Gluteus medius tendonitis: symptoms and treatment (complete guide)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

The hip pain are quite common in both men and women. The causes are variable and multiple, and include the gluteus medius tendonitis. What is this pathology? What is it due to? What are his symptoms ? What treatments are recommended? This article will allow you toLearn more about gluteus medius tendonitis.

What is gluteus medius tendonitis?

In medical terms, tendinitis is defined by theinflammation of a tendon. A gluteus medius tendonitis is therefore the attack of the tendon of the gluteus medius. It happens that inflammation of the tendon of the small gluteus muscle occurs at the same time.

Remember that a tendon is a structure that allows the attachment of the bone to a muscle. In this pathology, the affected muscle is the one that provides walking, for the most part. This muscle allows the unipodal station by exerting a significant force on the pelvis. The gluteus medius muscle or gluteal medium is located in the outer part of the hip. It is inserted over the iliac bone and over the greater trochanter. This is located at the top of the femur.

What causes gluteus medius tendonitis?

The causes of this condition are often unknown. However, we observe more gluteus medius tendonitis in athletes. Runners of marathons and various jumps are the most affected. The latter are often in monopodal support. The following sports may be involved:

• Ski ;
• Rollerblading ;
• Figure skating ;
• Martial arts.

This also suggests an origin linked to repetitive strain injuries. Overexertion can cause gluteus medius tendonitis.

It is reported that the number of women with gluteus medius tendonitis is higher, compared to men. This is explained by the woman's pelvis which is wider. Constraints at the gluteal level are increased.

Fluoroquinolones (a family of antibiotics) promote tendon ruptures. Surgical treatment, with nail or screw placement, may also cause pain. This is explained by a conflict between the gluteal muscles and the osteosynthesis material.

In addition, various infections are risk factors for gluteus medius tendonitis:

• A scleroderma (a dermatological pathology);
• Diabetes;
• A drop ;
• A rheumatoid arthritis: an autoimmune pathology;
• Gonococcal infection.

We must not forget that age influences tendon structures. Also, gluteus medius tendonitis is more likely to appear when the person is a smoker or obese.

What are the symptoms ?

The symptoms of gluteus medius tendonitis boil down to pain when the gluteus medius muscle is used. This pain can be located in different areas:

• on the hip;
• on the outer side of the hip: both sides may be painful;
• on the back of the buttocks.

The pain may radiate to the outer part of the thigh, and even to the foot.

Also, the triggers of pain are:

• climbing stairs;
• the race;
• standing: especially when it is prolonged;
• an inappropriate position at the office.

The journey of pain reminds us of a sciatica. However, it is different from sciatica by its origin. Sciatica is often the manifestation of a herniated disc. Thus, the source of the trouble comes from a lumbar problem and not a tendon.

Gluteus medius tendonitis can lead to lameness. This is the case when the pain becomes permanent, monopodal support being painful.

Le diagnosis of gluteus medius tendonitis is made following a clinical examination. The doctor will palpate the tendon and trigger a characteristic pain. We are talking about exquisite pain. He may also ask you to stand on the painful leg. This position will awaken the same pain.

There are a few maneuvers that can also cause this pain. This is a counter-resistance movement made by the examiner. Moreover, any passive mobilization at the level of the hip also arouses pain. It can for example be:

• a bending;
• external rotation;
• or an abduction.

Other paraclinical examinations are often prescribed in case of doubt:

• an X-ray: of the pelvis and hip, in front and profile view;
• an ultrasound;
• an MRI.

They make it possible to specify the attack and to appreciate the signs of complications. They are also intended to rule out other differential diagnoses.

What are the treatments for gluteus medius tendonitis?

Rest is recommended in case of severe pain. However, absolute rest is not recommended. Improving the strength and flexibility of the gluteal muscles is possible, but it must be done gradually. The more the injured tendon is used, the more the pain will be unbearable.

What exercises can be done in case of gluteus medius tendonitis?

