Gluteus maximus tendonitis is an uncommon but often overlooked cause of buttock pain, particularly in active individuals. The gluteus maximus is the largest muscle in the body and plays a crucial role in powerful movements, such as running, sprinting, or climbing. When the tendon attaching this muscle to the bone becomes inflamed, it can cause pain in the hip or buttock during sports activities. So, what is tendonitis of the gluteus maximus, and how do we treat it? 

Symptoms of Gluteus Maximus Tendonitis

Symptoms of gluteus maximus tendonitis are usually present in the outer lower buttock region, near the buttock fold. Common symptoms include:

  • Deeper pain in the lower buttock, often worse with walking, running and climbing. 

  • Discomfort when lying directly on the affected side.

These symptoms may mimic other conditions, such as trochanteric bursitis and hamstring origin tendonitis, which is why a precise diagnosis is essential.

Diagnosis of Tendonitis of Gluteus Maximus

location of pain in lower buttock from gleus maximus tendoniti

Diagnosis begins with a clinical assessment. Your sports doctor will ask about the location of your pain and any factors that aggravate or relieve it. Your doctor will examine your buttock and hip. In gluteus maximus tendonitis, tenderness occurs at the site of the swollen tendon.  Pain is often reproduced with resisted hip joint extension. Your doctor must examine other areas of your hip, buttocks, and lower back to rule out other potential causes of pain. 

Imaging is usually necessary to confirm the diagnosis:

  • X-rays are helpful for looking for calcification or to exclude hip arthritis. 

  • Ultrasound is a practical and dynamic tool for visualising thickening, inflammation and calcification of the gluteus maximus tendon.

  • MRI provides a clear view of the gluteal tendons and surrounding structures, allowing for the detection of tendon swelling or tears, as well as co-existing pathologies, such as tendonitis in other hip tendons or inflammation of joints, including the sacroiliac joint.

Treatment 

Treatment of tendonitis of the gluteus maximus focuses on reducing tendon load, controlling inflammation, and restoring hip strength.

  • Modified activity is advised to reduce strain on the tendon, particularly by avoiding explosive activities such as running or sprinting. 

  • Physiotherapy plays a pivotal role, including: 

    • Isometric and progressive strengthening of the hip and gluteal muscles. 

    • Correction of biomechanical issues (e.g., hip control, pelvic stability).

    • Soft tissue therapy to treat tightness in the hip and pelvis. 

  • Pain relief can be achieved with regular NSAIDS such as ibuprofen. 

  • Shockwave can induce tendon remodelling and reduce pain. 

Most cases respond well to conservative treatment over 6–12 weeks.

Injection for Gluteus Maximus Tendonitis

If symptoms persist despite a comprehensive rehabilitation program, an ultrasound-guided injection may be helpful.

  • Cortisone injections, guided by ultrasound, can help reduce inflammation and pain, particularly in areas where bursal irritation is present.

  • Platelet-rich plasma (PRP) injections may be considered for chronic cases that fail to respond to standard treatment, aiming to promote tendon healing rather than reduce inflammation. PRP injections are also helpful for partial tears. 

  • Bartotage procedure, often used for shoulder calcification, is used for cases of gluteal tendon calcification. 

Injections should always be combined with rehabilitation, as they address symptoms but not the underlying contributing factors.

Frequently Asked Questions About Gluteus Maximus Tendonitis

How do you distinguish between gluteus maximus tendonitis and greater trochanteric pain syndrome?

Greater trochanteric pain syndrome (GTPS) is much more common and typically involves the gluteus medius or minimus tendons. Pain in GTPS is usually located higher on the outer hip and is aggravated by lying on the affected side or crossing the legs. In contrast, gluteus maximus tendonitis causes pain lower in the buttock, often near the gluteal fold, and is more closely associated with hip extension movements. A clinical assessment, combined with imaging, can help accurately differentiate the two conditions.

Final Word from Sportdoctorlondon about Gluteus Maximus Tendonitis 

If you’re struggling with persistent hip or buttock pain, especially if you’re active or returning to exercise, it’s worth considering less common causes, such as gluteus maximus tendonitis. Early diagnosis and a tailored treatment plan can help you return to pain-free sporting activities. 

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