Pain in the gluteus medius muscle, located in the upper, outer quadrant of the buttock, often presents as pain on the side of the hip. This discomfort frequently originates from a problem with the muscle’s tendon where it connects to the thigh bone, a bony prominence known as the greater trochanter. While the pain is localized, the underlying causes are varied. These causes can stem from direct injuries or issues elsewhere in the body.
The Role of the Gluteus Medius Muscle
The gluteus medius is a fan-shaped muscle situated beneath the larger gluteus maximus. Its primary mechanical action is hip abduction, which involves lifting the leg out to the side. Its most significant function is stabilizing the pelvis during activities involving single-leg support, such as walking, running, and climbing stairs.
When walking, the gluteus medius on the stance leg contracts to prevent the opposite side of the pelvis from dropping, maintaining a level hip line. Dysfunction in this muscle can quickly lead to an altered gait pattern and pain due to this stabilizing demand. The muscle must absorb significant forces, sometimes up to 3.5 times the body’s weight during running, making it susceptible to overload and injury.
Direct Injuries to the Gluteus Medius Tendon
The most frequent source of chronic gluteus medius pain is Gluteal Tendinopathy, often grouped under Greater Trochanteric Pain Syndrome (GTPS). This is typically a degenerative issue where the tendon structure breaks down due to repetitive loading that outpaces the body’s ability to repair it. The pain is localized on the outer hip and is often worse at night, especially when lying on the affected side. It is also aggravated by weight-bearing activities like climbing stairs.
In contrast to chronic tendinopathy, an acute Gluteus Medius Strain or Tear involves a sudden, traumatic event. These injuries range from a partial-thickness tear to a complete avulsion of the tendon from the greater trochanter. They are often seen in high-impact athletes or following a fall. The pain from an acute tear is usually sharp and immediate, often accompanied by weakness in the hip abductor muscles.
Underlying Biomechanical Stressors
Direct tendon injuries frequently result from underlying biomechanical problems that repeatedly overload the muscle and tendon unit. One common stressor is weakness in the surrounding hip and core musculature, particularly the gluteus maximus. When these muscles are not strong enough to handle force, the gluteus medius is forced to compensate, leading to excessive strain and eventual tendinopathy.
Poor movement patterns place undue compressive stress on the gluteus medius tendon as it rubs over the greater trochanter. Examples include a running form that causes the knee to collapse inward or an excessive side-to-side shift of the pelvis.
Prolonged static postures also contribute to this problem. Habitually sitting with the legs crossed or standing for long periods while shifting weight onto one hip can compress the tendon and weaken the muscle.
Leg length discrepancies can also disrupt the balance of forces across the pelvis. This forces the gluteus medius on one side to work harder to maintain a level pelvis during gait.
Other Nearby Pain Sources
Pain felt in the gluteus medius region can sometimes be confused with or coexist with other conditions. Greater Trochanteric Bursitis involves inflammation of the bursae that cushion the greater trochanter. While historically considered the primary cause of lateral hip pain, current understanding suggests the bursa is often secondarily inflamed due to underlying gluteal tendinopathy.
Referred pain from the lower back is another common mimic of gluteus medius discomfort, specifically Lumbar Radiculopathy, often called sciatica. When a nerve root in the lower spine is irritated, the resulting sharp, burning pain can travel down into the buttock and hip area. This nerve-related pain may also be accompanied by tingling, numbness, or weakness in the leg. This helps differentiate it from a purely muscular or tendon issue.