Gluteus Medius Tendinopathy, or Dead Butt Syndrome

Dead Butt Syndrome (DBS), technically known as gluteus medius tendinopathy (GMT), is a painful condition caused by inflammation in the tendons of the gluteus medius muscle.

The gluteus medius (GM) is one of the smaller, lesser-known buttocks muscles, providing stability and support to the hip and pelvis during weight-bearing activity. Most commonly affecting distance runners, DBS can also strike those beginning a new exercise program or increasing their workout intensity.

gluteus medius tendinopathy

Orthopedic specialists have noted an increase the number of DBS cases over the last few years, possibly due to how many patients run for long distances after sitting for hours during the workday.

Causes of Dead Butt Syndrome

The GM muscle functions to contract the weight-bearing hip during running or walking. When this muscle activates, your hip flexors release and vice versa. When the tendon becomes inflamed, however, the GM muscle may fail to activate — hence the “dead butt” term.

Many runners work all day in a sitting position, which causes the hip flexors to become tight. Failure to stretch the hip flexors before running can result in DBS. However, the most common underlying causes are more complex.

Poor gluteal and hip muscle control can lead to excess stress on the GM tendon. Runners often eschew cross-training and weight lifting, which work to strengthen the large muscles that support the pelvis while running. Consequently, the hip’s smaller muscles and tendons take on the extra pressure.

Left untreated, runners often compensate for the pain by adjusting the mechanics of their stride, placing pressure on other portions of the lower extremities. This can lead to complications and additional injuries, including trochanteric bursitis, IT band syndrome, plantar fasciitis and calf injury.

Symptoms and Diagnosis of Dead Butt Syndrome

The most common symptoms of DBS are stiffness, pain and strength loss in the hip. The pain typically worsens during weight-bearing exercise, including running, walking or climbing. For many patients, the pain radiates down the thigh, similar to the symptoms of sciatica and hamstring tendinopathy.

Many patients also report pain when lying on the affected hip in bed, as well as stiffness or pain during the night and upon rising in the morning.

If DBS progresses beyond the initial stage, the hip bursa may become inflamed (trochanteric bursitis), causing swelling, tenderness, redness or warmth in the hip.

To diagnose GMT, the doctor will take a detailed medical history and determine the nature and extent of your symptoms. Imaging, including X-rays and MRI, are not effective for diagnosing dead butt syndrome, but may be used to rule out other potential causes of your symptoms.

Dead Butt Syndrome Treatment

It is important to see an orthopedic or sports medicine specialist for comprehensive diagnosis and treatment, especially if your goal is to continue your training and running regimen.

The doctor will likely recommend that you back off your routine temporarily and apply the RICE treatment protocol (rest, ice, compression and elevation). Physical therapy and deep tissue massage may also be recommended. You may also be given specific muscle activation, strengthening and hip mobility exercises to do at home.

For more advanced DBS cases, the doctor may recommend platelet-rich plasma therapy or other regenerative medicine therapies using musculoskeletal ultrasound to guide the treatment.

To get you back up and running and prevent a recurrence of DBS, a functional movement screening (FMS) can be used to analyze the biomechanics of your gait and other sport-specific movement. Based on the results of your FMS, we will provide an individualized training program to help improve your form, increase your performance and reduce the risk of recurring dead butt syndrome or other injuries.

Robert Engelen, DO
Dr. Engelen served as a Lieutenant in the Navy and operated as the medical officer for Marines in North Carolina and for a deployment to Afghanistan. He has served as a team physician for a high school and a Division II Collegiate athletic sports team in Pittsburgh, and currently serves as the team physician for West Jordan High School.

Dr. Engelen has a special interest in fluoroscopic procedures, diagnostic ultrasound and ultrasound guided procedures, regenerative medicine, biomechanical analysis, and treatment of all sports and spine injuries. His unique practice focuses on non-surgical treatments.