Gluteal muscle tendinitis or tendinopathy

Other names for this condition

• Gluteus medius tendinopathy
• Trochanteric tendinitis
• Greater trochanter pain syndrome

What is the difference between tendinitis and tendinopathy?

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

Science has recently discovered that inflammation is not always present in tendon pain. When there is tendon pain without inflammation, it is referred to as tendinopathy. When there is tendon pain with inflammation, it is referred to as tendinitis.

In both cases, treatment is not very different. We will therefore include tendinopathies and tendinitis as the same condition in this article.

What is a tendon?

A tendon is the structure that attaches muscle to bone. When a muscle contracts, the force is transmitted to the tendon and the tendon stiffens to move the bones. It is like a strong rope that transmits the force of your muscles to your skeleton.

What is gluteal tendinopathy?

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

The gluteus medius attaches to the greater trochanter, the bony protrusion you can feel on the side of your hip. When this tendon becomes irritated or painful, it is referred to as gluteus medius tendinopathy.

This condition is the most common tendinopathy of the lower limb. It particularly affects women over the age of 40 and can cause significant pain that affects walking, sleep, and 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 is increased too quickly, such as taking up running again after the winter or going on a mountain hike without being used to it.

Tendon irritation can be caused by:

• Too rapid an increase in the amount of physical activity
• Repetitive hip movements that are poorly controlled
• Muscular imbalance in the hip stabilizers
• Prolonged overload on the tendon

Some classic examples of the development of this condition:

• Resuming running after winter without carefully pacing your progress, especially if you do a lot of hill training.
• Hiking in the mountains without being used to it
• Quickly increase leg exercises at the gym

What are the risk factors for developing gluteal tendinopathy?

Women over the age of 40 are 2 to 4 times more likely than men to develop this condition. The period around menopause is particularly conducive to this, as the decline in estrogen affects tendon health.

Tendinopathies of the gluteal muscles are more common in the following groups:

• Women, especially after age 40 (peak between ages 45 and 63)
• People in perimenopause or postmenopause
• Runners who increase their mileage too quickly
• People with a sedentary lifestyle who resume physical activity
• Those who are overweight or obese
• People with muscle imbalances in the hip area

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 may radiate to 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 may radiate along the side of the thigh
• Pain worse at night, especially when lying on the affected side
• Difficulty finding a comfortable sleeping position

Pain is generally increased by:

• Walking, especially long distances
• Standing on one leg
• Sway your hips (shift your weight onto one hip)
• Going up or down stairs
• Running or cycling
• Sit cross-legged
• Standing up after sitting for a long time

How is gluteal tendinopathy diagnosed?

The diagnosis is mainly based on the history of symptoms and clinical examination. Imaging is rarely necessary, except to rule out other conditions such as a tendon tear.

Your physical therapist or doctor will ask questions about:

• The exact location of your pain
• Movements or activities that aggravate it
• How long have you been in pain?
• Your recent sports or professional activities
• Your sleep habits

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

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

When should I see a physiotherapist for gluteal tendinopathy?

You should consult a physical therapist if you have symptoms such as those 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 physical therapist. If your condition requires medical attention, your physical therapist will be able to advise you and refer you to a doctor.

Consult quickly if:

• Pain limits your daily activities
• You have difficulty walking normally
• The pain is keeping you awake.
• Symptoms have lasted for more than 2 weeks without improvement.

What physiotherapy treatments are available for gluteal tendinopathy?

Treatment is based on progressive exercises to strengthen the glutes and education on load management. Studies show that this approach is more effective than cortisone injections, especially in the long term.

Your physical therapist will first conduct a comprehensive 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 results of the assessment, your physical therapist will be able to:

• Give you specific exercises to gradually strengthen your gluteal muscles
• Teaching you how to modify your activities to reduce tendon irritation
• Helping you gradually ease back into activities
• Move your hip if necessary to reduce pain.
• Advise you on positions to avoid and 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. Focus on low-impact activities and do strengthening exercises regularly.

• Swimming
• Stationary bike with a well-adjusted seat
• Moderate walking on flat terrain
• Aqua fitness

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

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

If you see no improvement after 10 to 14 days of modifying your activities, consult a physical therapist.

How long does it take for gluteal tendinopathy to heal?

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

With early treatment and an appropriate strengthening program, the vast majority of gluteal tendinopathies resolve without more invasive interventions such as 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.