Gluteus Medius Tendinitis

• A sudden fall onto the hip.
• Repetitive or overuse activities, prolonged sitting or certain sporting activities.
• It is common in middle aged women who suddenly increased their activity level such as participating in an aggressive walking or running program.
• Weakness of the gluteus medius muscle is secondary to another hip or leg injury.

• Pain along the lateral hip with standing, walking, going up or down stairs and getting out of a chair.
• Pain on palpation of the gluteus medius muscle.
• Weakness of the gluteus medius or when abducting the hip
• A visible limp or antalgic gait (trendelenberg) a perceivable change in walking pattern when weight bearing on the affected side of the hip.

Treatment of gluteus medius tendinitis will depend on the severity of the condition. When treating acute gluteus medius tendinitis the principles of RICE (rest, ice, compression and elevation) should be initiated.

• Rest: avoid the activities that produce the pain (jumping, running, going up or down stairs, kneeling and squatting.)
• Ice: apply ice to the tendon or area of inflammation. It is one of the fastest ways to reduce swelling, pain and inflammation. Apply it right away and then at intervals for about 20 minutes at a time. Do not apply ice directly to the skin.
• Compression: such as an ace bandage to help take stress off the injured muscle may be useful. When using ice, apply light compression. This is especially helpful if swelling is present.
• Elevation: elevate the area to help reduce swelling.
• Crutches for ambulation or moving around may be necessary in the case of ruptures or significant injuries of the rectus, hamstrings or adductors.

Mild

In mild cases rest, ice and medication may be enough to reduce the pain. Once the pain is reduced, physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent reoccurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.

Moderate to Severe

If the problem persists, consulting with your health care provider should be the next step. Your physician and/or physical therapist will perform a thorough evaluation to determine what tendon(s) is involved, the severity of the condition, and the best course of treatment.

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Your physical therapist will perform a thorough evaluation to assess and determine the following:

• Tendon: a series of tests will be performed to determine which tendon is involved.
• Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances
• Flexibility: tight muscles can contribute to poor mechanics and weakness creating imbalances and making the hip more susceptible to tendinitis.
• Technique: Often it is the way we perform motions (run, jump, cycle or row) that may cause a problem. Discuss and observe the activities you participate in, that may have started the problem to improve technique.
• Training: review your training program and any sudden changes that may have precipitated or caused the present condition.
• Alignment or footwear: a physical therapist will assess your leg lengths, foot mechanics and alignment to see if there are any imbalances. Checking for appropriate footwear is a crucial part of balancing the stresses applied to your legs and body.

Physical therapy for gluteus medius tendinitis must remain conservative at the onset to avoid aggravating the condition. Emphasis will be on rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has been reduced, a program of stretching and strengthening will be initiated to restore flexibility to the muscles involved and improve strength to reduce stress on the tendons and the hip. Taping or strapping to rest and reduce the stress placed on the tendon and promote healing may be necessary. Your therapist is trained in these specific taping techniques.

Common Physical Therapy interventions in the treatment of Gluteus Medius Tendinitis include:

• Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the knee and hip. Use of mobilization techniques also help to modulate pain.
• Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the knee and lower extremity to support, stabilize and decrease the stresses place on the bursa and tendons of the hip joint.
• Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, kneeling, squatting and jumping) of the involved lower extremity to reduce stress on the bursa and tendons in daily activities. Taping, strapping or bracing may be useful to rest the tendon and promote healing.
• Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the involved tendon and bursa.
• A home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Avoiding the activities that produce the pain or stress the involved tendon is the first line of treatment.

• RICE: Rest, Ice, Compression Elevation should be used to reduce the stress on the bursa.
• NSAIDS (Non steroidal anti-inflammatory drugs) to reduce pain and inflammation.
• Injection of steroids may be necessary to reduce inflammation of the involved tendon
• Immobilization, strapping or bracing may be beneficial to rest the tendon and promote healing.