From the Guidelines
The treatment for insertional gluteal tendinopathy with an intrasubstance tear typically begins with conservative management for 3-6 months, focusing on relative rest, activity modification, and physical therapy with progressive loading exercises. This approach is based on the principle of reducing further damage and promoting healing and pain relief, as suggested by the evidence 1. The key components of conservative management include:
- Relative rest with activity modification to avoid painful activities like prolonged sitting, climbing stairs, and running, as recommended by 1
- Physical therapy focusing on progressive loading exercises for the gluteal muscles, typically 2-3 sessions per week for 6-12 weeks
- Pain management may include NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation, as supported by the evidence 1
- Corticosteroid injections are generally avoided as they may weaken the tendon further, as cautioned by 1
- Extracorporeal shockwave therapy (ESWT) may be beneficial, typically administered once weekly for 3-5 sessions, as suggested by 1 For cases not responding to conservative treatment after 6 months, platelet-rich plasma (PRP) injections might be considered, though evidence is still emerging. Surgical intervention, including endoscopic or open debridement and repair, is reserved for cases failing 6-12 months of conservative management, as recommended by 1. This stepped approach is recommended because gluteal tendons have relatively poor blood supply, especially at the insertion point, which slows healing, and progressive loading through physical therapy helps stimulate collagen remodeling and strengthen the tendon while maintaining function. The use of orthotics and braces may be considered based on clinical experience and patient preference, as noted by 1. Overall, the goal of treatment is to promote healing, reduce pain, and improve function, while minimizing the risk of further damage or complications.
From the Research
Treatment Options for Insertional Gluteal Tendinopathy with Intrasubstance Tear
- The treatment for insertional gluteal tendinopathy with an intrasubstance tear in gluteal tendons can involve various approaches, including:
- Platelet-rich plasma (PRP) injections: Studies have shown that PRP injections can be an effective treatment option for gluteal tendinopathy, with significant improvements in pain and function 2, 3.
- Exercise and education: Exercise and education can be cautiously recommended as the core approach for pain management and function, potentially supplemented by other treatments 4.
- Corticosteroid injection: Corticosteroid injection has moderate strength evidence of a small effect on pain in the short term, but its effect is short-lived 4.
- Shockwave therapy: Focused shockwave therapy (f-ESWT) demonstrates superiority in the long term compared to corticosteroid injection for pain 4.
- Surgical procedures: Surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair may be considered for grades 1 and 2 tendinopathy, while surgical repair for grades 3 (partial-thickness tears) and 4 (full-thickness tears) tendinopathy has low-level evidence 5.
Stage-Adjusted Treatment Recommendation
- The treatment approach may vary depending on the stage of gluteal tendinopathy:
- Grades 1 and 2 tendinopathy: Platelet-rich plasma, shockwave therapy, exercise, and corticosteroids may be effective treatment options.
- Grades 3 (partial-thickness tears) and 4 (full-thickness tears) tendinopathy: Surgical repair may be considered, but the evidence is limited.
Considerations for Treatment
- The treatment approach should be individualized based on the patient's specific condition, symptoms, and response to treatment.
- A comprehensive treatment plan may involve a combination of non-surgical and surgical interventions, as well as education and exercise to manage the condition and prevent further injury 6, 5.