Gluteal Tendinopathy

What is Gluteal Tendinopathy?

Gluteal tendinopathy or Greater Trochanteric Pain Syndrome (GTPS) refers to localised pain on the outside of the hip joint, commonly coinciding with dysfunction of the gluteal muscles.  The gluteal tendons attach the gluteal muscles of the buttocks to the side of the hip. The gluteal muscles are essential for walking, running, stair climbing and providing stability for the hip and pelvis, however overloading this area can lead to pain and degeneration of the tendons.

Who does it affect?

Gluteal tendinopathy can be seen in both an athletic and non-athletic population. It is a common complaint in runners due to high load demands placed on the gluteal muscles while running. While Gluteal tendinopathy can affect both males and females it is most commonly seen in females due to their pelvic bony structure and particularly in peri-menopausal woman as hormonal changes can affect the tendons’ ability to tolerate load.

Signs and symptoms

The signs and symptoms of a  gluteal tendinopathy include any or all of the following:

• Pain felt on the outside of your hip
• Pain that radiates down the thigh to the knee
• Pain that is worse before and after exercise
• Pain that improves initially with exercise (Warms up)
• Pain when lying on the affected side
• Difficulty walking up-stairs or hills
• Difficulty standing on one leg (on the affected side)

Treatment options:

• Load management – This should be the first line treatment in managing any tendinopathy including gluteal tendinopathy. This does not necessarily require you to stop all exercise it will require you to reduce certain aggravating activities i.e Running, to a more tolerable level which is not causing long lasting pain. This does not need to be a permanent change and the role of rehabilitation will be to get you back to your pre-injury level as symptoms reduce.

• Avoiding compression – Often when we have pain we feel it is necessary to stretch our muscles to get some relief. In the case of gluteal tendinopathy stretching will cause compression of the tendon against the bone which can exacerbate symptoms. Stretching to end range should therefore be avoided. Compression can also be caused by sitting with your legs cross or sleeping on the affected side.

• Progressive resistance training – Mellor et al (2018) have shown significant improvements in symptoms when treated with a graded strengthening programming targeting the gluteal muscles. When combined with patient education on load management this was shown to have better results than steroid injection at both 8 weeks and 52 weeks.

• Biomechanical assessment and running gait re-training may also be used in order to improve running mechanics and reduce load on the gluteal tendons

• Shockwave Therapy – Shockwave therapy can be used in conjunction with progressive resistance training in order to facilitate tendon healing and improved load tolerance

Gluteal tendinopathy is one specific cause of hip pain however there are a large number of structures in this area that can contribute to pain or reduced function. If you are experiencing any of the symptoms mentioned above or any other symptoms which are preventing you from functioning at 100%, it is important to have these assessed by a professional. Your physiotherapist will then be able to help identify a specific cause of pain and potential contributing factors and guide you back to full activity.