Gluteus Medius Tendinopathy

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In this blog we are going to follow on from our blog about hip pain and look in depth at one of the most common causes of a painful hip: gluteus medius tendinopathy which was previously known as trochanteric bursitis. Before considering how physiotherapy might be able to help with gluteus medius tendinopathy or trochanteric bursitis we first need to have a look at exactly what it is and some anatomy.

What is Gluteus Medius Tendinopathy?

The gluteus medius muscle, located in the hip region (well actually it is one of the large muscles of the bum), plays a crucial role in stabilizing the pelvis and maintaining balance during activities such as walking, running, and jumping. Tendons connect muscles to bones, and when the tendons of the gluteus medius become inflamed or damaged, it leads to gluteus medius tendinopathy.

What is the Gluteus Medius?

The gluteus medius muscle lies on the lateral (outer) surface of the pelvis. It extends from the ilium (the uppermost part of the hip bone) and attaches to the greater trochanter of the femur (the bony prominence on the outside of the thigh bone). The gluteus medius has a fan-shaped appearance, with fibres that run diagonally downward and outward. It is widest at its upper portion and narrows as it extends downward toward its attachment point on the femur. The muscle is composed of several distinct portions or fascicles that work together to perform its functions. These include the anterior, middle, and posterior portions. The anterior fibres primarily assist in hip flexion and internal rotation, the middle fibres are responsible for hip abduction, and the posterior fibres aid in hip extension and external rotation. The gluteus medius muscle narrows into a strong tendon as it approaches its attachment point on the greater trochanter of the femur. This tendon is important for transmitting the muscle's forces to the bone.

What Does the Gluteus Medius Muscle Do?

The primary function of the gluteus medius is to stabilize the pelvis during weight-bearing activities and control hip movement. It works with other muscles, such as the gluteus maximus and gluteus minimus, to maintain proper alignment and balance during walking, running, and various lower body movements. Additionally, the gluteus medius is responsible for initiating hip abduction (moving the leg out to the side), which is crucial for activities like maintaining a stable pelvis during single-leg support.

What is Gluteus Medius Tendinopathy?

As highlighted the gluteus medius is a large muscle of the bum and hip and the tendon that connects it to the hip joint can sometimes become irritated. Gluteus medius tendinopathy is  a condition characterized by inflammation, irritation, or degeneration of the tendons of the gluteus medius muscle. We shall likely have a whole blog on tendons and tendinpathy at some point but for now: tendons are tough, fibrous tissues that connect muscles to bones. In the case of gluteus medius tendinopathy, the tendons that attach the gluteus medius muscle to the greater trochanter (a bony prominence on the outside of the thigh bone) become damaged or irritated. This can occur due to repetitive stress, overuse, muscle imbalances, or degenerative changes associated with aging.

What are the Symptoms of Gluteus Medius Tendinopathy?

The main symptom of gluteus medius tendinopathy (trochanteric bursitis) is pain, which is generally around the outer part of the hip, specifically near the greater trochanter (this is the bony lump that you can feel on the outside of the hip). Some common symptoms associated with gluteus medius tendinopathy (trochanteric bursitis) are:

1. Outer Hip Pain: Pain is the hallmark symptom of gluteus medius tendinopathy. It is usually felt as a deep ache or sharp pain on the outer side of the hip. The pain may be localized or radiate down the side of the thigh.
2. Tenderness: There may be tenderness and sensitivity when pressure is applied to the affected area over the greater trochanter.
3. Pain with Movement: Pain is often aggravated by activities that involve repetitive or prolonged hip movements, such as walking, running, climbing stairs, or sitting for extended periods. Movements that require the gluteus medius muscle to stabilize the pelvis, such as shifting weight onto one leg or standing on one leg, may also elicit pain.
4. Weakness: Individuals with gluteus medius tendinopathy may experience weakness and a feeling of instability in the hip. This can affect balance and make activities that require stability more challenging.
5. Stiffness and Reduced Range of Motion: Some individuals may experience stiffness in the hip joint and a decreased range of motion. This can make it difficult to perform certain movements, such as crossing the affected leg over the opposite leg.
6. Night Pain: In some cases, the pain may worsen at night, affecting sleep quality and causing discomfort when lying on the affected side.

It is important to be aware that symptoms can vary. If you're experiencing persistent hip pain or any of the above symptoms, it is advisable to consult a physiotherapist for a thorough evaluation and diagnosis.

Who Can Get Gluteus Medius Tendinopathy?

