy: a single-blinded, randomised clinical trial. British Journal of Sports Medicine, 52(22), 1464-1472.
Neumann, D. A. (2010). Kinesiology of the hip: A focus on muscular actions. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 82-94.
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.