Gluteal tendinopathy is a condition involving the tendons that attach the gluteal muscles to the hip bone and is a common source of pain on the outer side of the hip. This condition is a primary cause of greater trochanteric pain syndrome (GTPS), a term for pain around the bony point of the hip called the greater trochanter. The tendons undergo changes that lead to pain and decreased function, arising from the breakdown of tendon tissue rather than simple inflammation.
Identifying the Symptoms
The main symptom of gluteal tendinopathy is pain localized to the outer aspect of the hip. This discomfort can radiate down the outside of the thigh, sometimes reaching the knee. The pain often intensifies at night, particularly when lying on the affected side, and the area over the greater trochanter is tender to the touch.
Pain may worsen when climbing stairs, walking up hills, or rising from a chair after sitting for an extended period. Standing on one leg, such as when getting dressed, can also provoke the pain. A feeling of stiffness or weakness around the hip joint is another common complaint.
Underlying Causes and Risk Factors
Gluteal tendinopathy often develops from repetitive or excessive loading of the gluteal tendons. A sudden increase in activities like running, walking, or stair climbing can place more stress on these tendons than they can tolerate. Conversely, a sedentary lifestyle can also be a contributing factor, as underused tendons can become weak and less capable of handling everyday loads.
Biomechanical factors play a significant part in the development of this condition. Weakness in the gluteal muscles themselves, particularly the gluteus medius and minimus, can alter how the hip and pelvis move. This weakness can lead to instability and poor movement patterns during activities like walking, which in turn increases compressive forces on the tendons.
The condition is most frequently seen in women over the age of 40. This demographic pattern is thought to be related to differences in pelvic anatomy, which can affect the mechanics of the hip. Hormonal changes that occur around menopause may also influence tendon health, making them more susceptible to injury. Additionally, being overweight can increase the load on the gluteal tendons, raising the risk of developing tendinopathy.
How Gluteal Tendinopathy Is Diagnosed
A diagnosis of gluteal tendinopathy typically begins with a thorough physical examination by a healthcare professional. This usually involves palpation, which means pressing on the area over the greater trochanter to check for localized tenderness, a key sign of the condition.
To reproduce the pain and confirm its source, specific physical tests are often employed. One common test is the single-leg stance, where the patient is asked to stand on the affected leg for 30 seconds. This position loads the gluteal tendons and will often trigger the familiar pain in individuals with tendinopathy. Other tests may involve assessing the hip’s range of motion and muscle strength to identify any weaknesses or imbalances.
While the clinical examination is often sufficient for a diagnosis, imaging studies may be used to rule out other potential causes of hip pain. An ultrasound or MRI can help differentiate gluteal tendinopathy from conditions like a tendon tear, hip joint arthritis, or bursitis. These scans are used to exclude other pathologies, as the diagnosis is largely based on the patient’s symptoms and physical test results.
Effective Treatment and Management Approaches
The foundation of managing gluteal tendinopathy is a combination of education, load management, and specific exercises. The initial goal is to modify activities that compress and irritate the gluteal tendons. This involves avoiding aggravating postures and movements without complete cessation of activity. Simple changes, like placing a pillow between the knees when sleeping on the side and avoiding sitting with legs crossed, can reduce tendon compression. Standing with equal weight on both feet, rather than “hanging” on one hip, is also advised.
Exercise therapy is aimed at strengthening the gluteal muscles and improving the load tolerance of the tendons. Treatment often starts with isometric exercises, where the muscle contracts without moving the joint, as these can help reduce pain. An example is a gentle gluteal squeeze while lying down. As pain subsides, the program progresses to isotonic exercises, which involve moving the joint through a range of motion, such as bridges, clamshells, and side-lying leg lifts. The focus is on slow, controlled movements to build strength and stability around the hip.
Stretching is often discouraged in the early stages, as many common hip stretches can actually increase the compressive load on the gluteal tendons. In particular, stretches that involve pulling the knee across the body should be avoided. As the tendon heals and strengthens, a gradual and carefully managed return to more strenuous activities can begin, guided by a physical therapist.
In some cases where conservative management does not provide sufficient relief, other interventions might be considered. Shockwave therapy, which uses acoustic waves to stimulate healing, has shown some benefit. Injections, such as corticosteroids, are sometimes used for short-term pain relief, but exercise remains the primary long-term solution.