Do you suffer from chronic low back pain, or pain deep in the buttocks when sitting or standing for too long? Have trouble sleeping due to pain on the outside of your hip when lying on your side? Have you developed any groin or front hip pain, or do you start to waddle, fatigue, or lose balance after walking for too long? All of these are symptoms of one very particular issue—a tear in your gluteus medius muscle.
What is the gluteus medius?
The gluteus medius muscles run along the outside of the buttocks, starting where the base of the back meets the top of the buttocks, and end along the bony protuberance along the upper side of your thigh, known as the greater trochanter. Although we often think of our gluteus maximus as our main butt muscle, it is the gluteus medius (the middle butt muscle) that is the most important stabilizer of our pelvis and the work horse of our core musculature. Its primary role is to pull our thigh out to the side (abduction), and also to keep our pelvis level and balanced when standing and walking.
What causes a gluteus medius tear?
A gluteus medius tear is generally caused by degeneration of the soft tissue through normal wear and tear, and less commonly from injury. These tears are most commonly found in women between the ages of 50 and 70—women are 10 times as likely to suffer a gluteus medius tear than men. More research is needed, but the general belief is that the disproportionate rates of gluteus medius tears in women are due to a woman's pelvic anatomy and hormonal changes associated with menopause. The reduction in estrogen levels have been implicated in weakening soft tissue structures such as tendons and muscles.
What are the symptoms of a gluteus medius tear?
Given the anatomic location of the gluteus medius, a tear can present in a variety of ways. The most common symptoms of a gluteus medius tear include:
- severe side hip and buttocks pain
- low back pain
- pain sleeping at night
- pain that radiates down the side of the leg, sometimes all the way to the foot
- weakness in the hip and leg
- difficulty walking short distances with loss of balance and waddling walking pattern
- pain in and around the hip after sitting or standing for long periods of time
How are gluteus medius tears diagnosed?
A gluteus medius tear is officially diagnosed by MRI. Prior to working with a health care provider to obtain a scan, you should first seek treatment, including a discussion of medical history and a physical exam, with your primary care provider, physical therapist, or chiropractor.
Getting a correct diagnosis can sometimes take a while, up to many years, because of the location of the gluteus medius and the pain pattern associated with the muscle. Some common misdiagnoses include:
How are gluteus medius tears treated?
Once a gluteus medius tear diagnosis is confirmed by medical history, physical exam, and MRI, conservative treatment can be attempted first, depending on the size of the tear and the duration and severity of symptoms. Conservative treatment consists of physical therapy, prescription anti-inflammatory medications, activity modifications and careful use of cortisone injections.
If conservative management is not an option, or has been attempted and failed, then surgical repair of the tear is an option. This should be done by an orthopedic surgeon who is specially trained in this procedure. The goal of surgery is to reduce pain and restore strength and function.
There is a real push to educate health care providers and make them aware of this highly prevalent problem. One 2003 survey of orthopedic surgeons revealed that 45 percent of respondents did not know gluteus medius tears could occur. If you suffer from any of the symptoms of a gluteus medius tear, speak with your primary care provider or orthopedic specialist about the possibility of a tear. Otherwise, the problem can progress and become a chronic condition without a correct diagnosis.
Talk with your primary care provider about hip pain and whether a referral to an orthopedic specialist may be right for you.
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