Gluteal Injury

The goal of gluteal injury treatment is to return patients to their normal level of function.

• The gluteal region of the body (the buttocks) consists of three major muscles: gluteus maximus, gluteus medius, and gluteus minimus.
• The gluteus muscles function to move the hip and to a lesser extent help with knee movement in association with the iliotibial tract.
• Other muscles, nerves, and bursae in the gluteal region that may cause buttock pain include the following:
  • Hip rotator muscles: Piriformis, obturator, quadratus, and gemellus muscles
  • Ischial bursa
  • Sciatic nerve
• Most commonly, gluteal injuries are due to local trauma from falls or direct blows.
• Treatment is often supportive with ice, elevation, and rest.

A gluteal contusion is a bruise to the muscle area. A gluteal muscle strain is a stretch or partial tear of the muscle or tendon.

Trauma, either by a fall or a direct blow to the buttock area, causes most gluteal injuries.

Overuse injuries of the hip may cause inflammation and damage to the gluteal muscles that help move the hip or to the tendons that attach the gluteal muscles to the greater trochanter of the hip.

Falls are a common cause of a gluteal or buttock contusion. In patients who are anticoagulated or on blood thinners, a large amount of bleeding can occur within and around the muscle, causing significant pain and swelling.

Gluteal muscle and tendon strains occur because of overuse injuries, usually of the hip joint. Repetitive motions like squatting and lifting at work may cause inflammation in tissues surrounding the hip.

In athletes, gluteal tendinopathies may mimic hip bursitis. Injuries may occur because of overtraining, especially with weightlifting and squats.

Inflammation of the hip, piriformis, iliotibial band, and the gluteus muscles are common running injuries.

Falls or direct blows to the buttock can cause bleeding, inflammation, and swelling. This leads to pain, making it difficult to sit on the buttocks, or stand and/or walk normally because of the decreased range of motion of the hip. When the gluteal muscles are inflamed, movement of the hip joint causes pain. Because of bleeding that may be deep and not immediately apparent on the surface of the skin, inflammation may occur causing the buttock to feel swollen, warm, and become slightly red.

History is the first important step in helping the health care provider make a diagnosis.

• Was there an injury or fall? It is important that other parts of the body be examined to look for other potential injuries.
• Did it just happen or has the pain been persistent and ongoing? Is this an acute injury, or has it been a chronic ongoing problem?
• Is the patient able to walk, and if so, is there a limp? Any fall or blow may be associated with fractures or broken bones of the pelvis, hip, or lower back (sacrum, lumbar spine).
• Is the patient taking blood thinners? Gluteal injuries may have significant bleeding in these patients.
• Is there any numbness or tingling or pain that radiates down the leg? The health care professional may check for sciatic nerve inflammation and the cause of gluteal or buttock pain.
• Has there been any issue with the ability to urinate or have a bowel movement? Acute changes in bowel or bladder function are associated with potential spinal cord injury, like cauda equina syndrome, a medical emergency.

Physical examination will focus on the low back, buttock, and hips.

• Inspection or looking at the buttock area might reveal bruising of the skin or the buttock may appear swollen and red.
• Palpation, or feeling the buttock, may expose tenderness associated with a contusion. The overlying skin might feel warm. Swelling, redness, and warmth may be due to a gluteal contusion but also might signal a deep infection.
• Examining the hip may uncover pain with tenderness over the joint line or the greater trochanter. This can be associated with gluteal tendinopathy (inflammation and damage of the gluteus tendon that attach the gluteal muscles to the greater trochanter). An injury may decrease hip range of motion. Moving the hip may cause pain in the buttock due to muscle inflammation and damage.
• X-rays may be done to look for fractures of the hip, pelvis, and lumbar spine.
• CT scan or MRI may be considered if the health care professional has a high index of suspicion for a hip fracture, but the plain X-rays are normal.
• Ultrasound may be helpful to look for a large collection of blood deep in the buttock muscle or to look for an abscess if infection is a concern.
• Blood tests are not usually done, except for patients who take warfarin (Coumadin) as a blood thinner.

Should the gluteal injury be due to a direct blow or fall, resulting in a contusion, treatment aims to decrease the inflammation in the area.

Ice, elevation, and rest may be helpful. Most commonly, gluteus muscle injuries heal with time and no further treatment.

A rubber donut may be used to decrease the pain of sitting on a swollen buttock

Some patients with gluteal injuries have difficulty sitting on the commode and become constipated. A stool softener may be considered for a short period of time.

If the gluteal injury is due to overuse, or an abnormal gait (pattern of walking), physical therapy may be considered to prevent further injury and inflammation.

Physical therapy may also be helpful in treating tendinopathies and other inflammation of the gluteus muscles not due to trauma. Treatment modalities may include massage and ultrasound. Rehab may include exercises to strengthen muscles and maintain range of motion to prevent future injury.

In some circumstances, medical professionals may consider administering steroid injections. Using ultrasound, a long needle is guided near the injury site so that the injected steroid can work directed at the site of inflammation.

Surgery is not commonly considered but may be an option when nonsurgical treatments have failed, and torn muscles need to be repaired.

Most traumatic gluteus injuries resolve on their own with time and conservative therapy, but recovery time may be measured in weeks and not days.

Overuse injuries may take longer to heal, but the goal is to return patients to their normal level of function.

People may sometimes avoid accidental falls. It is important to have good footwear, be aware of surroundings, especially when the weather is rainy, snowy, or icy. This is especially true for elderly patients and those who may have impaired balance. Warming up and stretching before activities may help decrease injury risk.