The phrase “dead butt” refers to a painful condition caused by inflammation in the tendons of the gluteus medius muscle, one of several major muscles composing the buttocks. This condition, known medically as gluteus medius tendinopathy, is also called “dead butt syndrome.”

What is dead butt syndrome?  While the name may have a level of seriousness, our bodies are naturally resilient; muscles rarely die unless there is extreme trauma, such as the muscle being cut off from its blood supply. However, gluteus medius syndrome is painful, and pain experienced during this tendinopathy can bring the buttocks to the front and center of your attention.

Although a person’s posterior may look relatively simple, our backsides are actually quite complex. Gluteus medius is a smaller, lesser-known muscle in the buttocks with an essential function. The gluteus medius muscle actively contracts during weight-bearing while we run or walk. The gluteal muscles (three) are just several muscles that compose the familiar anatomical structure we call the “butt,” originating from the ilium and inserting on the femur.

To best understand gluteus medius tendinopathy, we need to understand what happens with tendinopathies in general, how exercise or well-intentioned but poorly managed daily routines can contribute to our butts becoming “dead,” what to do about it!

Pain and dysfunction with gluteus medius syndrome

Pain, the type of pain, and the location of pain help point a person toward a diagnosis of dead butt syndrome. Not all types of pain are equal.  Lateral hip pain with an insidious onset can be several conditions of the low back or hips, such as hip osteoarthritis.  Therefore, pain alone isn’t enough to make a definitive diagnosis.  Dysfunction of the gluteus medius tendon should be considered in the following scenarios where the pain accompanies other situations, such as:

  • Pain into the lateral thigh and knee
  • Pain with prolonged sitting or sitting in a crossed legs position
  • Pain with weight-bearing activities such as walking, climbing stairs, running, and standing
  • Limping while walking
  • Rotating hip causes discomfort
  • Tenderness on the hip with palpation, especially along the greater trochanter
  • Pain while lying on the affected hip, such as experienced in bed
  • Weakness with other muscles of the affected leg

If you’re experiencing any of these signs or symptoms, you should give our office a call and make an appointment for a thorough evaluation.  

How is gluteus medius tendinopathy diagnosed?

A thorough hip examination is required to diagnose gluteus medius tendinopathy.  Your exam will not only include obtaining your patient history but also a physical examination combined with clinical and hands-on musculoskeletal tests, including orthopedic tests.  Movement of the hip, including range of motion for both legs, should be obtained.

Some tests may elicit discomfort due to the tightness or inflammation of potential tendons, muscles, and other soft tissue structures associated with the buttocks. Any discomfort experienced during testing should be communicated to your chiropractor.  Pain provocation and reproduction of your symptoms through muscle loading and testing can be a desired outcome!  If a test is designed to create discomfort, your doctor will tell you this in advance, and any pain experienced should be relayed to the doctor. This will help clinically determine what is going on with your hips, and the correct diagnosis will guide your treatment and musculoskeletal care.

Here's a great research article by Drs. Charlotte Ganderton and Jill Cook, leading experts in the field of greater trochanteric pain in women: https://pubmed.ncbi.nlm.nih.gov/28263673

And another article about the tendon’s ability to change with load, especially as it pertains to a pathology of the tendon.  This article is also by Dr. Jill Cook: https://bjsm.bmj.com/content/43/6/409

Although we won’t delve into the granular details of tendon pathology, degeneration, and recovery of overuse or underuse injuries with tendons, it’s important to note that this field is complex – hence why your condition is best assessed in our office and not online.  Plus, just as Dr. Jill Cook says, recovery times and expectations can vary; some tendons recover with simple interventions, yet others remain resistant to all treatments.

Thankfully, we have many ways of treating gluteus medius tendinopathy in our office!

How is dead butt syndrome treated?

Imaging is rarely utilized for most gluteus medius tendinopathies. Ultrasound or MRI may be used to rule out another possible diagnosis if the diagnosis is unclear or if conservative treatment has failed.

Correct management of gluteus medius dysfunction is imperative. The wrong exercise or rehabilitation approach may delay or decrease optimal recovery!

