Sports Medicine
Sports Injury Prevention & Rehabilitation

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Gluteal Strain

(Also known as Gluteal Tear, Buttock Strain, Torn Gluteal Muscle)
What is a gluteal strain?
A gluteal strain is a condition that is rarely seen in clinical practice and is characterized by tearing of one or more gluteal (buttock) muscles.
The gluteal muscles are a strong group of muscles situated at the back of the pelvis forming the buttock. The gluteals primarily comprise of 3 major muscles including:
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
These muscles originate from the pelvis and insert into the top of the thigh bone (femur).
The gluteal muscles are primarily responsible for straightening the hip during activity, stabilizing the pelvis and assisting with outer movements of the hip (e.g. taking the leg to the side or changing direction when running). They are particularly active during running, jumping, squatting and lunging. During contraction of the gluteals, tension is placed through the gluteal muscles. When this tension is excessive due to too much repetition or high force, one or more of the gluteal muscles can tear. This condition is known as a gluteal strain.
Tears to the gluteal muscles can range from a small partial tear whereby there is minimal pain and minimal loss of function, to a complete rupture. Gluteal strains range from a grade 1 to a grade 3 tear and are classified as follows:
Grade 1: a small number of fibers are torn resulting in some pain, but allowing full function.
Grade 2: a significant number of fibers are torn with moderate loss of function.
Grade 3: all muscle fibers are ruptured resulting in major loss of function.
The majority of gluteal strains are grade 2 tears.

Causes of a gluteal strain
Gluteal strains usually occur due to a sudden contraction of the gluteal muscles often when they are in a position of stretch. This sometimes occurs with rapid acceleration whilst running, when performing an explosive jump or when lifting excessive weight (e.g. loaded squats or lunges in a gym). Gluteal strains are occasionally seen in running and jumping sports such as football, basketball, soccer, rugby, and athletics (particularly sprinters, hurdlers, and long jumpers) or during weight training. Gluteal strains tend to occur more commonly in the older athlete and particularly following an inadequate warm-up.

Signs and symptoms of a gluteal strain
Patients with a gluteal strain usually feel a sudden sharp pain or pulling sensation in the buttock region during the activity. In minor cases, the patient may be able to continue the activity only to have an increase in symptoms upon cooling down. In more severe cases the patient may be unable to continue the activity and will often limp or be unable to walk off the playing field.
Patients with a gluteal strain usually experience an increase in pain during activities which place load on the gluteal muscles. These activities may include: walking (especially uphill), going up and down stairs, running, jumping, squatting, lunging and sitting. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning.
Patients with this condition may also experience swelling, muscle spasm, weakness, tenderness and bruising in the gluteal region.

Diagnosis of a gluteal strain
A thorough subjective and objective examination from a doctor is usually sufficient to diagnose a gluteal strain. Further investigations such as an MRI scan or Ultrasound may be required to confirm diagnosis and assess the severity.

Treatment for a gluteal strain
Most patients with this condition heal well with appropriate therapy. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities placing large amounts of stress through the gluteals should also be minimized, these include: running, jumping, squatting, lunging and going up stairs. By avoiding these activities, the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain-free a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with a gluteal strain is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Diligently following RICE in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time in patients with a gluteal strain. This should primarily involve rest from aggravating activities, regular icing and the use of compression. Anti-inflammatory medication may also help to reduce inflammation, pain and swelling. The use of crutches when walking may be necessary to protect the gluteal muscle from further damage and to hasten the healing process.
A graduated flexibility and strengthening program guided by a physiotherapist is essential to recondition the gluteal muscles and reduce the likelihood of injury recurrence. Careful assessment by the therapist to determine which factors have contributed to the development of the gluteal strain, with subsequent correction of these factors is essential to ensure an optimal outcome.
A graduated return to running program in the final stages of rehabilitation of a gluteal strain is required to recondition the muscle for running in a safe and effective manner. This should include the implementation of progressive acceleration and deceleration running drills.

Prognosis of a gluteal strain

With appropriate management, patients with minor gluteal strains can usually recover in one to three weeks. With larger tears, recovery may take four to six weeks or longer depending on the severity. In cases of a complete rupture of one of the gluteal muscles, surgery may be considered with intensive rehabilitation to follow. Return to sport or activity may then take 6 months or longer.

Contributing factors to the development of a gluteal strain
There are several factors which can predispose patients to developing a gluteal strain. These need to be assessed and corrected with direction from a therapist or doctor. Some of these factors include:
  • poor gluteal flexibility
  • inadequate conditioning of the gluteal muscles
  • muscle weakness (particularly the gluteals and hamstrings)
  • muscle tightness (particularly the gluteal and hip flexor muscles)
  • inappropriate training or technique
  • poor biomechanics
  • poor posture
  • decreased fitness
  • fatigue
  • inadequate warm up
  • joint stiffness (particularly the lower back or hip)
  • poor core stability
  • inadequate rehabilitation following a previous gluteal injury
  • neural tightness
  • muscle imbalances

Physical therapy for a gluteal strain
Physical therapy for patients with a gluteal strain is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • stretches
  • muscle energy techniques
  • joint mobilization
  • ice or heat treatment
  • education
  • biomechanical correction
  • the use of crutches
  • dry needling
  • progressive exercises to improve strength, flexibility, core stability and balance
  • activity modification advice
  • technique correction
  • anti-inflammatory advice
  • devising and monitoring a gradual return to sport or activity plan

Other intervention for a gluteal strain
Despite appropriate rehabilitation management, some patients with a gluteal strain do not improve adequately. When this occurs, the treating physical therapist or doctor can advise on the best course of management. This may include investigations such as an ultrasound, CT scan or MRI, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. In very rare cases, of complete gluteal rupture, surgical intervention may be considered.