What is Gluteal Tendinitis: Causes, Symptoms, Treatments, Exercises, Prevention

Gluteal tendinitis, also referred to as Gluteal tendinopathy, is an injury or inflammation of the tendons of gluteal muscles and is a common cause of hip pain. Our buttocks are made of a group of three gluteal muscles, namely the gluteus maximus, gluteus minimus, and gluteus medius. These muscles help in the hip movement and also support the entire body in weight-bearing, especially while walking and running. Gluteal tendinitis is mostly seen in inactive individuals, and also in the case of hikers and runners. When someone is affected with gluteal tendinitis, they experience hip pain because there is inflammation, tear, or injury to the gluteal tendons. Usually, overuse of gluteal muscles leads to gluteal tendinitis.

Women in their 40s to 60s get affected with Gluteal tendinopathy or gluteal tendinitis, and they experience chronic lateral hip pain along with tenderness.⁽¹⁾This condition is mostly seen in inactive individuals, and also in the case of hikers and runners. Gluteal tendinitis affects people predominantly above 40 years of age and more in the case o females as compared to males.

One of the most common symptoms of gluteal tendinitis is pain and tenderness when the outside of the hip or greater trochanter is palpated and when the glutes are pressed upon. There is also pain when crossing legs and during the night while lying on the affected side.

Weight-bearing activities can increase the pain of gluteal tendinitis. People with the condition have reported that they have difficulty lying on their side, walking, standing, climbing up and down stairs, and prolonged sitting.⁽²⁾ Mild limping can also be experienced when walking.

Another symptom of gluteal tendinitis is the gluteal area and the greater trochanter gets red, swollen, and hot. Moreover, there is also irritation in the area with prolonged standing or sitting.

If you are feeling stiffness in the morning, it might be due to gluteal tendinitis. This symptom would generally be lasting for less than 30 minutes.

Here are some known causes of Gluteal Tendinitis:

Every person is different and so is their skeleton. Each one of us has a slightly different skeleton with having different structure and muscle mass. A hypermobile person or an individual with leg length discrepancy can put extra load on those muscles in various ways, thus making them work harder and ultimately leading to irritation in tendons

Certain underlying pathologies like the knee, ankle, hip, or pelvic issues resulting from injuries or operations or certain kinds of instability in these joints can cause excessive loading in the gluteal tendons and thus irritate the tendon.

One more cause for gluteal tendinitis could be certain biomechanical changes, which alter the gait cycle, running mechanics, and also daily movements in people, along with specific imbalances in the muscles that can result in excessive loading in the glutes and can cause tendon irritation.

Muscle imbalances that arise from less use of some muscles in the lower extremities or certain cases of excessive loading to other muscles can also lead to certain imbalances, thus putting excessive stress on the gluteal muscles and can irritate the tendon.

To diagnose gluteal tendinitis, your doctor would go for a detailed case history and obtain information regarding the duration of pain or discomfort and its progression, and also discuss previous or recent injuries that might be causing the lateral hip pain.

Following this, you will be undergoing a physical examination. Your doctor will press the area to check for any pain and also check for any change in the surrounding tissues. You will be asked to stand and do certain active movements so that your doctor would know about any pain or restriction.

A passive physical examination will also be done to recheck for any abnormality or restriction in joints.

In the case of athletes, a gait and running analysis will be required to identify the reason causing any irritation of the gluteal tendons that might be causing gluteal tendinitis.

Various treatment options are available for treating Gluteal tendinitis and these options depend on the level of severity and specific needs of the individuals. Some of the treatment methods include:

Rest and contrast bath therapy, i.e. hot and cold therapy along with rehabilitation of the tendon by using progressive loading is the first treatment option for gluteal tendinitis.

Physical therapy including physiotherapy and osteopathy are known to release the tension in the muscles and also aid in improving the mechanics of the joints to reduce the tension that goes through the gluteal tendons.

This is another treatment option for gluteal tendinitis. Acupuncture along with massage might help to speed up the healing process of irritated or affected tissues and also reduce the recovery time that might be needed.