Management of this condition includes specific loading exercises and management strategies for the affected tendon(s), rehabilitation including guided exercises and movements, ergonomic changes to your work or home, or co-management with another doctor.  Certain exercises may need to be modified or changed from your usual workout routine, or you may have new exercises introduced as a home exercise program.  You may be asked to avoid or alter other postures, for example, avoiding sitting with your legs crossed or adding a pillow between your knees while you sleep at night.

Some treatment options are more invasive than the conservative musculoskeletal route and may be considered if recovery is slow or progress is less than optimal.  These include corticosteroid injections, platelet-rich plasma (PrP) injections, and surgery.  Should your condition not respond to your treatment plan, we can easily refer your care for co-management with the appropriate physician.

Is a chiropractor the right doctor to manage gluteus medius tendinopathy?

Absolutely.  If you’re not sure about what step is appropriate to take, call your chiropractor.  An evaluation will determine the extent of muscle injury and if further intervention is required.  The doctor can also determine if you need to restrict activities, take days off work, or, depending on the severity, co-manage your care with another physician to provide pain relief and improvement in mobility.

Prevention is the best form of treatment.  Taking breaks to get up and move can reduce or even eliminate the impact of gluteus medius tendinopathy.  Stretching before and after exercising can help reduce the likelihood of developing dead butt syndrome, too, but these well-intentioned interventions may not be enough.

When it comes to managing this condition, it depends on the timing (when it started and when you make your appointment).  The sooner treatment can begin, the better the outcome.  Additionally, management depends on the severity of the symptoms and the ability to continue performing usual activities and movement patterns.  Additionally, conservative care options will depend on the severity, duration, and frequency of your pain, as well as the activities impacted by your condition.

How we address gluteus medius tendinopathy?

Our goal is to not only provide you with the correct diagnosis of your injury but also determine the underlying root cause of your injury and create an individualized treatment plan specifically for you.  We have many tools in our toolbox to conduct an effective evaluation and create an appropriate treatment. 

Conservative care is a keystone for our Boca Raton Sports Chiropractic practice.  Treatment options may include specific stretches for muscles and tendons of the affected muscle, joint mobilization, specific exercises to strengthen the surrounding muscles and tendons, hands-on soft tissue work into the muscles and fascia, changes in exercise routine or modifications at work or home, home exercise, and stretching programs, and more.

Your treatment plan is unique to you and your condition.  Some approaches we may use to help your pain consists of sports rehabilitation exercises to perform at home or in the office, as well as targeted soft tissue therapies including Active Release Techniques (Muscle Work), chiropractic, Graston Technique®, and deep tissue laser therapy.

Frequently Asked Questions (FAQ)

Can I do anything at home for a “dead butt”?

Initial treatment involves ice, non-steroidal anti-inflammatory drugs (NSAIDs), and avoiding aggravating activities to decrease pain and inflammation.  If the gluteus medius is torn or beyond rehabilitation, an endoscopic hip surgery may be necessary.

But what if I can’t avoid the aggravating activity?

We understand it isn’t always possible to change our daily routine, especially if it involves consistent exercise or ergonomic stresses such as sitting, standing, use of power tools, etc.

Although we’ve made sweeping advances in technology in the last few decades, our bodies have not adapted to a 21st-century lifestyle.  As we live longer and engage in repetitive activities, we increase our risk of developing muscle and soft tissue injuries, such as gluteus medius tendinopathy.  Your doctor can advise you to modify your activities to include rest, perform alternate methods or procedures to reduce injury, or incorporate another treatment intervention such as specific exercises and supervised rehabilitation to improve your condition.

Could my “dead butt” be something else?

The short answer is always yes.

Gluteus medius tears may be mistaken for bursitis or another musculoskeletal condition in your hips, muscles, or lower back.  If you experience symptoms of a gluteus medius tear that doesn’t get better after rest, icing, taking anti-inflammatory or pain medications, and modifying your activities, you should see us for a consultation.

If you are dealing with buttocks or hip pain and want a same-day examination and treatment for your injury, call our Boca Raton or Miami chiropractic and sports injury office at 561-997-8898 or schedule online!