Gluteal Tendinopathy

Causes, Symptoms, Treatments, and Other Resources

Ever wonder what that nagging pain on the side of your hip is? What are Gluteal Tendons? What is Tendinopathy? How is Gluteal Tendinopathy Diagnosed? How do you fix Gluteal Tendinopathy? What comprehensive, regenerative treatment options exist? Let’s dig in.

What Are the Gluteal Tendons?

The Gluteal muscles are a group of three muscles that make up the buttocks. They include the Gluteus Maximus, Gluteal Medius, and Gluteus Minimus. They are important as they allow us to bend, extend, and rotate the hip joint and leg. These muscles arise from the waist bone and tail bone and together attach on the outside of the hip. However, muscles can not attach directly to the bone. So the tendon allows the muscle to attach to the bone. Tendons are thick bands of connective tissue that attach muscles to the bone. They are susceptible to injury and can be a source of pain.

What Is Tendinopathy?

Tendinopathy is a group of tendon disorders. The most common form of Tendinopathy is Tendinosis (1). Tendinosis is a degenerative condition that is characterized by collagen degeneration and micro-trauma in the tendon due to repetitive overloading. Gluteal Tendinopathy is a clinical condition in which there is moderate to severe debilitating pain due to injury of the Gluteal tendons. It is the most common Tendinopathy in the lower leg (2) and is more common in women (3).

Symptoms

Symptoms include:

Pain and swelling located on the outside of the hip (4).
Pain at night when lying on the affected, painful side.
Pain that extends down the outside of the thigh to the knee.

Butt Pain

Throwing this question out to the social-media masses is sure to bring out the cyber “comedians” among us, but the truth is when you really do have butt pain, it’s no laughing matter. So we’re glad you came here to ask because we actually do see many patients in our clinic with this problem. There are a number of issues that can cause butt pain, but the root causes we most often discover are hamstrings tendinopathy, a pinched low-back nerve, or sacroiliac joint syndrome. Let’s take a look at each of these individually. – Hamstrings Tendinopathy: The hamstrings are actually a collection of large muscles…

Gluteus Medius Pain

The gluteus medius is one of the major muscles in your buttock and hip. There are three gluteal muscles you have probably heard about: They layer one upon the another much like a layer cake. The gluteus minimus is closest to the body followed by the gluteus medius and then the larger gluteus maximus.Gluteus Minimus – The gluteus minimus is the smallest of the three gluteal muscles. It is a small triangular muscle that lies underneath its bigger brother, the gluteus medius. It functions to stabilize the hip, rotate the thigh, and move the hip in an outward direction.Gluteus Medius -A powerful muscle that starts at the backside of your waist bone…

Hip Pain that Radiates Down the Leg

Hip pain is miserable making walking across the room almost impossible at times. Hip labral tears are the most common cause, but there are more to consider. What is a hip labrum? Are there other causes of hip pain down the leg besides a hip labral tear? Does the presence of hip labral tear with pain down leg mean I need surgery? What are the treatment options for hip labrum tears? Given that labrum tears are present in patients without hip pain it is important to understand the other causes of anterior thigh and hip pain. SI Joint, muscles, irritation of low back nerves…

Read More About Hip Pain that Radiates Down the Leg

Sit Bone Pain / Ischial Tuberosity

The ischial tuberosity, also called your Sitz bone, sis a pair of rounded bones that extends from the bottom of the pelvis. They are the bones that we sit on. The pelvis consists of three strong bones fused together: the ilium, ischium and pubis. The ilium are the tall, thin bones that create the iliac crest aka the waist bone. The pubis bones are the small anterior bones that are joined together by the pubic symphysis. The ischium forms the lower and back part of the pelvis. It is situated between the ilium and pubis A tuberosity is defined as a large prominence…

Read More About Sit Bone Pain / Ischial Tuberosity

How Is Gluteal Tendinopathy Diagnosed?

In most cases, physical examination alone is sufficient to diagnose Gluteal Tendinopathy. If symptoms continue despite conservative care, other studies may be warranted which include ultrasound and MRI.

Gluteus Medius Tendonitis Treatment

Gluteus medius tendonitis, also known as hip tendonitis, is a condition characterized by inflammation of the tendons surrounding the gluteus medius muscle, a key stabilizer of the hip joint. This inflammation often results from overuse, muscle imbalances, or repetitive stress on the hip, leading to pain and discomfort in the outer hip and buttock region. Proper treatment is crucial to alleviate symptoms and prevent the condition from worsening. In this guide, we’ll explore various aspects of gluteus medius tendonitis treatment, including self-care strategies, exercises, and medical interventions, to help individuals better understand and manage this condition effectively.

Read More About Gluteus Medius Tendonitis Treatment

NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition. After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day. I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

Prolotherapy Injections

It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…

PRP Injections

PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…

Tenex Procedure

The Tenex Health TX® System is a minimally-invasive, percutaneous procedure using ultrasonic energy to treat pain-generating soft and hard tissue conditions. This treatment is clinically proven to remove tendon pain for over 85% of patients1,2,3,4,5. If conservative approaches such as physical therapy, cortisone injections, medication, and downtime do not provide relief, Tenex may be your next option.Using this technique, we help patients restore musculoskeletal function, may provide quick pain relief, and avoid invasive surgery and dangerous drugs. Tenex may also be effective if you have had a failed surgical procedure. Your doctor will use image-guidance to identify and target the…

How Do You Fix Gluteal Tendinopathy?

