Gluteus Medius Syndrome

with Rehab

Gluteus medius syndrome is a condition that causes pain and inflammation on the outer portion of the hip. Gluteus medius syndrome is caused by a muscle tear (strain) in the muscle or tendon in the gluteus medius muscle. The gluteus medius muscle is responsible for moving the thigh away from the other thigh (abducting), as well as stabilizing the hip while walking, running and jumping. Gluteus medius syndrome usually involves a grade 1 or 2 strain of the muscle or tendon. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament due to the ligament being stretched or partially ruptured. With grade 2 strains there is still function, although the function may be decreased.

SYMPTOMS

  • Pain, and often a limp, with walking or running.

  • Tenderness over the outer hip.

  • Pain, tenderness, swelling, warmth, or redness over the outer thigh, often worsened by moving the hip.

  • Often, weakness of the hip.

  • Pain or weakness that gets worse when outwardly moving the thigh.

CAUSES

Gluteus medius syndrome may be caused by either a severe (acute) or ongoing (chronic) injury. These injuries are often due to a sudden increase in the intensity, frequency, or duration of training. Typically, this condition is associated with tilting of the pelvis, with running.

RISK INCREASES WITH:

  • Endurance sports (distance running, triathlons, or race walking), especially running along street curbs and/or banked surfaces. Or if the foot crosses the midline toward the other leg, when running.

  • Poor strength and flexibility.

  • Failure to warm up properly before activity.

  • Legs of unequal length (affects longer leg).

  • Alignment problems of the lower legs, including wide pelvis and excessively knocked knees.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper running technique.

  • Wear shoe lifts (orthotics) if legs are not equal in length.

PROGNOSIS

If treated properly, gluteus medius syndrome usually heals within 2 to 6 weeks.

RELATED COMPLICATIONS

  • Prolonged healing time, if not properly treated, or if not given adequate time to heal.

  • Chronically inflamed tendon, causing persistent pain with activity that may progress to constant pain.

  • Recurring symptoms, if activity is resumed too soon, with overuse, with a direct blow, or if using poor technique.

TREATMENT

Treatment first involves the use of ice and medicine, to help reduce pain and inflammation. It is important to complete strengthening and stretching exercises, as well as modify any activity that aggravates symptoms. These exercises may be completed at home or with a therapist. For people with legs that are unequal in length, a shoe lift (orthotic) may be recommended. Rarely, surgery is needed, and is only considered after more than 6 months of unsuccessful non-surgical treatment.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medications (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be recommended. However, these injections should only be used for serious cases, as they can only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Gluteus Medius Syndrome

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH - Hip Rotators

  • Lie on your back on a firm surface. Grasp your right / left knee with your right / left hand and your ankle with your opposite hand.

  • Keeping your hips and shoulders firmly planted, gently pull your right / left knee, and rotate your lower leg toward your opposite shoulder until you feel a stretch in your buttocks.

  • Hold this stretch for __________ seconds.

Repeat this stretch __________ times. Complete this stretch __________ times per day.

STRETCH – Iliotibial Band

  • On the floor or bed, lie on your side so your right / left leg is on top. Bend your knee and grab your ankle.

  • Slowly bring your knee back, so that your thigh is in line with your trunk. Keep your heel at your buttocks and gently arch your back so your head, shoulders and hips line up.

  • Slowly lower your leg so that your knee approaches the floor or bed, until you feel a gentle stretch on the outside of your right / left thigh. If you do not feel a stretch and your knee will not fall farther, place the heel of your opposite foot on top of your knee and pull your thigh down farther.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete __________ times per day.

STRENGTHENING EXERCISES - Gluteus Medius Syndrome

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Hip Extensors, Bridge

  • Lie on your back on a firm surface. Bend your knees and place your feet flat on the floor.

  • Tighten your buttocks muscles and lift your bottom off the floor, until your trunk is level with your thighs. You should feel the muscles in your buttocks and the back of your thighs working. If you do not feel these muscles, slide your feet 1-2 inches further away from your buttocks.

  • Hold this position for __________ seconds.

  • Slowly lower your hips to the starting position, and allow your buttock muscles to relax completely before beginning the next repetition.

  • If this exercise is too easy, you may cross your arms over your chest.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Straight Leg Raises

Be aware of your form throughout the entire exercise, so that you exercise the correct muscles. Poor form means that you are not strengthening the correct muscles.

  • Lie on your side so that your head, shoulders, knee and hip line up. You may bend your lower knee to help maintain your balance. Your right / left leg should be on top.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Lift your top leg up, 4-6 inches, leading with your heel. Be sure that your foot does not drift forward and that your knee does not roll toward the ceiling.

  • Hold this position for __________ seconds. You should feel the muscles in your outer hip lifting (you may not notice this until your leg begins to tire).

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Quadriped

  • On a firm, lightly padded surface, position yourself on your hands and knees. Your hands should be directly below your shoulders and your knees should be directly below your hips.

  • Keeping your right / left knee bent, lift your leg out to the side. Keep your legs level and in line with your shoulders.

  • Hold for __________ seconds.

  • Keeping your trunk steady and your hips level, slowly lower your leg to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Standing

Be aware of your form throughout the entire exercise, so that you exercise the correct muscles. Poor form means that you are not strengthening the correct muscles.

  • Tie one end of a rubber exercise band or tubing to a secure surface (table, pole) and tie a loop at the other end.

  • Place the loop around your right / left ankle. Turn your body sideways so that your opposite side faces the table or pole and your right / left leg away from the table or pole. Step away from the pole or table, until there is tension in the band.

  • Hold onto a chair, as needed, for balance.

  • Keeping your back upright, your shoulders over your hips, and your toes pointing forward, lift your right / left leg out to your side. Be sure to lift your leg with your hip muscles. Do not "throw" your leg or tip your body to lift your leg.

  • Slowly and with control, return to the starting position.

Repeat exercise __________ times. Complete this exercise __________ times per day.