What is Gluteus Medius Tendinopathy?

Figure 1: Hip pain - Gluteus medius tendinopathy and hip bursitis - Physio Frenchs Forest, Physio Macquarie Park

What are tendons?

Tendons are the collagenous bands of fibrous connective tissue that attach muscles to bones. The term tendinopathy is used to describe both the pain and associated cellular changes to a tendon that cannot tolerate the load under which it has been placed. Therefore, tendinopathies are generally considered to be a load, or overuse, style of condition. Contrary to popular belief, tendinopathies involve minimal inflammation at the site of pain.

Figure 2: Hip pain - Gluteus medius tendinopathy and hip bursitis - Physio Frenchs Forest, Physio Macquarie Park

Gluteal Tendinopathy

A tendinopathy that involves the gluteal muscles, and in particular a muscle called Gluteus Medius, is a common presentation in a variety of populations. These muscles start at varying points around the pelvis, and attach onto an area at the top of the femur. This group of muscles actively extend and externally rotate the lower limb at the hip joint. 

In an effort to simplify diagnosis, gluteal tendinopathy is now classed under the umbrella term of Greater Trochanteric Pain Syndrome (GTPS), which includes other regional contributors to pain, such as the trochanteric bursa. 

 

What are the signs and symptoms of gluteus medius tendinopathy?

Certain areas of the body commonly see tendinopathies manifest more so than others. These areas include; the Rotator Cuff tendons in the shoulder, the Patella and Quadriceps tendons of the knee, the Achilles Tendon of the ankle & the Gluteal Muscle tendons in and around the hip.

If you are suffering from gluteal tendinopathy, you are likely to be experiencing: 

  • Point tenderness over the greater trochanter (the large bony protuberance on the outside of the femur)

  • Pain that can refer from the hip into the outside of the thigh 

  • Lateral hip pain that worsens with certain activities (e.g. climbing stairs, running)

  • Pain with prolonged sitting, or when sitting with legs crossed 

 

What Causes Gluteal Tendinopathy?

  • One of the main causes of gluteal tendinopathy is the weakness of the gluteal muscles themselves, which for biomechanical reasons can end up with greater compressive forces being placed on these tendons 

  • Due to anatomical variances, gluteal tendinopathy is more common in females than in males 

  • The presence of gluteal tendinopathy can display a strong association with obesity, due to the increased biomechanical forces placed on the tendons of the hip

  • Gluteal tendinopathy is most commonly seen in patients aged between 40 and 60 years old 

  • Training/load errors are also flagged as a major cause of gluteal tendinopathy, whether this be due to a dramatically increased training load, or a change in surface that the training takes place on

 

How is Gluteus Medius Tendinopathy Treated?

  • Activity modification is an important part of the treatment for gluteal tendinopathy. Reducing your training load to an appropriate amount is likely the first step your physiotherapist will make. We recommend you remove other irritating factors such as laying on your side, crossing your legs and sleeping on your good side but allowing the sore leg to rest over the front. The patient should also avoid long walks, taking longer strides and hills/steps.

  • Over the first few weeks of your treatment plan, your physiotherapist will likely perform manual therapy of the muscles and joints surrounding your hip, in an effort to reduce your pain and increase your ability to participate in your chosen activities.

  • The Physiotherapist will also prescribe you with a home exercise program, that aims to progressively build up the strength and endurance of the hip musculature, to ensure long term resolution of your symptoms. In particular strengthening the glutues medius muscle is important.

See our expert Physiotherapy team at Frenchs Forest and Macquarie Park!

 

References: 

  • Fearon AM, Scarvell JM, Neeman T, Cook JL, Cormick W, Smith PN. Greater trochanteric pain syndrome: Defining the clinical syndrome. BR J Sports Med. 2012;0:1-5. 

  • Lin CY, Fredericson M. Greater Trochanteric Pain Syndrome: An Update on Diagnosis and Management. Curr Phys Med Rehabil Rep. 2015:3(1);60-66. 

  • Speers CJ & Bhogal GS. Greater trochanteric pain syndrome : a review of diagnosis and management in general practice. BR. J. Gen. Pract. 2017;67(663);479-480.

Reece Jonesgluteus medius tendinopathy, hip bursitis, hip pain, Greater Trochanteric Pain Syndrome, frenchs forest, macquarie park