A Patient’s guide to Gluteal Tendinopathy

GTPS is an umbrella term for pain over the outer side of the hip related to changes in the gluteal tendons or to the hip bursae.

The gluteal tendons attach the gluteal muscles to the outer side of the hip. Changes to the gluteal tendons causing pain and weakness is called Gluteal Tendinopathy.

The bursa is a fluid filled sack that reduces the friction between the tendons and the bones. If there is an increase in the fluid in the bursa this is termed Trochanteric Bursitis.

Gluteal Tendinopathy is a common tendinopathy affecting the lower limbs. It is more common in females than males, with a ratio of 3:1, peaking in the peri-menopausal period, 40-60 years.

The reason for Gluteal Tendinopathy is still being explored, but it is usually associated with weakening of the gluteal muscles and moving in ways that increase the load and compression on the gluteal tendons.

Tendons need load to maintain their health. However, too much load or a sudden increase in loading to the tendons, which the tendon is not regularly used to, can aggravate the tendons. Similarly, too little load can also affect tendon health.

Other contributing factors for Gluteal Tendinopathy include: high cholesterol, diabetes, increased weight around the stomach area, previous use of fluoroquinolone antibiotics, genetic factors, age, hormones, vascular issues and other hip or spinal pathology.

Symptoms from Gluteal tendinopathy and Trochanteric bursitis can significantly impact on sleep and quality of life.

Symptoms usually include:

• Tenderness on touching the outer hip bone
• Pain lying on the side
• Pain on rising from a chair
• Pain on walking, particularly up hills or stairs
• Pain on rising from a chair, especially on the first few steps
• Pain on standing on one leg, for example when dressing the lower half

Recent evidence supports that the best first line treatment for tendinopathy is physiotherapy.

Treatment consists of two main parts:

1. Activity modifications to manage the load to the gluteal tendons and reduce compressive forces to the tendon.
2. An exercise programme, tailored to improve the control and strength of the muscles around the hips and pelvis.

Recent evidence supports that the best treatment for tendinopathy is physiotherapy. Your therapist will do a detailed assessment of your hip and also assess your postural and movement habits. Treatment then consists of two main parts:

1. Activity modifications over the 24 hour period to reduce the compression of the gluteal tendons
2. An exercise programme, tailored to improve the control, recruitment and capacity of the muscles around the hips and pelvis

Due to the multi-factorial nature of this problem your physiotherapist may also discuss weight management and diet if this is appropriate.

Your physiotherapist will guide you regarding work and leisure activities. If your pain is very severe you may need to reduce or modify these initially.

Your physiotherapist will guide you regarding work and leisure activities. If your pain is very severe you may need to reduce or modify these initially.

Due to the multi-factorial nature of this problem, your therapist may also discuss weight management, smoking cessation and diet if this is appropriate.

For further information, please see the NHS website ‘Live Well’ pages.

Understanding what positions aggravate your problem can significantly help manage your symptoms.

Activity Modifications

Sitting

• Minimise the time spent crossing your ankles or legs
• Reduce the time spent sitting on low chairs. When you sit aim to sit with the hips higher than the knees, using a wedge cushion may help this

Sleeping

• If you prefer to sleep on your side avoid sleeping on the sore hip and put a pillow between your knees
• Another sleeping position that can be helpful is semi prone (halfway between lying on your tummy and your side- to avoid direct compression on the affected hip). Again, pillows need to be used to support the top leg and in front of the trunk to avoid rolling fully onto your tummy and the underside hip can be straightened
• If both hips are painful, an option is sleeping on your back with pillows under your knees
• An eggshell mattress topper can be helpful as it reduces the amount of compression through the hips

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Functional movements

• When standing, try and keep the weight equal between both feet
• Minimise walking on hills and stairs where possible
• When using the stairs, hold onto the rail and walk with your feet a little wider

Your physiotherapist will advise you of activity modifications, to reduce the compression on the gluteal tendons, that are specific to your needs.

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Each patient with Gluteal Tendinopathy is individual. In order to ensure that your symptoms are appropriately managed your physiotherapist will tailor an exercise programme specific to your functional ability and to ensure adequate loading to improve the strength of the muscles around the hips and pelvis.

Gluteal Tendinopathy symptoms can improve over several months with exercise and modification of irritable positions.

There are other treatment options for those who do not respond initially to an exercise programme and activity modifications.

These include:

Shockwave therapy

Shockwave therapy can be used with growing evidence in this area. It must always be delivered alongside a physiotherapy directed exercise programme.

Injections

Corticosteroid injection (CSI) can be used to help with gluteal tendinopathy symptoms with evidence showing short-term effect on symptoms.

Plasma injections (PRP) are another treatment option for gluteal tendinopathy symptoms with evidence showing some benefit to symptoms.

Surgery

Surgery can be a considered option for those who have tendon tears and who have not responded well to physiotherapy and an exercise programme. Surgery is not necessary for all tendon tears and many individuals with tendon tears can achieve full, pain free function. Surgery is only a considered option in a very small number of cases.

The Physiotherapy Department: 020 8909 5820