What is it?
Gluteal tendinopathy, sometimes referred to as “Greater Trochanteric Pain Syndrome”, is a degrading of muscles on the pelvis that support the hip (the gluteus medius and gluteus minimus muscles – see Fig. 2). Think of these as the muscles that prevent your pelvis from collapsing down when you are standing on one leg, as you would be when the opposite leg swings through during walking (see Fig 1).
The pain is sometimes incorrectly diagnosed as trochanteric bursitis which is an inflammation of a fluid sack that sits under an adjacent muscle (the tensor fascia latae).
Fig 1. Dropped hip while leg opposite the painful side is in swing (not in contact with the ground).
Fig 2. Side view of the pelvis and femur. Gluteus Medius tendon is shown, highlighted in circle where it inserts on the greater trochanter of the hip. The Gluteus Minimus tendon is below (underneath) this.
Who gets it?
Gluteal tendinopathy appears more frequently in women aged 40-60 years and appears to be correlated at a mild to moderate level with knee osteoarthritis and low back pain.
These correlations make some sense considering the changes in hip mechanics that come with back pain and knee arthritis. Imagine the painful looking walk of someone with bad knee or back pain and you can see how this might present problematic stress to muscles at the hip.
Intervention
An intervention protocol developed and tested by a research group led by Mellor et al. suggests strength training and education about activity modification are effective interventions for treating this.
Look at the video above. In it I describe a handful of simple strength training exercises including bridging, hip raises (abduction), and sidestepping. These easy to do exercises should be enough to get you started. Speak with your physiotherapist about increasing the challenge of these exercises over time.
Another important treatment consideration is avoiding adducted hip positions. These are positions that bring your knee toward or across the midline of your body. Examples include sitting cross legged, walking “knock kneed” or letting the pelvis drop during your gait. See the video above for an example of what this looks like.
If you have trouble controlling your walk or your gluteal tendinopathy is making an otherwise good looking walk painful, reduce the length of your step. Think about 75% of your normal step length, not a big enough change to look odd, but enough to reduce stress on those gluteal tendons.
If you are on the right track, you should notice an improvement within a couple of weeks; expect substantial resolution to take 8-12 weeks. Of course it is normal to have good and bad days over this time period. Still, if you follow interventions described here and in the video above you will be able to effectively manage this literal and metaphorical pain in the butt.
Further reading (if you really want to impress your friends)
Klauser, A. S., Martinoli, C., Tagliafico, A., Bellmann-Weiler, R., Feuchtner, G. M., Wick, M., & Jaschke, W. R. (2013, February). Greater trochanteric pain syndrome. In Seminars in musculoskeletal radiology (Vol. 17, No. 01, pp. 043-048). Thieme Medical Publishers.
Mellor, R., Grimaldi, A., Wajswelner, H., Hodges, P., Abbott, J. H., Bennell, K., & Vicenzino, B. (2016). Exercise and load modification versus corticosteroid injection versus ‘wait and see’for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC musculoskeletal disorders, 17(1), 1-17.
Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., … & Vicenzino, B. (2018). 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. bmj, 361.
Segal, N. A., Felson, D. T., Torner, J. C., Zhu, Y., Curtis, J. R., Niu, J., … & Group, M. O. M. S. (2007). Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of physical medicine and rehabilitation, 88(8), 988-992.
