Gluteal tendinopathy: A runner's guide to recovery and prevention
Gluteal tendinopathy is a common injury among runners, resulting in pain and decreased sports performance. Reading this, you may already know it can be challenging to treat.
The good news is with the proper knowledge and evidence-based strategies, it's possible to recover fully.
This article provides an in-depth overview of the symptoms, causes, treatments, and prevention strategies for gluteal tendinopathy.
What is gluteal tendinopathy?
Gluteal tendinopathy is an overuse injury of your gluteal tendons that results in pain over the outer side of your hip.
What are your gluteal muscles?
Your gluteal muscles, also known as your buttocks or "glutes," are the most superficial group of the posterior hip and thigh muscles. They consist of the following:
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
These muscles run from your sacrum and pelvis bone and attach via your gluteal tendons to your greater trochanter - the bony ridge you feel on the outer side of your upper thigh.
What do your gluteal muscles actually do?
Your gluteals help keep your body upright and move you forward. They are vital for proper pelvic alignment, propulsion during walking and running, and even balancing on one leg.
Without your gluteals, you wouldn't be able to propel yourself forward to walk or run, lower yourself slowly into a chair, stand up from a seated position, or climb stairs.
Gluteal tendinopathy and trochanteric bursitis
There are also several bursae around your trochanter. Bursae are small fluid-filled sacs that help reduce friction between bones and tendons.
Gluteal tendinopathy has been found to most commonly develop in the deeper glute medius and minimus tendons. Sometimes the bursae in the area of these muscles can also become injured and irritated, leading to bursitis (trochanteric).
Lateral (outer) hip pain is often due to a combination of gluteal tendinopathy and trochanteric bursitis. That’s why clinicians commonly refer to it as Greater Trochanteric Pain Syndrome, as it incorporates both conditions.
But, whether you have gluteal tendinopathy, hip bursitis, or Greater Trochanteric Pain Syndrome, they are all caused and aggravated by similar activities - and their rehab is the same.
Causes of Gluteal Tendinopathy
What causes gluteal tendinopathy?
Tendinopathy is an overload injury that typically develops under loads that are too high, too sudden, or sustained for too long compared to what you’re used to. When this happens, the tendon becomes injured. As a result, it loses strength and becomes painful.
Gluteal tendon overload is said to occur in two ways: Compression or overuse, and often a combination of the two.
Gluteal tendinopathy from excessive compression
This usually happens when your gluteal muscles are stretched and compressed against structures beneath them.
Things that can cause your gluteal tendon to stretch, compress, and become injured are:
Intense, repetitive, and frequent hip stretches
Strong hip stretches can pull on your gluteal tendons and compress them against the greater trochanter. For example, ITB side stretches and seated twist yoga pose.
But, these stretches don’t always cause problems; it’s only when they’re done excessively that they may cause issues.
When your core and hip muscles are weak, you may be unable to keep your pelvis level or your hips in optimal alignment when you stand, walk, run, or jump.
If your hips turn in excessively or your pelvis tilts too much when you run, it can increase the pull on your gluteal tendons, causing them to be compressed.
Poor postural habits
Certain postures can stretch your gluteal tendons, increasing the compression forces on them. If you assume these postures often, the constant compression from being stretched can cause trouble in your tendons.
Unhelpful postures for your gluteal tendons are:
- Sitting on a chair with your legs crossed
- Standing with your pelvis dropped on one side and hanging on your opposite hip
Gluteal tendon overload through overuse
Overload from overuse means you place more force through your muscle and tendon than they can cope with.
This can happen suddenly when you push yourself too hard in an exercise session after not being active for a while. Or it can happen gradually, when you keep training hard without adequate rest, not allowing your body to fully repair and recover.
How does poor running form cause gluteal tendinopathy?
Other causes and risk factors for gluteal tendinopathy
Other causes of gluteal tendinopathy
- A traumatic injury from a fall on your outer hip
- Misdiagnosis of an inflammatory condition like gout, rheumatoid arthritis, and psoriasis, which also causes tendon pain
Risk factors for gluteal tendinopathy
- Some medications can increase your risk of developing tendon injuries (like Fluoroquinolone antibiotics)
- Gaining significant weight can increase the strain on your tendons, leading to a higher risk of injury
- Menopause (more on this next)
Menopause and gluteal tendinopathy
Studies show that many people with gluteal tendinopathy are women over 40 who are in peri-menopause or menopause.
It's suggested that this link may be due to the hormonal changes associated with menopause, particularly the drop in estrogen. Estrogen plays a role in collagen turnover, which is how efficiently your body produces and repairs collagen fibers.
Collagen fibers are your tendons' building blocks. So when this process slows down, it impacts your body's ability to heal and maintain strong tendons - increasing the risk of gluteal tendinopathy.
Gluteal tendinopathy symptoms
The main symptom of gluteal tendinopathy is pain and tenderness, which can present in different areas and in various ways. It can range from a sharp stabbing pain to a deep aching pain.
Gluteal tendinopathy pain location
Generally, you will feel pain over the outer side of your hip, around the area of your greater trochanter.
