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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?

Key Gluteal Muscles

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?

Gluteal 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 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.

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.

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.   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.

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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, and 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 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.

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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.

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