Gluteal Tendinopathy

Gluteal tendinopathy is a condition where the tendons of the gluteal muscles (gluteus muscles) become overloaded. This often leads to pain on the outside of the hip, a complaint that can significantly impact daily functioning.

The gluteal muscles play a crucial role in stabilising the hip and supporting movements such as stepping and standing. Overloading of the tendons often occurs due to repeated strain without sufficient recovery time, which can lead to pain and restricted movement.

Overloading can be divided into three phases:

• Persistently overloaded tendon: severe damage due to prolonged overload, with scar tissue and an increased risk of tearing. Treatment varies from exercises to possible injections or surgery.
• Reactive tendon: the tendon reacts to sudden strain, becoming thicker and painful. Temporarily reducing the causative strain can help here.
• Altered tendon structure: the tendon changes due to sustained strain, remaining thick. Temporarily reducing the causative strain in combination with appropriate exercise therapy can help here.

How does gluteal tendinopathy develop?

Gluteal tendinopathy usually develops slowly and is a typical consequence of an imbalance between the load and the tendon's capacity. When the load exceeds the tendon's capacity, the risk of overload and injury increases.

With repeated loading of the gluteal tendons, pressure accumulates. The tendon tries to adapt to this, but this only succeeds if the tissue is strong enough and has sufficient time to recover. If one of these conditions is lacking, the body reacts with an inflammatory response in the tendon. This reaction is a warning that the tendon is overloaded.

Through this approach, the tendon can recover, and the chance of recurring complaints is significantly reduced. It is important to take the body's signals seriously and to support the recovery process step-by-step.

The load is not the only factor that can cause tendon overload. The following should also be considered:

• Age: as we age, the quality of tendon tissue decreases.
• Gender: women are more often affected by overload of the tendons of the lateral gluteal muscles.
• Hormonal: tendons have receptor cells for sex hormones. A change in hormonal balance can influence tendon tissue.
• Weight: extra weight can place more strain on the tendons.
• Emotions and stress: chronic stress can lead to increased muscle tension, which can increase the load on the tendons.
• Gait pattern and posture: certain postures and characteristics of your gait pattern can increase the load on the tendons. The overuse injury can thus be perpetuated.

Research shows that approximately 23.5% of women between 50 and 79 years old suffer from overload of the lateral gluteal muscles. This may partly be related to menopause, a phase in women's lives that often begins between 45 and 55 years of age.

During menopause and the period leading up to it, perimenopause, women experience a change in their sex hormones. Before menopause, women produce oestrogen and progesterone, hormones that help to inhibit inflammation and keep tendons healthy. The tendons of the lateral gluteal muscles have receptors for oestrogen. This makes these tendons extra sensitive to hormonal changes. The reduced production of oestrogen during this phase can cause the tendons to become less resilient and therefore more prone to inflammation or pain. In these transitional periods, the capacity of the lateral gluteal muscles is therefore somewhat lower. This means that women in menopause may experience tendon problems more quickly.

Men can also experience overload of the lateral gluteal muscles. In them, hormonal factors will play a smaller role.

In addition, stress and emotions can have a major influence on tendon overload. Chronic stress can lead to increased muscle tension, which can increase the load on the gluteal tendons. Stress and negative emotions can also slow down the recovery from tendon problems due to their influence on the immune system and overall health. Addressing stress and emotional well-being is therefore an important part of treating tendon overload.

Pain usually begins on the side of your upper thigh, but can also radiate to the knee, or upwards to the buttock and lower back. You may also feel stiffness after prolonged sitting, or a sensation of your leg giving way when standing on it.

With gluteal tendinopathy, discomfort is often experienced during activities such as:

• Walking, hiking, climbing stairs
• Lying on the affected side
• Prolonged sitting
• Start-up pain (the first steps after prolonged sitting)

Treatment for gluteal tendinopathy may include the following elements:

• Adjusting load and lifestyle
• Specific exercise therapy
• Injection
• If symptoms persist, there may be an underlying tear. This can be treated surgically with a gluteus medius repair.

We will discuss with you which treatment option is most suitable based on your specific situation and needs.