Well, almost anyone can get gluteus medius tendinopathy and it can affect individuals of all ages and activity levels. However, certain factors may increase the likelihood of developing this condition. Below are some groups of people who may be more susceptible to gluteus medius tendinopathy:

1. Athletes and Active Individuals: People who engage in activities that involve repetitive hip movements, such as running, dancing, and sports like soccer or basketball, may be at a higher risk. These activities can put increased stress on the gluteus medius tendon, leading to overuse and potential tendon damage.
2. Middle-aged and Older Adults: Gluteus medius tendinopathy is more commonly seen in middle-aged and older adults. As we age, tendons tend to lose some of their elasticity and become more prone to injury and degenerative changes. Additionally, age-related muscle weakness and changes in biomechanics can contribute to the development of tendinopathy.
3. Individuals with Poor Biomechanics: Poor alignment, muscle imbalances, or faulty movement patterns can increase the strain on the gluteus medius tendon. For example, excessive inward rotation or collapse of the knee during movement can place added stress on the tendon, making it more susceptible to injury.
4. Previous Hip Injuries or Surgeries: Individuals who have experienced previous hip injuries, such as hip fractures, or have undergone hip surgeries may be at an increased risk of developing gluteus medius tendinopathy. These conditions can alter the mechanics of the hip joint, potentially leading to imbalances and overloading of the gluteus medius tendon.
5. Sedentary Individuals with Sudden Increases in Activity: People who lead a sedentary lifestyle and suddenly engage in strenuous activities or increase their exercise intensity without proper conditioning may put excessive strain on the gluteus medius tendon. The tendon may not be adequately prepared for the sudden increase in demand, leading to potential injury or tendinopathy.

What Causes Gluteus Medius Tendinopathy?

It is difficult to be certain of exact causes and the research points to a range of factors at present. However, it is typically caused by a combination of factors that contribute to excessive stress and strain on the tendons of the gluteus medius muscle. Below are some common factors that may cause you to develop gluteus medius tendinopathy or trochanteric bursitis:

1. Overuse or Repetitive Stress: Engaging in activities that involve repetitive hip movements or excessive stress on the gluteus medius tendon can lead to overuse and subsequent tendinopathy. This can occur in athletes or individuals who participate in sports or activities that require frequent jumping, running, or lateral movements.
2. Muscle Imbalances: Imbalances between the gluteus medius and other muscles around the hip and pelvis can contribute to tendinopathy. Weakness or lack of coordination in the gluteus medius muscle may result in increased strain on the tendon during movement.
3. Poor Biomechanics: Faulty movement patterns, improper alignment, or abnormal mechanics of the lower extremity can put increased stress on the gluteus medius tendon. For example, excessive inward rotation of the hip or collapse of the knee during walking or running can overload the tendon and lead to tendinopathy over time.
4. Age and Degenerative Changes: an unfortunate fact is that as we age, tendons naturally undergo degenerative changes and become less resilient. The gluteus medius tendon may become weaker and more susceptible to injury or degeneration, leading to tendinopathy, particularly in middle-aged and older adults.
5. Trauma or Previous Hip Injuries: Previous hip injuries, such as hip fractures or dislocations, can disrupt the normal mechanics of the hip joint and affect the gluteus medius tendon. In some cases, surgical interventions in the hip area can also contribute to altered biomechanics and increased strain on the tendon.
6. Insufficient Warm-up or Cool-down: Inadequate warm-up or cool-down routines before and after physical activity can increase the risk of developing tendinopathy. Properly preparing the muscles and tendons for exercise and allowing them to recover afterward can help prevent excessive strain and injury.

It's important to note that individual factors, such as genetics, anatomical variations, and overall health, can also contribute to the development of gluteus medius tendinopathy. If you suspect you have gluteus medius tendinopathy or are experiencing symptoms, it is best to get in touch with a physiotherapist for an assessment of the underlying cause.

How is Gluteus Medius Tendinopathy Diagnosed?

In general gluteus medius tendinopathy or trochanteric bursitis is usually diagnosed through a combination of a thorough physical examination, a review of symptoms, and as a last resort imaging. Below is a summary of a usual process

1. Physical Assessment: A a physiotherapist or possibly GP (who is likely to refer onwards to a physio), will begin by conducting a physical examination. They will assess your hip and pelvis for tenderness, swelling, and range of motion. They may also evaluate your gait and perform specific tests to assess the strength and function of the gluteus medius muscle.
2. Review of Symptoms: The physio will ask about your symptoms, including the location, intensity, and duration of pain, as well as any factors that aggravate or alleviate the symptoms. They will also inquire about your activity level, any previous hip injuries, and your overall medical history.
3. Imaging Studies: Occasionally if physical examination and a review of symptoms are inconclusive it may be necessary to have imaging of the hip. This can provide valuable information, imaging studies are often used to confirm the diagnosis and evaluate the extent of the tendon damage. Common methods are:

• Ultrasound: This non-invasive imaging technique uses sound waves to create real-time images of the tendons, muscles, and surrounding structures. It can help visualize tendon abnormalities, such as thickening, tears, or inflammation.
• Magnetic Resonance Imaging (MRI): An MRI scan provides detailed images of the soft tissues, including tendons, muscles, and bones. It can help assess the integrity and condition of the gluteus medius tendon and rule out other potential causes of hip pain.

