Working from their anchor points across the buttock region, the gluteal muscles; the jackhammer-like maximus, the stabilising medius, and the movement-assisting minimus, together create the perfect pelvic rotations, hip extensions, and bursts forward that enable us to be active and do so many things.
The large gluteus maximus muscle forms the prominent bulk of the buttocks, firing the hips and pelvis forward with immense force to drive activities like sprinting, jumping, and ascending from a squat. The other gluteals; the medius and minimus, connect the side and back of the pelvis to the outside of the hip, and their roles are more intricate, allowing multi-planar hip motions like the external rotation of a ballet pirouette.
A gluteal strain is a stretch injury or tear within one of these critical muscles, usually from sudden trauma to the area or repetitive overuse over time.
Symptoms of gluteal strains
The most common symptoms of a gluteal muscle strain are:
- Pain – Typically localised pain in the buttock area near the strained muscle.
- Tenderness – There may be tenderness and palpation directly over the muscle.
- Stiffness – The strained muscle may feel tight and stiff, especially after rest periods.
- Bruising – Some severe muscle strains cause bruising over the injured region as blood leaks into the muscle tissue.
- Spasms – Muscle spasms sometimes occur as the strained muscles involuntarily contract.
- Weakness – Difficulty activating the injured muscle due to pain and dysfunction, inhibiting activities involving hip extension, like climbing stairs.
Gluteal strains are prevalent in sports requiring explosive power, like football and basketball. Athletes constantly accelerate, decelerate, change direction, jump, and land in these sports. These dynamic movements require massive force output from the large gluteal muscles. The high loads predispose the muscle tissue to tearing. Specific mechanisms leading to strains include suddenly attempting to sprint at top speed, rapidly changing direction by twisting the hips, absorbing the impact of an awkward landing, or being tackled directly onto the buttocks. The excessive eccentric load strains the muscle fibres past capacity.
Limited flexibility through the hips and pelvis significantly contributes to gluteal strain risk. Tightness in muscles like the hip flexors, hamstrings and calf muscles causes the gluteal muscles to be placed in a chronically shortened position. This negatively impacts the optimal length-tension relationship in the muscle tissue, forcing the glutes to operate at a mechanical disadvantage. Then, when it springs into action for tasks like hip extension, external rotation or stabilising the pelvis, it strains beyond capacity. Stretches and mobility work help normalise muscle length and mitigate strain risk.
The gluteal muscles do not work alone but are part of a synergistic group of hip muscles sharing the load during movement. Imbalances or weakness in some synergistic muscles, like the deep hip external rotators, lead to overburdening of the glutes. For example, weak external rotators increase torque requirements of the glutes to control rotation predisposing to tissue failure. Addressing deficits in flexibility and strength through personal training helps to prevent gluteal injuries.
Any blunt trauma applied directly to the buttock region can potentially tear gluteal muscle fibres. Forces from falling and landing directly on the bottom muscles or a blow to the back of the thigh can strain tissue.
Repetitive hip extension, rotation and pelvic stabilisation from the glutes required in running, cycling, and other sports can cause fatigue. When increasing distance or intensity too rapidly, the cumulative demand can exceed tissue capacity, especially when paired with poor flexibility. Even after prolonged activity at submaximal levels, a sudden increase in load, like sprinting for a finish line, commonly triggers a strain. A slow progression in training allows tissue adaptation to prevent overload.
Diagnosing a gluteal strain starts with a thorough history of the onset of symptoms and a physical examination focused on the hips and pelvis, where the clinician palpates the gluteal muscles, feeling for areas of increased warmth, swelling and tenderness.
They will also assess the active range of motion, watching for pain with movements like hip extension and external rotation. Resistance applied to the glutes helps evaluate weakness in the strained muscle.
Comparisons to the uninjured side help characterise deficits. For example, weakness when extending the hip on the injured side indicates the gluteus maximus muscle strain. The clinician combines the examination findings with the mechanism of injury and the symptoms to determine the strained muscle and severity of injury.
