Having written a couple of blogs on “Pain in the Bum”, (see #1 and #2) gluteal pain (gluteal; pertaining to the buttock muscles or the buttocks) is an interesting one as – generally speaking – despite the name, this usually reports, initially at least, as a hip condition…
Gluteal tendinopathy usually causes pain towards the outside of the hip. Also attributed to this condition are muscular stiffness, and/or loss of strength in the hip musculature. Other symptoms can include;
- pain that is worse when you use the tendon e.g. running, jumping or hopping.
- pain and stiffness that may be worse during the night or first thing in the morning.
- pain that is often worse when you lie on your affected hip.
- The outside of the hip may have tenderness, redness, warmth, or even visible swelling if there is inflammation of the hip bursa (sack of fluid).
Risk factors of the Gluteal Tendinopathy include being female(!) – as females are more at risk in the region of 4:1 – a high BMI, weak hip ABduction (the ability to take the leg away from the bodies midline) and excessive hip ADDuction (the movement of the leg across the bodies midline). It is also seen in high explosive sports and/or a rapid increase in explosive movements, such as plyometrics or HIIT workouts.
It is often mis-diagnosed as Tronchanteric Bursitis, which is an inflammation of a “sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation”. The actual cause of the pain is thought to be a combination of pathology between gluteus medius and minimus (Ref 1)
Gluteus Medius (GM) is an important muscle in controlling the level of the hips. The role of the GM during activities such as walking and running is to dynamically stabilize the pelvis in a neutral position during single leg stance. Weaknesses often results in a trendelenburg sign, which is an abnormal walking/running gait where the hip of the swinging leg drops down, rather than raises up. On my Strength & Conditioning for Runners Workshop we spend a good portion talking about the ability to ABduct the hip, and the importance of the smaller gluteal muscles in not only the ability to achieve their primary function, but also to reduce the effects of their opposite movements. We spend a long time looking at effective ways of strengthening this potentially weak link – and it is way more simplistic than the well outdated method of doing hundreds of Clams….
Treating an aggravated tendon such as this is a great example of how stretching and or foam rolling is not the answer. Stretching the glutes can increase tendon compression and in doing so delay recovery and even make symptoms worse. Massage can help relax muscles but we should avoid allowing anyone or anything from applying direct pressure to the painful area. Successful treatment of GT includes, in ascending order, Education, Isometric Loading, Isontonic loading (without compression), Isotonic Loading (with compression) and, finally, graded exposure to explosive, plyometric based loading. This approach was found to have a 78.6% success rate at just 8 weeks (2), whereas corticosteroid injection was less effective (57%).
For particularly stubborn tendinopathies, Shockwave Therapy treatment is becoming a more widely used therapy, to enhance recovery.
As always, when I doubt, get it checked out.
REFERENCES
Ref 1 Long et al, 2013 Sonography of greater tronchanteric pain syndrome and the rarity of primary bursitis
Ref 2 Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial, Melloret al, 2018, https://www.bmj.com/content/361/bmj.k1662
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.