Do you have pain in the side of your hip or buttock? It may be gluteal tendinopathy!

Gluteal tendinopathy is a condition that usually presents as pain over the side of the hip, especially if you push on the area.

What are the symptoms?

  • Pain with walking, running, climbing stairs
  • Pain with prolonged sitting
  • Pain down the lateral (side of) thigh
  • Pain lying on affected side
  • Stiff feeling hip joint when getting up in the morning (or in middle of night)
  • Pain when pushing into the side of the hip

Will it get better?

Gluteal tendinopathy usually has a good prognosis if you receive a thorough assessment, correct diagnosis and appropriate physiotherapy exercises. Discomfort may take between 8 weeks and 1 year to resolve (78% chance of recovery in this time frame with physiotherapy led exercises).

So, what is happening?

The gluteal muscles usually do a great job of helping us move, stand and sit. They can handle quite a lot of pressure and load. The gluteal tendons attach to the side of our hip, and are excellent at storing and releasing this load (which is what helps us to stand, move our legs and bodies). As we age, the tendons experience normal wear and tear, occasionally injury or disease (tendinopathy) may occur in the tendon. When affected by tendinopathy, these tendons have a reduced capacity for load bearing and in turn, may lead to pain in the side of the hip.

Things that may affect tendon wear and tear/loading ability and increase the risk of gluteal tendinopathy:

  • Change or sudden increase in activities
  • Aging
  • Diabetes
  • Menopause
  • General use of corticosteroids
  • Thyroid conditions
  • Gluteal tendinopathy typically affects females more than males.

What does the evidence say about best management of gluteal tendinopathy?

What can I do about it?

  • Keep moving! But you may have to modify, reduce, limit or increase certain activities to see progress and pain reduction (your physiotherapist will help you with movement modification and helpful exercises).
  • See your physiotherapist and start progressive gluteal muscle rehabilitation over 8-12 weeks (completing your daily home exercises will really help with success!)
  • If there is no response to physiotherapy management, an ultrasound or MRI may be recommended. Imaging is not currently needed or recommended if the diagnosis is clear with physical testing.

What should I expect from my physiotherapy consult?

  • a few questions on the history of the pain/discomfort, this helps to ensure the correct diagnosis
  • a thorough physical assessment of the lower back, hips and lower limbs (some of this testing may produce pain and be uncomfortable)
  • treatment will be specific to your suspected diagnosis and may include home exercises and education. Following the exercises discussed is very important, as it addresses any muscle weakness or tightness, and helps with recovery. Massage, dry needling and taping may be used if necessary, and icing the painful area is useful for some cases.
  • It is common for recovery and rehabilitation to take about 12 weeks. Typically, tendinopathy symptoms take longer to reduce the longer you have had symptoms. It will be important to be patient and diligent with your rehabilitation to ensure you have the best outcome.

May be helpful to some

  • Corticosteroid injection (usually provides short term pain relief, but typically there is a high reoccurrence of pain)
  • Rarely: Surgery may be recommended by an orthopaedic surgeon if the underlying cause of pain is a gluteal tendon tear. The history you give your physiotherapist and the tests they conduct will assist in diagnosing a gluteal tear. You will be referred on for further medical advice if this is the case. Surgery is not currently recommended for gluteal tendinopathy.
  • Rarely: Platelet rich plasma (PRP) injections.

Conditions which share similar signs or symptoms:

  • Trochanteric Bursitis (sometimes used interchangeably with term gluteal tendinopathy)
  • Gluteal tendon strain/tear
  • ITB syndrome
  • Hip osteoarthritis
  • Femoral acetabular impingement (FAI)
  • Avascular necrosis of the hip joint
  • Lumbar radiculopathy (referral of pain to hip)

Your physiotherapy assessment will help to differentiate these from a gluteal tendinopathy diagnosis and advice you on the best course of treatment.

If you would like advice or treatment on this condition, please book in for physiotherapy.

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References

Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial BMJ 2018; 361 :k1662 doi:10.1136/bmj.k1662

Segal NA, Felson DT, Torner JC, et al, Multicenter Osteoarthritis Study Group. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 2007;88:988-92. doi:10.1016/j.apmr.2007.04.014

Semciw, A. I., Pizzari, T., Woodley, S., Zacharias, A., Kingsley, M., & Green, R. A. (2018). Targeted gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst trial – Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial. Trials19(1), 511. https://doi.org/10.1186/s13063-018-2873-3

Note: This post is designed to be educational and informative. The information provided is not exhaustive and does not replace medical advice. Decisions, diagnosis and treatments regarding your health should always be made in consultation with an appropriate health professional.