Gluteal tendinopathy (GT) is a painful hip condition negatively affecting physical activity, work participation and quality of life. Far more common in women than in men, it has a prevalence rate between 2.9 and 4.2 per 1000 people. The condition is complex to diagnose and is often associated with comorbidities of the lower limb and back. It is considered to be a key contributor to greater trochanteric pain syndrome. The burden of GT tends to increase with age and is associated with anxiety and depression.

Symptoms of GT include persistent lateral hip pain over the greater trochanter, radiating down the lateral side of the thigh, with pain occurring during or after loading activities including standing, walking, running, navigating stairs, sitting and rising from sitting. Patients report difficulty sleeping or lying on both the affected and unaffected sides. Common comorbidities include low back pain; groin, buttock or anterior thigh pain; hip osteoarthritis; lower limb injuries; inflammatory disease; and being overweight or obese, resulting in the need for a careful and thorough examination including functional activity assessments and consideration of comorbidities.

In her Journal of Physiotherapy Invited Topical Review, Angela Fearon outlines both non-physiotherapy and physiotherapy interventions for GT. The former includes corticosteroid injections, platelet-rich plasma treatments and surgical approaches such as bursectomy and tendon repairs. Physiotherapy interventions discussed include exercise, education, manual therapy, taping and other adjunct therapies such as shockwave therapy, ultrasound, dry needling and orthotics. Of these interventions, exercise and education have been shown to have the most benefit, while corticosteroid injections provide only short-term pain relief. Other interventions showing some evidence of benefit include shockwave therapy as an adjunct to exercise and taping. No preventive studies were identified.

Angela notes that since 2017, there has been an improvement in the quality of research into GT treatments and interventions but suggests that more large, high-quality trials are needed to provide confidence in the evidence and that patient-reported outcome measures need to be validated. She says that the highest priorities include identifying appropriate education content and delivery strategies along with exercises, in patients with and without comorbidities. Other areas for research include generating better evidence on taping and other alternatives to corticosteroid injections and understanding the relationship between GT and hip osteoarthritis.

For more information and to read the entire article, see Invited Topical Review.

This blog is a Physiotherapy Research Foundation (PRF) initiative.

Dr Angela Fearon is a research and clinical physiotherapist and an associate professor at the University of Canberra, where she teaches entry-level physiotherapists and undertakes clinical research. Angela s primary area of research is the assessment and management of hip pain.