Cortisone or corticosteroid injections, being anti-inflammatory, can be beneficial in reducing pain in a short term, after completing at least 12 weeks of prescribed exercises.
It must be noted that cortisone will not fix the problem, rather will just provide short-term relief from the pain so that you can continue with a progressive strengthening exercise routine.

NOTE: Cortisone or corticosteroid injections when taken in excess can cause a hazardous effect on your tendon health. A study shows that cortisone injections can have harmful effects on the tendon health and tendon structure since they reduce the strength of the tendon by reducing healing and restricting the formation of connective tissue.⁽³⁾

Shockwave therapy can treat chronic gluteal tendinitis pretty effectively. The exact mechanism involved in this therapy is still unclear. However, it is thought that shockwave therapy stimulates healing by stimulating cellular activity and increasing the flow of blood.

A systematic review has shown that shockwave therapy when used to manage the greater trochanter pain syndrome, including the gluteal tendinitis has found that individuals who underwent the treatment benefited for 12 months.⁽⁴⁾

Surgery for treating gluteal tendinitis is the last option if other treatment methods do not work. Surgery to treat the condition might include repair of the gluteal tendon, removal of the bursa, and removal of the bone beneath the tendon.

It might take a few weeks to a year or more to recover from gluteal tendinitis. An acute state of gluteal tendinitis can be less than eight weeks, however, a chronic state could last for more than eight weeks.

The recovery period also depends on how accurately and quickly your doctor picks up the condition and begins the treatment. It is important to understand the cause of gluteal tendinitis so that appropriate treatment could be possible.

Exercise can do wonders for patients with gluteal tendinitis. According to a study, it has been found that strength exercises can help in promoting the growth of new tendon fiber and thus assist in the healing of the affected tendon.⁽⁵⁾ Your physiotherapist would prescribe the best exercises for you. Below are some forms of exercises that might be helpful in the case of gluteal tendinitis.

1. Isometric Hip Internal Rotation

   This can be done by either seating or standing next to a wall and getting the hip closer to it to 90 degrees and pushing for at least 20 seconds. Repeat this five times by taking a 10-seconds of relaxation in between.

2. Isometric Gluteus Medius Activation:

   For isometric gluteus medius activation, you need to stand on one leg with the opposite knee bent to 90 degrees and touch the wall. Then push the bent knee against the wall, ensuring that the rest of your body is still. Hold this for 20 seconds, relax for 10 seconds, and repeat the same at least five times.

3. Eccentric Contraction Of Gluteus Medius

   Abduct both legs using an elastic band over your knees. Do it till you feel the tension in the band. Then balance on one leg slowly whilst bringing the other leg off the ground. Counteract the pull from the elastic band whilst abducting the hip(that is off the ground) slowly. Repeat five times on each side and do three sets.

4. Concentric Contracton Of Gluteus Muscles

   You will need an elastic band for this. Lie onto your side with hips at 45 degrees and your knees at 90 degrees, with an elastic band over the knees. Make sure both your feet and ankles are in contact with each other. Start by lifting the knee at the top, making sure that there is no rotation at the pelvis. Then return the top knee to its starting position. You need to repeat this on each side for the sets of twelve reprtitions.

5. Functional Loading Of Gluteal Muscles/Strength Exercises

   For functional loading of gluteal muscles or improving the strength, flexibility, and mobility of your gluteal muscles, you can perform lunges, squats, glute bridges, and hip thrusts. You can perform these exercises with or without weights and with varying repetitions and sets.

Some preventive measures for gluteal tendinitis include:

• Remain physically active while paying attention to your body and the signs of hip pain that might be there.
• Do not go for repetitive activities that put a huge amount of pressure on the hips
• If your hips are irritated, take a break from certain activities like running, or walking.
• Try to reduce weight if possible especially if you are overweight.
• Strengthen your gluteal muscles by lifting weights.
• If you have lower back pain, treat it as soon as possible.
• Practice good posture
• Practice stretching exercises and yoga that would help your hip muscles to remain flexible.

If you have been experiencing severe hip pain that might be interfering with your ability to exercise, sleep, or daily activities of motion, then you should consult with your doctor and get a proper diagnosis of the condition and start with the most appropriate and prescribed treatment before it turns more complicated.

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