Differentiating Buttock Pain - Gluteal Tendinopathy
Original Editors - Mariam Hashem
Top Contributors - Mariam Hashem, Kim Jackson, Tarina van der Stockt, Lucinda hampton and Ewa Jaraczewska
Deep Gluteal pain can be a complicated presentation due to the variety of structures that could be involved in the pathology.
Gluteal Tendinopathy as a potential source of deep gluteal pain has been introduced as a concept very recently in the research compared to other structures that can cause gluteal pain such as SIJ and the Lumbar region.
Gluteal Tendinopathy[edit | edit source]
Also known as Greater Trochanteric Pain Syndrome is a pain that starts in the greater trochanter region and may radiate to the lateral thigh and/or leg. Trochanteric Pain primarily is caused by the gluteal tendons and a secondary cause of this pain is the bursal inflammation that used to be thought as the main source of pain. Other structures that could be involved int he pathology are the posterior hip capsule, Gemelli's and the Obturators.
This condition has significant impacts on sleep quality, physical activity, work participation and the quality of life. One study reported the quality of life of Gluteal Tendinopathy patients is equivalent to the severity of a patient waiting for a total hip replacement for severe osteoarthritis of the hip.
The pain of Gluteal Tendon origin can refer to the sacroiliac region, the buttock, the groin and into the anterior thigh. This overlap of referral pattern doesn't help in differentiating other pathologies.
The Visa G questionnaire was validated by Angie Fearon as an outcome measure for disability resulting from lateral hip pain. The questionnaire looks at activities such as lying on the affected side, stairs negotiation and the overall severity of the hip pain.
This condition should be differentiated from Deep Gluteal Pain as this is mainly originated from a structure working on the hip joint (Lateral or groin pain). Patients often may refer to the whole area as hip pain but the reality is that pain could come from a deeper structure in the buttock that is not directly related to the hip.
Gluteal Tendinopathy is more relevant in females over 40 years old. 73% of the patients are believed to be either menopausal or peri-menopausal indicating a link between hormonal changes and tendinopathy. Certain medications are also shown to influence the tendon structural changes such as quinolone antibiotics, oestrogen inhibitors such as Tamoxifen for patients who had breast cancer.
Other factors that were found to affect the presence and prognosis of Tendinopathy are:
- Smoking
- Diabetes
- Steriods
- Changes in load either underload or overload.
A common sign is a reported difficulty in walking after sitting for a period of time. A Patient can describe it as'' hobbling''.
Selection of Exercises[edit | edit source]
Compression forces can aggravate the lateral hip pain. An exercise such as Clam can provoke the tendon pain due to the high compressive force. Similarly, sitting with crossed legs and sleeping on the affected side place the gluteal tendon under a high compression force of Tensor Facia lata.
An important finding is that hip abductor strength wasn't associated with the severity of the tendinopathy. Factors such as greater psychological stress, poorer quality of life, a greater waist girth and a higher BMI were relevant in sever cases. However, these factors might also develop as a result of pain