Treating Gluteus Medius Tendinopathy

As there are an array of underlying causes it is first important to understand what is causing the tendinopathy. However most treatment metods will typically involve a combination of conservative approaches aimed at reducing pain, inflammation, and promoting healing of the affected tendon. Below are some usual approaches:

1. Rest and Activity Modification: It's important to initially rest the affected hip and avoid activities that exacerbate symptoms. Modifying activities that place excessive stress on the gluteus medius tendon, such as running or high-impact exercises, can help prevent further irritation.
2. Physiotherapy: A structured physiotherapy program is often a key component of treatment for gluteus medius tendinopathy. The focus is on strengthening the hip muscles, improving flexibility, and correcting any muscle imbalances or faulty movement patterns. Physiotherapists may incorporate exercises such as hip abductions, lateral leg raises, clamshells, and hip stabilization exercises to target the gluteus medius muscle.
3. Pain Management: Various pain management techniques may be employed to alleviate discomfort. These can include:

•  Ice or Heat Therapy: Applying ice packs or heat pads to the affected area can help reduce pain and inflammation. Ice is typically recommended in the acute phase to control swelling, while heat may be used to promote blood flow and relaxation of the muscles during the recovery phase.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help reduce pain and inflammation. It's important to follow the recommended dosage and consult with a healthcare professional before taking any medication.
• Corticosteroid Injections: In some cases, corticosteroid injections may be considered to provide short-term pain relief and reduce inflammation. These injections are typically administered under guidance using ultrasound or fluoroscopy.

4. Biomechanical Corrections: Identifying and addressing any underlying biomechanical issues or muscle imbalances is crucial for long-term management of gluteus medius tendinopathy. This may involve gait analysis and the implementation of corrective exercises or orthotic devices to improve alignment and reduce stress on the tendon.
5. Gradual Return to Activity: As symptoms improve, a gradual return to activity is recommended under the guidance of a physio. This may involve a progressive increase in exercise intensity and volume to avoid re-injury.

How Long Will My Gluteus Medius Tendinopathy Last?

This is a difficult question but on that as physiotherapists we get all the time, unfortunately the duration of gluteus medius tendinopathy can vary from person to person. It depends on several factors, including the severity of the injury, individual healing capacity, adherence to treatment, and lifestyle factors. In general, gluteus medius tendinopathy can last for several weeks to months. Mild cases of gluteus medius tendinopathy may resolve with conservative treatment measures, such as rest, activity modification, physiotherapy, and strengthening exercises, within a few weeks. However, more severe or chronic cases of tendinopathy may take longer to heal and may require a more comprehensive and prolonged treatment approach.

One of the most important points to note is that tendons generally have a slower healing process compared to other tissues due to their limited blood supply and as such the time frames may well be longer than you hope for.

How Can ThreeSpires Physiotherapy Help with My Gluteus Medius Tendinopathy?

Physiotherapy can be extremely useful if you have gluteus medius tendinopathy or trochanteric bursitis and one of our physiotherapists will be able to help with:

1. Assessment & Diagnosis of Gluteus Medius Tendinopathy: this as mentioned earlier is a vital part of healing your gluteus medius tendinopathy (trochanteric bursitis) and the sooner you have an assessment the sooner you will know what you are dealing with. Our physiotherapists will be able to comprehensively assess your hip and make a diagnosis of the underlying cause of your pain.
2. Management Plan: once a diagnosis of gluteus medius tendinopathy (trochanteric bursitis) has been made it is vital that you get a clear and comprehensive plan to begin healing and recovering.
3. Exercises for Gluteus Medius Tendinopathy (trochanteric bursitis): your physiotherapist will be able to determine which are the most appropriate exercises for your gluteus medius tendinopathy and will be able to prescribe the optimum number and frequency to promote recovery.
4. Treatment for Gluteus Medius Tendinopathy (trochanteric bursitis): In conjunction with load management and exercises your physio will be able to use soft tissue and hands on techniques to treat any areas that have become overloaded and tight.

Okay, I hope that you have found this article about gluteus medius tendinopathy (trochanteric bursitis) helpful, over the next few months we will be continuing with this series of articles about each of the specific causes of hip pain. Should you or anyone you know have developed gluteus medius tendinopathy (trochanteric bursitis) please get in touch and one of our physios would be happy to help.