Gluteal Tendinopathy

Question 1

Which Muscles Are Part of the Gluteal Tendons?

Answer 1

The gluteal tendons refer mainly to the tendons of the gluteus medius and minimus muscles, which are responsible for hip abduction (moving the leg out to the side) and internal rotation.

Question 2

Does the Gluteus Maximus Have a Tendon Inserted at the Greater Trochanter?

Answer 2

No, the gluteus maximus does not insert at the greater trochanter. Instead, it attaches to the iliotibial (IT) band and the gluteal tuberosity on the femur. It’s mainly responsible for hip extension and external rotation.

Question 3

Where Do the Gluteus Medius and Minimus Tendons Attach?

Answer 3

The tendons of the gluteus medius and minimus attach to the greater trochanter of the femur. This attachment point is key for stabilizing the hip and supporting hip abduction and internal rotation.

Question 4

How Are the Gluteal Tendons and IT Band Connected?

Answer 4

The IT band and gluteal tendons are closely related, both located around the greater trochanter. The IT band passes over the greater trochanter, while the gluteal tendons insert into it.

Question 5

Why Can Tightness in the IT Band Affect the Gluteal Tendons?

Answer 5

Because of their close proximity, tightness or inflammation in the IT band can create pressure on the gluteal tendons, leading to increased friction and potentially contributing to tendinopathy.

Question 6

What is Gluteal Tendinopathy?

Answer 6

Gluteal tendinopathy is a condition where the tendons of the gluteus medius or minimus become inflamed or damaged, often resulting in pain around the hip, especially near the greater trochanter.

Question 7

Common Symptoms of Gluteal Tendinopathy

Answer 7

Symptoms include pain on the side of the hip, which can worsen with prolonged standing, lying on the affected side, or crossing the legs. Pain may also increase during or after activities like running or climbing stairs.

Question 8

Why Do Compression and Overload Aggravate Gluteal Tendinopathy?

Answer 8

Compression occurs when the gluteal tendons are pressed against the greater trochanter, especially during hip adduction (e.g., crossing legs). Overloading results from repetitive or intense activity that stresses the tendons without sufficient recovery time.

Question 9

Common Activities that Cause Compression or Overload

Answer 9

Common aggravating activities include sitting with legs crossed, lying on the affected side, standing with a hip drop, and running on uneven surfaces. These positions increase strain and compression on the gluteal tendons.

Question 10

What Are the Key Risk Factors for Gluteal Tendinopathy?

Answer 10

Risk factors include poor hip mechanics (excessive hip adduction), tightness in the IT band, muscle imbalances, hormonal changes (e.g., post-menopausal women), and frequent participation in activities with repetitive hip movements.

Question 11

How Does Age and Gender Influence Gluteal Tendinopathy?

Answer 11

Women, especially those in peri-menopausal or post-menopausal stages, are at higher risk due to hormonal changes affecting tendon elasticity. Gluteal tendinopathy also tends to increase with age as tendons naturally lose elasticity.

Question 12

What Questions Help Assess Gluteal Tendinopathy?

Answer 12

Key questions include asking about the onset and location of pain, activities that worsen or relieve it, sleeping positions, and any prior history of hip, back, or knee pain that might contribute to gluteal overload.

Question 13

Observational Tests for Gluteal Tendinopathy

Answer 13

Single Leg Stand Test
Palpation Test
Resisted Hip Abduction
External Hip De-Rotation Test
Trendelenburg Sign

Question 14

Single Leg Stand Test?

Answer 14

How to Perform: Stand on one leg for 30 seconds without support. The examiner observes the position of the pelvis and any signs of instability or pain around the hip area.
Why it’s Important: Gluteal tendinopathy often causes pain or weakness during single-leg stance due to the role of the gluteus medius and minimus in stabilizing the pelvis. Pain or inability to maintain a level pelvis is a positive indicator for gluteal tendinopathy.

Question 15

Palpation Test?

Answer 15

How to Perform: The examiner applies gentle pressure along the greater trochanter (the bony point on the outer hip).
Why it’s Important: Tenderness over the greater trochanter or slightly posterior to it is often present in gluteal tendinopathy, helping to confirm the condition and differentiate it from other sources of hip pain.

Question 16

External Hip De-Rotation Test (Supine Position)

Answer 16

How to Perform:

Patient Position: Have the patient lie on their back with the affected leg extended and relaxed.
Starting Position: Flex the patient’s hip to about 90 degrees and bend the knee to 90 degrees.
External Rotation: Gently rotate the leg outward so that the hip is in an externally rotated position (the knee points slightly outward).
Resistance: Ask the patient to actively rotate their leg back to neutral (straighten the knee toward the midline) while you provide resistance by applying inward pressure on the ankle to prevent the leg from rotating inward.
Observe and Ask: Monitor for any discomfort, pain, or weakness as the patient attempts to return the leg to the neutral position.

Question 17

Key Management Strategies for Gluteal Tendinopathy

Answer 17

Management includes activity modification to avoid aggravating movements, gradual loading exercises, and reducing compressive positions (like crossing legs or lying on the affected side) to allow healing.

Question 18

Advice for Managing Compression and Overload

Answer 18

Advise patients to avoid prolonged standing on one leg, crossing their legs, or standing with a dropped hip. Sleeping with a pillow between the knees

Question 19

What Could Go Wrong During Gluteal Tendinopathy Rehab?

Answer 19

Progressing exercises too quickly, returning to aggravating activities, or performing hip adduction stretches (e.g., clamshells or crossing legs) too early can worsen symptoms by increasing compression.

Question 20

Recognizing Signs of Overload or Flare-Up

Answer 20

Signs of overload include increased pain during or after exercise and tenderness in the hip. Encourage patients to reduce load, take rest days, and resume exercises gradually if flare-ups occur.

Question 21

Give example for Early-Stage Exercises

Answer 21

In early stages, gentle isometric exercises (e.g., lying on the back with a belt around the knees, pushing knees outward) help strengthen without compression. Avoid hip adduction or rotation.

Question 22

Bridging Exercises – Safe Hip Strengthening

Answer 22

Bridges are a good choice for strengthening while minimizing hip adduction. Start with double-leg bridges and progress to single-leg if tolerated.

Question 23

Mid-Stage Exercises – Controlled Squats and Side-Stepping

Answer 23

Once pain decreases, progress to controlled squats (ensuring knees don’t adduct inward) and side-stepping with a resistance band to target gluteal muscles without compressive load.

Question 24

Advanced Stage – Dynamic Loading Exercises

Answer 24

In later stages, incorporate hopping, jumping, and multi-directional movements like side-to-side hops to prepare the tendon for high-impact activities. Gradually reintroduce hip adduction with caution.

Question 25

Avoiding Exercises that Increase Compression

Answer 25

Avoid hip adductor stretches or clam exercises in early rehab, as they place compressive load on the gluteal tendons. Reintroduce these only when tendons are stronger and symptoms have improved.