Gluteal Tendinopathy - what do I do?

Gluteal tendinopathy is one of the most common conditions we see here at Lifecare Ashburton Sports Medicine.  It's also known as 'Trochanteric Pain Syndrome', 'Gluteus medius tendinitis' or 'Gluteal Bursitis'.

The condition is caused when there is an increased load through the gluteal tendons. This can cause compression of the tendon and the bursa, which results in characteristic pain on the outside of the hip

This condition affects females more than males and is especially common in females over the age of about 50.

How do you know if you have gluteal tendinopathy?


You will likely have pain on the outside of your hip - as seen in this photo. For all of these photos - assume the sore hip is the RIGHT hip.  The pain is normally quite localised although it can radiate down the outside of the thigh in some situations


If you can stand on the affected leg for 30 seconds WITHOUT any pain, it's likely you DO NOT have this condition.   Make sure you keep your hips level and your torso/trunk upright when trying this test!

 

Pain in this region can also be referred from the back or hip joint - although this is less common.


Pain is often worse with stairs, or with lying on the sore side at night time.

Pain when laying on your side is often the first sign of gluteal tendinopathy and unfortunately can be one of the last ones to get better!

 


So what can you do to relive the symptoms of gluteal tendinopathy?

Firstly - avoid lying on the sore side in bed. This causes compression of the tendon and can aggravate the tendon problem.  Lying on your back or on your opposite side with a pillow between the knees can help in reducing the tendon compression.


Standing with a good posture can help.  'Hanging' on the sore leg can make things worse


Sitting on a low chair can also cause more compression of the hip tendon and should be avoided where possible.


Sitting in a higher chair so that the hip is ABOVE the knee is preferred. If you don't have a high chair (e.g. in the car) you can use a foam wedge or towel to lift up the hip


Crossing your legs unfortunately also compresses the tendon and should be limited.  The same is true to stretching of the gluteal muscles - this can aggravate symptoms and should be avoided.


Walking up stairs can be tricky with gluteal tendinopathy.  It's best to place your feet slightly wider on the steps to make things easier.


So how do you 'fix' this problem? Unfortunately the evidence suggests that cortisone injections or blood injections don't provide long term relief.  In fact cortisone injections appear to make this condition worse in the long term!

Appropriate strength and control exercises from your physiotherapist, as well as avoiding compression of the tendon as mentioned above, can be helpful to reduce the pain from the tendon.  It's important to monitor activity levels particularly for activities such as hilly walks, stairs, or other activities that increase the tendon pain.

Sometimes we will use shockwave therapy as an adjunctive treatment.

We will look at typical rehabilitation exercises for this problem in an upcoming blog article.  Your Lifecare Ashburton Sports Medicine Physiotherapists are experts in treating problems such as gluteal tendinopathy. 

 


Aidan Rich is an APA Sports Physiotherapist at Lifecare Ashburton Sports Medicine.  He has a particular interest in hip, and tendon pathologies. Currently he is the head APA Sports Physiotherapist for the Boroondara Express netball team in the Victorian Netball League