Traditional treatment focuses primarily on the symptoms. So the aim of most treatments is to reduce pain and dysfunction. Options include rest, activity modification, ice or heat, physical therapy, dry needling, and chiropractic care. Shockwave therapy is also effective in reducing pain (5). Medications are often used and include NSAIDs, muscle relaxants, and narcotics. When conservative care fails, steroid injections are frequently recommended. While steroids are powerful anti-inflammatory agents they are also are toxic to tendons as they have been shown to depress stem cell production and compromise healing, putting tendons at risk for rupture. (6). Steroids can also suppress your immune system and should be avoided.

Are there new, natural options? Yes

SANS Approach and PRP

At Centeno-Schultz Clinic rather than merely treating the symptom, we dig deeper to identify and treat the underlying problem. So in patients with Gluteal Tendinopathy, our concern is what is causing the Gluteal Tendon to become irritated and a source of pain. A comprehensive approach that looks beyond the painful tendon is utilized in every evaluation and treatment plan. It is called the SANS approach which stands for Stability, Articulation, Neurologic, and Symmetry.

3 Common Causes of Gluteal Tendon Dysfunction

Three common but often missed causes of Gluteal Tendon dysfunction and pain are:

Low back nerve irritation
Low back disc injuries
Sacroiliac Joint Dysfunction

To better understand Gluteal Tendinopathy please watch the video below.

PRP is rich in growth factors that can increase blood flow, reduce tendon inflammation, and promote healing (7). At Centeno-Schultz Clinic all injections are performed under ultrasound or x-ray guidance to ensure accurate placement of the PRP.

In Conclusion

The Gluteal muscles are a group of three muscles that make up the buttock. Tendons attach muscles to bone and are susceptible to injury. Tendinopathy is a group of tendon disorders. Tendinosis is the most common and is characterized by degeneration and micro-trauma. Common symptoms include pain and swelling on the outside of the hip. In most cases, diagnosis is made by physical examination. Most treatment options focus on reducing the symptoms and include rest, physical therapy, dry needling, and NSAIDs. Steroids are powerful anti-inflammatory agents but are toxic to tendons and should be avoided. The Centeno-Schultz Clinic is committed to understanding the underlying cause of your Gluteal Tendon dysfunction and pain. Identifying and treating the underlying problem will provide you with better clinical results.

If you have undergone the traditional treatment options and your gluteal pain continues to sideline you, schedule a Telemedicine evaluation with a board-certified, fellowship-trained physician to learn about comprehensive, natural treatment options.

Empty Spacer

Our Doctors Who Treat Gluteal Tendinopathy

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

Empty Spacer

Other Resources for Gluteal Tendinopathy

Everything You Need to Know about Hip Ligaments

The hip joint is a large ball and socket joint that’s important for lower extremity movement. The joints consist of the articulation of the femur (upper thigh bone/ball) and the acetabulum (the socket). The bones are lined with cartilage and the acetabulum is lined with a fibrocartilage called the labrum. The hip joints, as with…

November 5, 2023
Biceps Femoris Tendonitis Stem Cell Treatment: aka Hamstring Treatment Options

Hamstring injuries are a common sports injury. Dr. Schultz describes what the biceps femoris is, what tendonitis is, what biceps femoris tendonitis is, what causes it, the symptoms, treatment, and biceps femoris tendonitis stem cell treatment options.

February 5, 2021
Pelvic Ligaments: The Uncomfortable Truth You Need to Know!

The pelvis is held together by three principal ligaments: the iliolumbar, sacrotuberous and sacrospinous. Dr. Schultz discusses the causes of pelvic ligament injuries, symptoms, and novel new treatment options.

May 18, 2020
Groin Pain after Hip Replacement: What Is Being Missed?

Your hip replacement surgery was 6 months ago and you are still having pain. Is it normal to have groin pain after total hip replacement? What are the causes of groin pain after total hip replacement? What are the signs of a failing hip replacement? What treatment options exist? Let’s dig in. Is it Normal…

May 13, 2020
8 Reasons for Hip Replacement Failure

Hip replacement surgery replaces a worn out or damaged hip joint with an artificial joint called a prosthesis. The symptoms of hip replacement failure are pain and limited mobility. Dr. Schultz discusses the 8 major causes of hip replacement failure and important treatment options.

April 20, 2020
Levator Scapulae Massage: Options When It Doesn’t Work

The Levator Scapulae is an important neck muscle that lifts and rotates the scapulae. Dr. Schultz discusses the causes of levator scapulae pain and tightness and new, natural treatment options.

March 6, 2020

———————————————————————————————————————————————-

1.Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015 Aug 1;45(8):1107-19.

2.K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015 Aug 1;45(8):1107-19

3.Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):910-22.

4.Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy?. Br J Sports Med. 2012 Mar 1;46(3):163-8.

5.Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. The American journal of sports medicine. 2015 Mar;43(3):752-61.

6. Zhang J, Keenan C, Wang JH. The effects of dexamethasone on human patellar tendon stem cells: implications for dexamethasone treatment of tendon injury. J Orthop Res. 2013;31(1):105-10.

7.Miller LE, Parrish WR, Roides B, Bhattacharyya S. Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials. BMJ Open Sport Exerc Med. 2017;3(1):e000237.