Gluteal muscle tendinitis or tendinopathy

Other names for this condition

• Gluteus medius tendinopathy
• Trochanteric tendinitis
• Greater Trochanteric Pain Syndrome

What is the difference between tendinitis and tendinopathy?

Both terms describe tendon pain. Tendinitis involves inflammation, while tendinopathy refers to pain without significant inflammation. In practice, the treatment for both conditions is similar.

Science has recently discovered that tendon pain isn't always accompanied by inflammation. When there's tendon pain without inflammation, it's called tendinopathy. When tendon pain involves inflammation, it's called tendinitis.

In both cases, the approach to treatment isn't very different. Therefore, in this article, we will refer to tendinopathy and tendinitis as the same condition.

What is a tendon?

A tendon is the structure that connects muscle to bone. When a muscle contracts, the force is transmitted to the tendon, which then stiffens to move the bones. Think of it as a strong rope that transfers the force from your muscles to your skeleton.

What is gluteal tendinopathy?

It's an irritation of one or more tendons in the gluteal muscles. The most common form is gluteus medius tendinopathy, which affects a muscle located on the side of the hip that plays a crucial role in stabilizing the pelvis.

The gluteus medius attaches to the greater trochanter, which is the bony bump you can feel on the side of your hip. When this tendon becomes irritated or painful, it's called gluteus medius tendinopathy.

This condition is the most common tendinopathy affecting the lower limb. It particularly affects women over 40 and can cause significant pain that impacts walking, sleep, and overall quality of life.

What are the causes of gluteal tendinopathy?

The main cause is mechanical overload of the tendon. This often happens when physical activity increases too quickly, such as resuming running after winter or going on a mountain hike without being accustomed to it.

Tendon irritation can be caused by:

• Increasing physical activity too quickly
• Poorly managed repetitive hip movements
• Muscle imbalance in the hip stabilizers
• Prolonged overload on the tendon

Some classic examples of how this condition develops:

• Resuming running after winter without properly managing the progression, especially if you do a lot of hills
• Going on a mountain hike without being accustomed to it
• Rapidly increasing leg exercises at the gym

What are the risk factors for developing gluteal tendinopathy?

Women over 40 are 2 to 4 times more likely than men to develop this condition. The period around menopause is particularly conducive, as declining estrogen levels affect tendon health.

Gluteal tendinopathy is more common in the following groups:

• Women, especially after age 40 (peaking between 45 and 63 years old)
• People who are perimenopausal or postmenopausal
• Runners who increase their mileage too quickly
• People with a sedentary lifestyle who are returning to activity
• Those who are overweight or obese
• People with muscle imbalances in the hip

What are the symptoms of gluteal tendinopathy?

The main symptom is pain on the outer side of the hip, near the greater trochanter. This pain can spread down the thigh and is often worse at night or when lying on the painful side.

The most common symptoms are:

• Pain or tenderness on the side of the hip that develops gradually
• Pain that can spread down the side of the thigh
• Pain that is worse at night, especially when lying on the affected side
• Difficulty finding a comfortable sleeping position

Pain is generally increased by:

• Walking, especially over long distances
• Standing on one leg
• Swaying your hips (putting weight on one hip)
• Going up or down stairs
• Running or cycling
• Sitting with crossed legs
• Getting up after sitting for a long time

How is gluteal tendinopathy diagnosed?

Diagnosis is primarily based on your symptom history and a physical examination. Imaging is rarely needed, except to rule out other conditions like a tendon tear.

Your physiotherapist or doctor will ask about:

• The exact location of your pain
• Movements or activities that make it worse
• How long you've had pain
• Your recent sports or work activities
• Your sleeping habits

The physical exam includes specific tests to reproduce your pain and assess the strength of your stabilizing muscles. Clinical tests such as the loaded adduction test and dynamic Trendelenburg test help confirm the diagnosis.

Ultrasound or MRI may be helpful if a partial tendon tear is suspected or if symptoms do not respond to conservative treatment.

When should I see a physiotherapist for gluteal tendinopathy?

You should consult a physiotherapist if you have symptoms as described above, or if your doctor has already ruled out any other causes for your pain.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires seeing a doctor, your physiotherapist will be able to inform you and provide a referral.

Consult quickly if:

• Pain limits your daily activities
• You have difficulty walking normally
• Pain keeps you from sleeping
• Symptoms have lasted for more than 2 weeks without improvement

What physiotherapy treatments are available for gluteal tendinopathy?

Treatment involves progressive gluteal strengthening exercises and education on managing load. Studies show that this approach is more effective than cortisone injections, especially in the long term.

Your physiotherapist will first conduct a complete assessment to determine the factors contributing to your tendinopathy. This assessment includes:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your muscle strength and stability
• Your Walking Pattern

Based on the assessment results, your physiotherapist will be able to:

• Providing you with specific exercises to progressively strengthen your gluteal muscles
• Teaching you how to modify your activities to reduce tendon irritation
• Helping you gradually increase your return to activities
• Mobilizing your hip if necessary to reduce pain
• Advising you on positions to avoid and to favor

Gradual strengthening of the gluteal muscles is key to treatment. These exercises help the tendon regain its ability to tolerate load and reduce stress on the trochanteric bursa.

A study published in the British Journal of Sports Medicine showed that an 8-week exercise program yielded better results at 12 months than a cortisone injection or a 'wait and see' approach.

What can I do at home for gluteal tendinopathy?

Temporarily avoid positions that compress the tendon, such as crossing your legs or sleeping on the painful side. Opt for low-impact activities and do strengthening exercises regularly.

• Swimming
• Stationary bike with a properly adjusted seat
• Moderate walking on flat ground
• Aqua fitness

• Standing with your weight shifted to one hip
• Sitting with your legs crossed
• Sleeping on the painful side. If you are unable to sleep on your back, place at least one pillow between your thighs.
• Stretching the iliotibial band (this can worsen compression)

• Incorporate walking breaks into your running sessions
• Temporarily reduce your mileage and intensity.
• Avoid sloped or uneven surfaces.
• Do glute strengthening exercises regularly
• Allow at least 48-72 hours between running sessions.

If you don't see any improvement after 10 to 14 days of modifying your activities, consult a physiotherapist.

What is the recovery time for gluteal tendinopathy?

Most people see significant improvement within 6 to 8 weeks with appropriate treatment. Chronic cases may take several months, but the prognosis is generally favorable with an active approach.

Factors that influence healing time:

• How long you have had symptoms
• Your level of physical activity before the injury
• Your adherence to exercises and recommendations
• The presence of modifiable risk factors

With early management and a tailored strengthening program, the vast majority of gluteal tendinopathies resolve without more invasive interventions like injections or surgery.

Sources

• Grimaldi A, Mellor R, Hodges P, et al. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015;45(8):1107-19.

• Allison K, et al. Does menopausal hormone therapy, exercise, or both improve pain and function in postmenopausal women with greater trochanteric pain syndrome? Am J Sports Med. 2022;50(2):515-525.

• Ladurner A, et al. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation. Orthop J Sports Med. 2021;9(7).

• Mellor R, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy. BMJ. 2018;361:k1662.