(Also known as gluteal tear, buttock strain, torn gluteal muscle)
What is a gluteal strain?
A gluteal strain is a condition 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 are three major muscles:
- 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 (like 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 because of 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 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 one to a grade three 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.
Signs and symptoms of a gluteal strain
Patients with a gluteal strain usually feel sudden sharp pain or pulling sensation in the buttock region during provocative 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 (specially uphill), going up and down stairs, running, jumping, squatting, lunging, sitting or when firmly contracting the gluteal muscles (like squeezing the buttocks together). It is also common for patients to experience pain or stiffness after these activities with rest, specially upon waking in the morning.
Patients with this condition may also experience swelling, muscle spasm, weakness, and bruising in the gluteal region. Symptoms may also increase when firmly touching the affected gluteal muscle or when performing a gluteal stretch.
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 (particularly up hills), when performing an explosive jump or when lifting excessive weight (like 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 in the older athlete and particularly following an inadequate warm-up.
Contributing factors to the aggravation of a gluteal strain
There are several factors that predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors are
- muscle tightness (particularly the gluteal and hip flexor muscles)
- inadequate conditioning of the gluteal muscles
- muscle weakness (particularly the gluteals and hamstrings)
- inappropriate or excessive training or activity
- inadequate recovery periods from sport or activity
- poor running technique
- poor biomechanics
- poor posture
- inadequate fitness
- inadequate warm up
- joint stiffness (particularly the lower back or hip)
- poor core stability
- inadequate rehabilitation following a previous gluteal or lower back injury
- neural tightness
- muscle imbalances