Injury blog: Gluteal tendinopathy

By Megan Storey | June 3, 2020

Do you have pain on the outside of your hip area? If so, this blog will be worth a read. This month we are looking at a common issue we see in clinic involving a group of muscles known as the gluteal muscles. These muscles are prone to developing sore tender spots in them, but we are going to focus more on the tendons of these muscles… Specifically on an injury known as ‘tendinopathy’.

Your glute anatomy

The gluteal muscles are found in the hip and buttock region of the body and consist of three muscles altogether. These are:

  • Gluteus Maximus: A large buttock muscle which helps to move the hip backwards and rotate it outwards.
  • Gluteus Medius: A fan-shaped muscle found on the side of the hip between the pelvis and the hard bony ball you can feel a short way down your upper leg on the outside. This muscle helps to move the hip out sideways, as well as rotate the hip and stabilise the pelvis when we walk or run.
  • Gluteus Minimus: Another fan shaped muscle which sits deep to the gluteus medius muscle and performs a similar role.

The tendons of the gluteus medius and minimus muscles, where they attach into the thighbone, are commonly exposed to high amounts of compression and loading, which over time leave them open to injury. We will be talking about the medius and minimus muscles here.

What is tendinopathy?

Tendinopathy is the name we give to an injured tendon, whereby the tendon has undergone physical change, due to excessive loads acting on them when we move incorrectly over a long period of time. An example involving the gluteal muscles is where imbalances in the relationship between the pelvis and thighbone (i.e. from weakness of the gluteal muscles) result in the hip moving in an abnormal and inefficient way. Over time this places excessive strain on the gluteal tendons as the hip moves when we walk or run.

Initially the tendons and other tissues around them respond by becoming thicker, due to chemical changes that are occurring inside the tendon. A thicker tendon is able to cope more with the compression it is under, but there is a downside. During the thickening process, the tendon fibres also become disorganised or deranged, leaving the tendon less able to cope with the force a muscle exerts on it when it contracts or ‘pulls’ on it. As the process continues the tendon becomes more and more degenerated and eventually the tendon is no longer able to adapt to the excessive forces acting on it and a tear can occur. A tear can be the result of an untreated tendinopathy.

Who does it affect?

In the active population, gluteal tendinopathy is commonly seen in athletes, like runners. It is also commonly seen in people who are inactive where the effect of de-conditioning leads to weakness and changes in the way we move. So, you are not safe from this injury even if you don’t regularly exert yourself!

Signs and symptoms

The main symptom is pain on the outside of the hip that comes on without any real obvious ‘injury’ or event. This pain then worsens over time and is usually brought on by weight bearing activities like walking, running and climbing stairs. As with many tendon injuries, you may feel pain at the beginning of an activity, with a lessening of pain as the activity progresses, and then a worsening of pain again after you finish. A common symptom of gluteal tendinopathy is pain experienced at nighttime when lying on the injured side. You may also feel pain that radiates down the thigh to the knee.

Treatment

The good news is if you seek treatment early in the injury process, you can avoid long term complications like tears, which are notoriously much harder to treat. Our advice to you is come and see us as soon as possible after you start to feel pain.

We are extremely well versed in treating gluteal tendon injuries and can get to work immediately. There is a good chance weakness in your gluteal muscles will have been a factor in the development of the injury, as well as a disengagement of the way the trunk, pelvis and legs act together as a unit. Strengthening exercises which focus on building muscle mass, as well as specific exercises to gradually re-load and strengthen the tendon to its full capacity will be key to your recovery. We will also have to re-train your movement patterns to ensure any abnormal movements are corrected. That way we can be sure when you return to your full training schedule, or whatever activity you want, we won’t be seeing you back for the same problem two months down the line.

We may use any number of treatment techniques to help you back to full fitness. These may include massage, joint mobilisation, dry needling and shockwave therapy. So, if you have hip pain, come and see us today – we can help.