From the Guidelines
Gluteal tendinopathy should be managed with a combination of relative rest, eccentric strengthening, and pain management using NSAIDs, as these approaches have been shown to promote healing and pain relief 1.
Treatment Approach
The treatment of gluteal tendinopathy involves a multifaceted approach that prioritizes reducing tendon loading and promoting healing. This includes:
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
- Eccentric strengthening, which is an effective treatment that may reverse degenerative changes 1
- Pain management using NSAIDs, which are recommended for short-term pain relief, although they have no effect on long-term outcomes 1
Pain Management
Pain management is a critical component of treating gluteal tendinopathy. Options include:
- NSAIDs, such as ibuprofen or naproxen, for short-term pain relief 1
- Topical NSAIDs, which may have fewer systemic side effects, although it is unclear whether they are better than other analgesics 1
- Locally injected corticosteroids, which may be more effective than oral NSAIDs in acute-phase pain relief, but do not alter long-term outcomes 1
Surgical Intervention
Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1. Surgical techniques vary by tendinopathy location but typically include excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis 1.
Additional Considerations
Other treatments, such as therapeutic ultrasonography, corticosteroid iontophoresis, and phonophoresis, are of uncertain benefit for tendinopathy 1. Extracorporeal shock wave therapy appears to be a safe, noninvasive, effective, but expensive means of pain relief for chronic tendinopathies 1.
From the Research
Definition and Prevalence of Gluteal Tendinopathy
- Gluteal tendinopathy, also known as greater trochanteric pain syndrome, is a common cause of lateral hip pain, affecting 1 in 4 women older than 50 years and individuals within their fifth and sixth decades of life, regardless of activity level 2.
- The condition is believed to originate from age-related degenerative changes about the hip abductor tendon insertions and the surrounding bursae, and is exacerbated by congenital and acquired abnormal hip biomechanics 2.
Risk Factors and Demographics
- Females are more commonly affected than males, with a female to male ratio of 7:1 3 and 9:1 4.
- The mean age of affected individuals is around 53.7 years, with a range of 17-88 years 3.
- The condition can occur in both athletes and non-athletes, and is not limited to individuals with a specific activity level 5.
Clinical Presentation and Diagnosis
- Gluteal tendinopathy presents with lateral hip pain, which can be debilitating and interfere with sleep and common weight-bearing tasks 5.
- The diagnosis is often made clinically, with radiological confirmation using magnetic resonance imaging (MRI) 3.
- There is a lack of consensus on the best clinical examination tests for diagnosing gluteal tendinopathy, but a combination of provocative compressive and tensile loads is currently recommended 5.
Treatment Options
- Treatment of gluteal tendinopathy often begins with non-invasive, non-operative modalities such as activity modifications, nonsteroidal anti-inflammatory drugs, and physical therapy 2.
- Platelet-rich plasma (PRP) injections have shown good evidence for use in grades 1 and 2 tendinopathy, with improved outcomes compared to corticosteroid injections 3, 4.
- Shockwave therapy, exercise, and corticosteroids have also shown good outcomes, but the effect of corticosteroids is often short-term 3.
- Surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair may be considered for recalcitrant cases or more severe tendinopathy 3.
Contemporary Management
- Contemporary management of gluteal tendinopathy takes an active approach, empowering the individual to manage their own condition through education, load management, progressive exercise, and optimization of their general health 6.
- This approach refutes traditional beliefs that focused on anti-inflammatory treatments, including rest and corticosteroid injections as first-line management for trochanteric pain 6.