Gluteal muscle Strain,

A Gluteul muscle strain involves a strong group of 3 muscles that forms the buttock. Each of the gluteus muscles plays its part in stabilizing and moving the hip and pelvis. Standing up out of a chair, walking or climbing stairs will give a sharp cramp like feeling in your butt. Any one of these muscles’ fibers can be torn if the load placed on the muscle exceeds its normal boundaries. This will cause a gluteus muscle strain.

“Jumpers” are more likely to tear one of their gluteal muscles, due to the high intensity of the muscle contraction that is needed to push off out of a stretched position, for example sprinters, hurdlers, long jumpers and especially triple jumpers.

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The Gluteal muscle group

The Gluteal muscle group all attach to the Pelvic rim (illiac crest) and runs diagonally downward towards the femur head (thigh bone). The smallest gluteus (minimus) runs vertically down on the outside of the hip, where  medius sits under the larger gluteus maximus muscle.

Lets examine each muscle separately and look at what movements they are responsible for, in order to understand what goes wrong.

Gluteus Maximus muscle

Maximus – Is the largest of the group and is regarded as one of the strongest muscles in the human body, that extends your hips. The gluteus maximus is an important hip muscle because it is a prime mover of the leg bone into extension (moving the leg backwards) or propelling the body forward when walking or running.

It allows you to straighten your hips when standing up out of a chair or when walking up stairs.

Gluteus Muscle Strain

Gluteus Medius muscle

It is a muscle that pulls your leg outwards (Abduct) and plays a vital role in keeping your hip level when walking. The adductor muscle group on the inside of the thigh works together to keep your pelvis stable when you are transferring your weight from one leg to the other.

Its connection with the iliotibial band steadies the femur (thigh bone) on the articular surfaces of the tibia during standing, walking and jumping. This influences the force transferred to the leg, knee and ankle.

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Gluteus Minimus muscle

The gluteus minimus is one of the secondary muscles that assist with extending the hip. It is located deep and somewhat in front of the gluteus medius muscle. The gluteus minimus helps to move your leg sideways away from your midline and turns the thigh inwards. Together with the gluteus medius, it acts to stabilise the hip and pelvis when the opposite leg is raised from the ground.

Gluteal muscle Strain,
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How does a Gluteus muscle strain happen?

When a muscle needs to contract at a very high rate and force while it is in a stretched position, it causes an overload of ‘pulling’ on the muscle therefore causing small microscopic tears in the Gluteal muscle fibers. Your nervous system will react by contracting that muscle and increasing the muscle tension (to protect itself). This results in a temporary shortening of the muscle to allow healing to take place.

When you go into a position where you stretch or contract your gluteal muscles, you will feel a sharp stinging feeling. This is because the more you stretch it, the more you will damage the scar which is trying to heal the muscle fibers. Its like ripping the wound wide open again.

Movements like bending down forward to pick up something off the floor or going from a standing to a sitting down position will stretch the Gluteal muscles. Pain when contracting the Gluteus muscles involves standing up out of a chair (the deeper the seat, the more the pain) and walking up stairs.

Gluteal strains usually occur due to a sudden contraction of the gluteal muscles, often when they are in a stretched position. This sometimes occurs with rapid acceleration while running (particularly up hills), when performing an explosive jump or when lifting excessive weight (e.g. loaded squats or lunges in the gym).

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Repetitive muscle overload

Repetitive overload on the muscle will cause small tears inside the muscle. Your body will react by contracting the muscle to protect it from injury, as a result we see that patients tend to train through this ‘niggle’ of pain and continue to run, cycle, jump etc. Eventually a small tear develops into a bigger tear, until its too painful to contract or stretch the gluteal muscles.

The Gluteal muscle group tends to tear over the center (belly) of the muscle. Its usually accompanied by either a hip tendinitis or nerve irritation.

Causes of a Torn Gluteal Muscle

Acute Injury

  • Overuse – Increasing your running distance too fast or a sudden increase in repetitive jumps.
  • Overload – Increasing the leg press machine too fast. You can just imagine if you jump from 80kg to 100kg in one week. The muscle won’t be able to keep up. The Gluteal muscles are subjected to sudden forceful contraction.
  • Overstretch – Running uphill sprints or on a incline will force the muscles to contract from its stretched position. Muscles are very weak in its stretched position. When the Gluteaus muscles are forcibly stretched beyond their normal boundaries, the muscles will tear.

Chronic wear & tear

  • Weakness – Muscle fatigue can play a role in jumpers and runners who are not strong enough to run the distance.
  • Poor technique – During training (Wrong movement pattern), that can load the gluteus significantly more. Squat, Lunges, Jumps
  • Inadequate warm-up – A fast sudden contraction like a jump or to start sprinting when the muscle is not prepared for it can put you at risk of tearing the gluteus muscles.
  • Excessive stretching – of the muscle against a force, for example during weight lifting like a deadlift. When the load is applied on both sides of the tendon, while it needs to contract and lengthen at the same time. Same goes for Jumping lunges, squats, Plyometric training.
  • Wrong shoes – Poor support for your foot will cause muscle forces to concentrate along the inside of your leg, which load those muscle fibers more that the outer part. This abnormal force on the inside of your leg will cause the fibers to fatigue faster and tear first.
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How we test

These are some of the test that we perform in the practice:

 

Length Test & Stretch

If going into the position or if this position is painful, the test is positive.