Sometimes the pain can refer to your buttock, down the side of your thigh, and in rare cases, it radiates into your lower back.
What makes gluteal tendinopathy pain worse?
Strong hip stretches
Any activity that places your gluteal muscles on stretch may cause your pain to feel worse. If not immediately, then later.
- Doing glute or IT band stretches
- Sitting on a chair with your legs crossed
- Standing with your pelvis dropped, hanging on your hip
Sleeping on either hip
Sleeping can be very painful, whether lying on your injured or uninjured side.
- Lying on your injured side can increase the pain because you compress the painful area.
- Lying on your uninjured side means your injured side is on top and likely resting in adduction (closer to the midline) - this causes a low-level gluteal stretch and can make the pain feel worse if you stay in this position for long periods.
Single leg activities
Any activity where you have to take your weight on one leg can aggravate it, including the following:
- Running, walking, and jumping
- Simple everyday tasks like balancing on one leg while getting dressed
Walking, standing, and sitting
Gluteal tendinopathy pain may also worsen when you:
- Walk up hills (more than walking on flat terrain)
- Climb stairs
- Walk or stand for long periods
- Sit in low chairs for a long time
Tendinopathies develop and progress in stages and at different rates depending on your individual circumstances.
So, although these are some of the most common aggravating factors for gluteal tendinopathy, they will differ from person to person.
Your tolerance level to certain postures, positions, and activities will likely differ from everyone else's.
Other conditions that can feel similar to gluteal tendinopathy
Other conditions can also cause pain in your buttocks and along the outer side of your hip and thigh. These include the following:
- Lower back pain
- Piriformis syndrome
If any of these structures or areas are the source of your pain, you will likely experience some stiffness and discomfort in and around those areas too.
Diagnosing gluteal tendinopathy
MRI is the most reliable way of diagnosing gluteal tendinopathy, but this isn't always necessary. You can do quick tests to help determine if your pain may be coming from your gluteal tendon.
Quick gluteal tendinopathy tests
You may have gluteal tendinopathy if the following tests are painful:
- Press on the area over and around your greater trochanter
- Balance on one leg for 30 seconds
If you think you have gluteal tendinopathy, it's best to get a proper diagnosis from a healthcare professional to get started with the correct treatment as soon as possible.
What is the best treatment for gluteal tendinopathy?
Evidence suggests the most effective treatment for gluteal tendinopathy is a combination of education, rest, and exercise tailored to you.
Conservative treatment for gluteal tendinopathy
Alongside these primary components, it's vital to incorporate:
- Mobility and range of movement exercises: Helping you gain and maintain a good level of mobility for your sport and activities
- Movement retraining: Teaching you how to use and move your body more effortlessly and efficiently
- Running form correction: Adjusting how you run to reduce the strain and impact on your gluteal tendons
Other treatments for gluteal tendinopathy
Resting completely can help calm your pain initially, but it is not advised for prolonged periods. Research shows this can cause your tendons to lose more strength.
Massage can help with gluteal tendinopathy pain relief but cannot help you strengthen your tendons. Also, vigorous massage over your outer hip can irritate your gluteal tendons and bursae.
Some studies show that shockwave therapy can help reduce your pain. In addition, some studies show it may help speed up your recovery when combined with rehab exercises.
Corticosteroid injections can reduce your pain in the short term. However, evidence suggests it may have detrimental effects on your long-term recovery.
Hormone replacement therapy (HRT)
We need more research in this area. But, some studies show that taking HRT together with a targeted exercise program may help your recovery from tendon-related injuries if you are in any stage of menopause.
Electrotherapy modalities, like ultrasound, are not currently recommended by the research.
Surgery for gluteal tendinopathy
Surgery is rarely necessary for gluteal tendinopathy and is reserved for cases that do not respond to conservative treatments.
How long does gluteal tendinopathy take to heal?
There is no evidence describing a clear recovery timeline for this condition. However, in our experience, gluteal tendinopathy recovery typically takes between 12 weeks (for mild cases) and 18 months (for more severe cases).
Your recovery may take longer if you:
- Only start with the correct treatment several months after your symptoms appeared
- Are in any stage of menopause
How to prevent gluteal tendinopathy
You can reduce your risk of developing gluteal tendinopathy by:
- Allow enough recovery time after intense training sessions
- Switch up your training, so you work different muscles groups and at varying intensities
Avoiding training errors
- Avoid sudden increases in training intensity or volume
- Avoid excessive gluteal muscle and hip stretching
Adjusting to your circumstances
- Adjust your shoe height if you have a leg length discrepancy
- Adjust your training to compensate for the changes in collagen production when you enter perimenopause
Gluteal tendinopathy is a common running injury, but frustrating to treat without knowing what causes it and how to treat it effectively.
Hopefully, this article answered your questions and helped you understand gluteal tendinopathy better. With the right treatment plan and advice, you can get back on track quickly and efficiently.
Good luck with your recovery!
If you need help with your rehabilitation, the gluteal tendinopathy program in the app is designed to help you every step of the way.