Hip Pain: Is Gluteal Tendinopathy the Cause?

At a certain age, most of us have felt a twinge in one hip or the other. If you’re wondering whether a hip replacement is in your future, think again. The pain may actually be from a very common problem that typically doesn’t require surgery ― gluteal tendinopathy.

“Patients usually have moderate to severe pain at the outside of the hip that worsens over time. It can sometimes radiate from the hip to the knee and it can significantly impact a person’s life, making it difficult to walk or even sleep,” says Michael Yurubi, D.O., a board-certified family medicine and sports medicine physician with Baptist Health Orthopedic Care.

Michael Yurubi, D.O., a board-certified family medicine and sports medicine physician with Baptist Health Orthopedic Care.

 

The gluteal muscles are a group of large and strong muscles in the hip and buttock and, together with the tendons that connect them to bones, they help us stand, walk, run and move. When tendons in the area are aggravated, compressed or suffer numerous micro-tears, they can start to deteriorate, causing debilitating pain.

Anyone can develop gluteal tendinopathy, but it is more common in women over age 40 and in those who overuse the tendons (such as runners or people who increase their physical activity too quickly). In addition, those who are sedentary or obese are also more prone to gluteal tendinopathy.

Signs of Gluteal Tendinopathy

The most common symptom of gluteal tendinopathy, says Dr. Yurubi, is pain at the side of the hip closest to the top of the thigh bone. The area may be tender and the pain may run down to the knee.

Other signs include pain that worsens when you:

• First get out of bed in the morning
• Climb stairs
• Lie on the affected side
• Cross your legs when you sit or sit for an extended period
• Stand on one leg

Some patients also experience pain in the lower back or groin. Because there are many reasons for hip pain, it’s important to stop any activities that are increasing your pain and get to a physician, Dr. Yurubi stresses.

Treatment Options

“The good news is that 90 percent of patients respond to conservative treatment, and many see improvement at six to eight weeks after starting physical therapy,” Dr. Yurubi says. With no treatment, gluteal tendinopathy can resolve on its own, but it can take up to a year for symptoms to improve.

Doctors look at the severity of the problem, including the degree of any tears in the tendons, to determine what treatment is best. Among the conservative treatments for gluteal tendinopathy are physical therapy, exercise, injections and shock wave therapy.

Platelet-rich plasma (PRP) injections have a high rate of success, particularly for patients with mild to moderate gluteal tendinopathy, says Dr. Yurubi. The procedure involves drawing blood and spinning it to extract the concentrated platelets. To ensure the platelets are injected precisely into the injured area, physicians typically use ultrasound guidance.

"Platelets help with healing. The whole procedure may take up to 20 minutes," he says. "And there are no contraindications with repeating the procedure multiple times."

For patients with more severe tendinopathy, surgery may be recommended. It may be performed as an open procedure or endoscopically, which is less invasive.

Lowering Your Risk

While it’s impossible to predict who will get gluteal tendinopathy, there are some things people can do to lessen the chance. These include:

• Staying physically active while paying attention to your body and modifying or taking a break from any activity that irritates the hips
• Losing weight and maintaining a healthy weight
• Avoiding repetitive activities that put increased pressure on the hips
• Lifting weights to strengthen the gluteal muscles
• Stretching, particularly using exercises that keep the hip muscles flexible
• Practicing good posture and treating lower back pain

“We understand how excruciating and debilitating this can be,” Dr. Yurubi says. “It’s important for people to understand that if they have hip pain, they shouldn’t ignore it. We have all of the specialists here and we can help. These issues should be medically evaluated."