Lying on your back

  • To test the right side
  • Lie on your back lift your right knee towards your chest.
  • Hold your right knee and pull it towards your left shoulder
  • Pull your knee up until you feel a stretch in your buttocks

Long Sitting

  • To test the right side
  • Begin sitting on the floor with both legs in front of you
  • Place your right foot on the other side of your straight leg (left leg)
  • Keeping your back straight
  • Pull your right knee towards your chest, until you feel a stretch in the buttocks

Standing Lunge

  • Begin standing tall.
  • Extend your right leg behind you, lowering down into a deep lunge position.
  • If you can, you can touch your right knee to the floor.
  • Lean forward from your hips towards the left knee (in front)
  • You will feel a deep stretch in the gluteus of your left buttock

Crossed leg stretch

  • Begin sitting on the floor, legs bent in front of you.
  • Slide your left foot under your right leg until it’s next to your right hip.
  • Now, try to bring your right foot over to your left hip.
  • Let your right leg rest on top of your left as you do this.
  • You should feel a deep stretch in your right gluteal muscles.
  • Lean forward over your legs to deepen the stretch.

Lying

  • Begin lying flat on your back, legs extended.
  • Now, lift your right hip and leg, crossing it over your left, while keeping your back and shoulders flat on the ground.

Pretzel Stretch in Lying

  • Begin lying flat on your back, both knees bent.
  • Cross one leg over the other so that your ankle is resting on the opposite knee.
  • Gently pull the uncrossed leg toward your chest until you feel a deep stretch in your bum.
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Contraction & Strength Test

If it is painful when trying to contract the muscle or move it through the range, the test is positive.

Leg Swings in Standing

  • Stand next to a chair or wall so you can hold on with one hand if necessary to balance
  • Lift your opposite leg and swing it in front of you, then behind you, like a pendulum.
  • Swing for 10 to 12 reps, then switch to the other side.

Front Lunge

  • Begin standing tall with your feet together.
  • Step one foot in front of you and lower into a lunge, be sure to keep your knee behind you toes at all times.
  • Push back through your heel and gluteus to a standing position

Bridge Lying

  • Lie down flat on your back, knees bent at a 90-degree angle.
  • Keeping your heels on the floor.
  • Raise your hips until they are in a straight line with your shoulders and knees.
  • Hold hips parallel to the ground for a two-second count, then lower.

3 Ways the Gluteal muscles tear

  1. Sudden deceleration of the hip and leg (e.g. landing from a jump)
  2. Violent contraction of the gluteul muscles (jumping, lunges, stair sprints)
  3. Rapid deceleration of an overstretched muscle (by quickly change of direction) Jump from a lunge position, plyometric jumps.
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Other Causes of Hip pain

Physiotherapy Treatment

1st Phase

Key Action
P Protect We have found that patients tend to continue walking on the injured leg with a limp. The muscle still contracts every time that your weight is put onto the leg. It’s better to get crutches and keep the load off the muscle. The main concern is to prevent the muscle from tearing even further.
R Rest No weight on the injured leg. Use crutches to take the load off the muscle.
I Ice Ice cubes warped in a towel, tied around the gluteus reduces pain & inflammation and speeds up the healing process. For at least the first 3 days or until the swelling goes down, apply an ice pack for 20 minutes every two hours. Always keep a towel between the ice and your skin (to prevent a clod burn), and press the ice pack firmly against all the curve of your bum.
C Compress Use strapping (Leukotake S) or elastic compression bandage to keep the muscle supported and prevent blood pooling in your legs. This can be done either with taping or tube grip bandage and helps to control swelling.
E Elevate Lying on your back with your foot on a chair (your calf must be higher than your heart to allow gravity to assist in draining the pooled blood in your leg.) Raise your leg for 15 minute intervals during the day.

2nd Phase: Regain Full Range of Movement

The most important component of rehabilitation is to regain full range of movement of the muscle fibers. The scar tissue that forms inside the site of the tear must be lengthened and orientated to allow the muscle to contract without any restrictions. We use massage, stretches and neurodynamic mobilizations to achieve full range of movement. This will also prevent future reoccurrence.

3rd Phase: Eccentric Muscle Strength

A muscle contraction works in two directions: One where the muscle is contracted and it shortens like a heel rise (concentric), and controlling the descent going down from a heel rise (eccentric). This loads the muscle fibers while being lengthening. These type of exercises are vital to conditioning the muscle fibers to absorb a force.

4th Phase: Concentric Muscle Strength

Shortening of the muscle during a contraction involves strength and power exercises that will be progressed gradually as healing takes place. This will be tested frequently to determine if you can progress from non-weight bearing to full weight bearing (walking without crutches). The physiotherapist will guide and monitor the muscles reaction to normal forces like walking, climbing stairs and driving.

5th Phase: High Speed, Power, Proprioception

The calf muscles must be tested under high load and speed to ensure that the muscle will be able to keep up with the demand of your body. During this phase the physiotherapist will guide you to return to normal activities, as well challenging the muscle past its ‘normal’ boundaries to determine how it reacts to different forces and prepare you to return to participating in your sport.

6th Phase: Sport Specific Training

Depending on your sport, the physiotherapist will tailor specific exercises that will help strengthen the muscles pertaining to your sport. A successful outcome is when you have gained knowledge throughout the rehabilitation program and can participate at full power and speed, as well as minimizing your chance of future injury.

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