A presumptive diagnosis of muscle strain can be made clinically without imaging. However, x-rays may be considered after high-force trauma to rule out an avulsion fracture where the muscle tearing pulls off a piece of bone.
Advanced imaging like MRI provides a detailed evaluation of damaged gluteal muscle tissue, although it’s unnecessary for routine strains. MRI is useful for severe, high-grade injuries with extensive damage or cases failing to improve with comprehensive treatment. Imaging informs surgical decisions in refractory cases, confirming the extent of tissue disruption in cases of extensive damage.
Treatment of Gluteal Strain
Most gluteal muscle strains heal well over 2-6 weeks with conservative treatment focused on rest, ice, and gentle stretching. Severe grade III strains require longer recovery. Treatment approaches include:
Restrict sporting activity and avoid aggravating movements like climbing stairs early in recovery. Relative rest allows torn muscle fibres to heal. Continue modified activity as tolerated so the area doesn’t become overly stiff.
Applying ice for 10-15 minutes daily decreases pain and swelling. Ice reduces local blood flow to the injured tissue. Apply ice directly over the painful muscle belly with care not to burn the skin.
NSAID pain medications like ibuprofen can provide anti-inflammatory effects to help control swelling. Always follow medication precautions and directions.
Wrapping elastic bandages around the hips can help minimise swelling and provide comfort. Ensure bandages aren’t overly tight – allow airflow to the skin underneath. It can be difficult to bandage the gluteal region however.
Physiotherapy is the cornerstone of gluteal strain rehabilitation after the acute inflammation phase has resolved. A progressive programme focused first on flexibility, then muscle activation, and finally strengthening retrains the strained muscles.
Initially, the physiotherapist performs gentle stretches and joint mobilisations to restore a full, pain-free range of motion. Techniques like massage and gentle heat prepare the injured muscle for activation. Take care to avoid over-stretching the healing tissue.
Once flexibility is re-established, the therapist introduces gentle gluteal isometric holds, coactivating and re-educating synergist muscle groups like the deep hip rotators. Low-load isolated activation in safe ranges teaches the glutes to fire correctly. Neuromuscular connections are rebuilt.
Over weeks, the therapist increases the load on the healing glutes via eccentrics and concentric movement. Weight stays within tissue capacity until it’s ready for more. Appropriate loading stimulates collagen maturation while avoiding a re-tear. Compensatory patterns are corrected.
The carefully structured stages of rehabilitation restore muscle strength, endurance, and power to meet the demands of sport and activity without re-injury. Home exercises facilitate continued adaptation between sessions. The end goal is symmetrical, pain-free movement.
Recovery timeline for gluteal strain
Gluteal strains are categorised by severity of muscle fibre damage into grade I, II and III injuries. Recovery time correlates closely with strain grade:
- Grade I strains: Microscopic tearing of fewer than 5% of muscle fibres—mild soreness and tightness with minimal loss of strength or function. Often heal fully in 2-4 weeks.
- Grade II strains: More extensive damage with torn fibres but intact gross muscle anatomy. Moderate loss of function requires longer recovery over 4-8 weeks as scar tissue develops and then remodels.
- Grade III strains: A tear extending across the entire muscle cross-section is debilitating but rare. Surgical repair can restore anatomy and accelerate recovery in full-thickness tears. Recovery takes 3-6 months gradually.
Recurring injury is unfortunately widespread with gluteal strains, usually from early aggravation before mature collagen stabilisation at 12 weeks post-injury. Even small areas of stiffness or persistent weakness in the muscle substantially increase injury recurrence risk.
Optimising flexibility and strength through physiotherapy, while avoiding provocative activities until the tissue fully recovers, gives the best results. Proper loading facilitates remodelling to prevent future tears. With appropriate rest early on and gradual reconditioning, most athletes return to full participation by the start of the next season.
Contact us to discuss gluteal strain recovery with a trained physiotherapist.