In the acute phase, gentle stretching and isometric contractions are the most suitable. Once the pain becomes bearable, the duration and intensity of the exercises can be increased until a return to normal activities. It is important to control pain throughout the process to avoid inflammatory reactivation.

Some sports can be done, especially when the pain has subsided. Prefer the different discharge sports, as they are adaptable to the intensity of your pain. The goal is to maintain physical activity. You have the choice between cycling or swimming, among others. They put less strain on your gluteus medius muscles.

What is the place of physiotherapy and osteopathy?

Le physiotherapist contributes to pain relief. To do this, he can opt for massages directly on the tendon. We are talking about deep transverse massages. Electrotherapy treatments, although they do not demonstrate convincing efficacy in scientific studies, can be used to speed up recovery.

After the treatment sessions, the physiotherapist will typically suggest exercises to stabilize your pelvis, strengthen the muscles around the hip, stretch stiff structures, etc. This rehabilitation will help you resume your activities without pain, and reduce the risk of recurrence.

As for theosteopathy, it aims to find the causes of tendonitis within the different systems of the human body, such as:

• An influence of the sympathetic, parasympathetic system or of the various organs
• Muscle or joint imbalance
• muscle tension
• Etc

Adjuvant measures are undertaken according to the etiology found. 

Tools and accessories

In addition to the treatments mentioned above, there are several products and accessories available on the market to relieve the symptoms related to gluteus medius tendonitis. It should be remembered that these tools generally provide temporary relief, and should be used sparingly. Among the products recommended by our professionals, we have:

• acupressure mat

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• massage gun

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• Foam roller (sport massage roller)

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• Compex

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Infiltration to relieve gluteus medius tendonitis

When the usual analgesics are ineffective against tendonitis, doctors resort to anti-inflammatories. In case of failure, local drug infiltration is possible. Cortisone is mainly used, combined with other anti-inflammatories. It considerably reduces the pain ofgluteus medius tendonitis. Infiltrations are effective, but they must be performed several times.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

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• Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

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• Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 

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• Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

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• wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

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Other treatments

As a last resort, doctors can turn to surgery to treat gluteus medius tendonitis. It is considered when the tendon is provided with calcifications. These can lead to disinsertion of the bone. Surgical treatment is performed arthroscopically. The goal is to remove the calcifications. If the tendon is torn, surgery can reinsert it. Inflammatory areas will be cleaned at the same time.

How to sleep with gluteus medius tendonitis?

It is easy to conceive that if our buttock pain make us suffer at night, our quality of sleep will inevitably be affected. That's why it's important to find a comfortable sleeping position that can optimize your sleep and reduce stress on the buttock area.

In the presence of tendonitis of the gluteus medius, I often recommend that my clients adopt one of the following positions to see if there is a beneficial effect on the level of symptoms.

Lying on your side with a pillow between your legs

Keeping a pillow between the legs allows for a reduction in hip adduction movement. This is more comfortable for many people with buttock pain, because the tensioning of the gluteal muscles is reduced.

For added comfort, many of my patients opt for a knee pillow such as thereof from the French brand Cervi-care.

3. Lying on your stomach

If you are used to sleeping on your stomach, this position can avoid pressure on the gluteal region, especially if the latter is painful on palpation. A pillow placed under the belly can also improve comfort.

Consult the products of Cervi-Care if you are looking for a orthopedic, ergonomic or shape memory pillow to reduce stress on the cervical region.

References

• https://www.im2s.mc/tendinopathies-des-muscles-fessiers/#
• https://www.deuxiemeavis.fr/pathologie/tendinite-du-moyen-fessier
• https://www.reflexosteo.com/blog-sante-bien-etre/tendinite-du-moyen-fessier-symptomes-traitements-sport-et-osteopathie-481
• https://www.dr-francois-fr/les-tendinites-des-fessiers/
• Tendinitis and tenosynovid: MSD MANUALS app