Hip Pain... is it a Gluteal Tendinopathy?

When Pheobe, an enthusiastic runner who is preparing for a mid-year marathon, presented with lateral hip pain we suspected it was a tendonitis or bursitis, but what was the actual cause.

We assessed Pheobe and videoed her running style to conclude that she had developed a gluteal tendinopathy as a result of muscle fatigue and "poor hip core" control.

What is Gluteal Tendinopathy?

Gluteal tendinopathy is the most common hip tendonitis (hip tendon injury).

Your gluteal tendons are the tough fibres that connect your gluteal muscle to your hip bone. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

Tendinopathy or its aliases: tendonitis and tendinosis are all tendon injuries. Tendon injuries can develop in many different parts of the body. Essentially, wherever there is a tendon that attaches a muscle to a bone you can suffer a tendinopathy.

Tendinopathy (tendon pathology) describes two conditions that are likely to occur together: tendon inflammation, known as tendonitis, and tiny tears in the connective tissue in or around the tendon, known as tendinosis.

Your gluteal (buttock) muscles control your hip joint movement.

Gluteal tendinopathy is injury to the gluteal tendon complex and is often associated withtrochanteric bursitis.

What Causes a Gluteal Tendinopathy?

The most common onset of gluteal tendinopathy is due to poor hip and gluteal muscle control that leads to overstressing of the gluteal tendons, causing pain and hip-pelvis instability.

Continued hip instability can cause you to walk or run with poor control, which causes you hip bursa to become under friction load, leading to trochanteric bursitis.

What are the Symptoms of Gluteal Tendinopathy?

Gluteal tendinopathy usually causes lateral hip pain, muscular stiffness, and loss of strength in the hip muscles.

The pain may get worse when you use the tendon eg running or hopping.

You may have more hip pain and stiffness during the night or when you get up in the morning.

Pain is often worse when you lie on your affected hip.
The lateral hip may be tender, red, warm, or even swollen if there is inflammation of the hip bursa.

How is a Gluteal Tendinopathy Diagnosed?

In most cases, your doctor or physiotherapist will accurately suspect your gluteal tendinopathy diagnosis in their clinic.

If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

How is Gluteal Tendinopathy Treated?

In most cases, you can start treating your hip tendon injury at home using a RICE regime.

Rest the painful area, and avoid any activity that makes the pain worse.
Apply ice or cold packs for 20 minutes at a time, as often as second hourly, for the first 72 hours. Keep using ice as long as it helps.

Do gentle hip range-of-motion exercises and stretching to prevent stiffness.

Have your your hip joint and muscle function assessed by your physiotherapist.

Undertake a “Hip Core Stabilisation Program”. This is vital to prevent a recurrence.
Visualise and retrain your hip muscle control via Real-time Ultrasound.

Modify your return to sport under the advice of your physiotherapist.

Despite the common use of painkillers and anti-inflammatory medications the cause is related to hip control, so it is your control that should be retrained as a priority.

Persisting tendon injuries are best managed by exercise under the guidance of your physiotherapist.

Should your tendinopathy be slow to improve you have the option of a steroid injection under ultrasound guidance.

For the best long-term results, you should continue to strengthen your hip rather than rely solely of the steroid effects.

In severe cases, hip surgery may be required.

How to Return to Sport after Gluteal Tendinopathy

As soon as you are cleared by your physiotherapist, you can return to your activity, but take it easy for a while.

Don't start at the same level as before your injury. Build back to your previous level slowly, and stop if it hurts.

Warm up before you exercise.

After the activity, apply ice to prevent pain and swelling.

Continue your hip stabilisation exercises.

If these steps don't help, you may require a re-visit to your physiotherapist.

It may take weeks or months to fully rehabilitate a gluteal tendinopathy.

Be patient, and stick with your treatment. If you start using the injured tendon too soon, it can lead to more damage and further time delays.

If you have any concerns please seek the advice of your physiotherapist.

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