What is Gluteal Tendinopathy/GTPS?
Gluteal tendinopathy/GTPS is an injury to one or all of the gluteal or buttock tendons in isolation,
characterised by the gluteal muscles’ pain and dysfunction. Gluteal tendinopathy can also be
associated with trochanteric bursitis.
Your gluteal muscles are a group of three muscles which make up the buttocks: the gluteus
maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium (pelvic
bone) and sacrum (big bone at the bottom of your back just above your tail bone/coccyx), and
insert on the femur (thigh bone), and are responsible for hip movement and supporting the body
in weight-bearing (running and walking).
What Causes a Gluteal Tendinopathy/GTPS?
The most common cause of gluteal tendinopathy is reduced hip and gluteal muscle strength and
control, leading to increased load on the gluteal tendons. The result is pain and further muscle
weakness, resulting in hip-pelvis instability, which further perpetuates the cycle.
Hip instability can cause you to walk or run with poor control, which may increase the
compressive load to your trochanteric (hip) bursa. This bursa pressure raises your risk of
developing concomitant trochanteric bursitis.
Risk Factors for developing Gluteal Tendinopathy/GTPS
- Back pain
- Reduced angle of your hip joint to your thigh bone
What are the Symptoms of Gluteal Tendinopathy?
- Pain at the side of your hip and thigh
- Difficulty going up and down the stairs
- Difficulty/inability to sleep on your affected side
- Discomfort with any activity that involves standing on the affected leg
How is a Gluteal Tendinopathy Diagnosed?
Gluteal tendinopathy can be diagnosed clinically by your Physiotherapist, based upon presenting
signs and symptoms, clinical history, and pain response to loading tests. In most cases, you will
not require diagnostic imaging.
How common is GTPS?
- 1.8 patients per 1000 per year
- 23.5% in women at risk of knee osteoarthritis
- 5.4% in recipients of kidney transplants
It is often misdiagnosed so it likely to be more common than reported
What Causes Gluteal Tendinopathy?
The gluteal tendons’ role is to transfer the gluteal muscle forces to the hip and pelvis for everyday
movement and activity. Your tendons withstand repetitive loading. However, once the tendon
becomes painful, the more times you are required to perform the provoking action, the tendon’s
ability to cope decreases. The tendon’s efficiency is impaired and causes micro stresses in the
tendon in an attempt to make the tendon stronger. When this process occurs, the tendon can
recover if managed appropriately.
When accumulated tendon loads exceed the repair rate, this process is progressive and causes
pain and dysfunction. The result is gluteal tendinopathy.
Tips for reducing your hip pain:
- Stay active within your pain limits.
- Use ice/your usual pain meds for pain relief.
- Avoid going up or down stairs, use a lift where possible.
- Do not stand unevenly on both legs.
- Do not stand pigeon toed or favour one leg by ‘hanging on one hip’.
- Do sit with your feet shoulder width apart and ensure that your hips are
always higher than your knees when sitting in a chair. Sitting on a towel
or cushion can be helpful to bring your hips higher than your knees.
- Avoid sitting in low sofas and car seats, which generally slope backwards.
- Do not cross your legs at the knees when sitting.
- Do not sit with the feet wide apart and knees together.
- Do sleep on your back with a pillow under your knees.
- Try to avoid sleeping on your side, but, if you are unable to sleep in any other position, try: sleeping on an eggshell mattress overlay on your bed, positioning pillow/s between your knees and ankles so that your legs are approximately shoulder width apart.
Therapeutic Exercises for GTPS
Based on your physiotherapy assessment you will be given appropriate exercises to start to improve the ability of your gluteal tendons to bear load in a progressive manner. Strength of the thigh and calf muscles will also be addressed as appropriate.
I use other therapies in adjunct to these therapeutic exercises and educational advice on how to manage your pain. Therapies such as Strain/Counterstrain and or Dry Needling can be very helpful in addressing tender and painful and trigger points or taut bands within the gluteal and other buttock/hip muscles.
Myofascial release can be very effective in helping normal friction free movement and pliability of the affected muscles, tendons and joints.