Pain in the gluteus medius is a common problem in both athletes and people who do little physical exercise, which is often underdiagnosed.
Symptoms of gluteus medius syndrome
Gluteus medius syndrome causes pain that starts in the buttocks and spreads down the thigh to pain behind the knee. This myofascial pain is related to trigger points, which are very irritable and palpable points in the muscle that generate pain when compressed.
They can be confused with sciatica. However, when it is a pathology of the gluteus medius, the pain does not reach the foot and there are no alterations in strength and sensitivity, as in sciatica.
What are the causes of gluteal pain?
The causes of this pathology are usually related to the overload or deficit in the muscles of the gluteal area.
- Piriformis syndrome: it is caused by the pinching of the sciatic nerve with the contracted piriformis muscle. If the piriformis injury is the cause of the pain, it is possible to feel discomfort and tingling in the buttock and in the area of innervation of the sciatic nerve.
- Trochanteric bursitis: it is the inflammation of the bursa that covers the lateral part of the femur bone. Trochanteritis causes discomfort when walking, when turning the leg and if you sleep on the side of the inflammation.
- Herniated disc: generates pain in the lumbar area and alterations in sensitivity, which extend along the entire nerve, passing through the buttock until reaching the calf.
- Different leg length: when one leg is longer than the other, it is possible that when walking the longer leg “trips” on the ground. This situation, almost imperceptible, can cause gluteal overload and its corresponding pain.
- Osteoarthritis of the hip: can cause pain in the buttock, although it is more common to notice discomfort in the hip and groin area.
- Trauma: a strong blow to the buttock or repeated microtrauma from certain impact sports can inflame the gluteus medius, also causing buttock pain.
How is gluteus medius syndrome diagnosed?
The pain generated by gluteus medius syndrome can have different origins and to diagnose whether it is a gluteus medius problem, an examination must be performed.
During the clinical diagnosis, the orthopedic surgeon always asks the patient how he/she feels and what symptoms he/she has, as this is the best way to determine the origin of the gluteus medius pain. In fact, imaging tests (ultrasound or magnetic resonance imaging) cannot reveal any alteration, unless it is in advanced stages.
Even so, imaging tests are useful to rule out other diagnoses which, because they are so similar, can be confused, since they also generate internal gluteal pain, such as pyramidal syndrome.
How do we treat gluteus medius pain?
We always start with conservative, non-invasive treatments that can be developed with the help of a physical therapist.
If the patient is in an acute phase and the pain does not allow him/her to rest, he/she can take anti-inflammatory drugs for a few weeks, avoiding postures and movements that generate pain. Absolute rest is not advisable; the important thing is to keep moving so that the musculature does not weaken.
If, even so, the pain is not relieved, corticosteroid infiltrations can be performed. The anti-inflammatory effect of the infiltrations may be the definitive treatment for buttock pain. It is important not to infiltrate more than 3 times corticosteroids in the same area, as it can generate negative effects.
Currently, there are new treatments that can help you solve your buttock pain without side effects, such as platelet-rich plasma (PRP). It is a biological, non-chemical treatment that uses the patient’s own blood to repair an injury. The patient’s blood is extracted and treated to obtain platelet growth factors. Once we have this concentration of growth factors, they are injected again.
If the patient, after these treatments, does not improve, he/she must undergo endoscopic surgery, performed by specialists in charge of performing hip arthroscopy.