Gluteal Muscle Injuries: Diagnosis and Rehabilitation Options

Gluteus maximus injury

Hello, doctor.
I am currently a university student.
In May 2016, I sustained an injury while playing basketball.
Over the past year, I have undergone various treatments and received different diagnoses from multiple physicians, but my condition has not improved.

Injury details: At that time, I was competing for a rebound and landed with an unstable center of gravity, with only my right foot touching the ground first.
This caused all the pressure to concentrate on my right leg and right hip, resulting in noticeable pain in my right hip.
After resting for two days, the pain from the strain disappeared, leaving only soreness in my thigh.
I then began daily jogging as aerobic exercise, which worsened my condition.
To this day, over a year later, I am unable to stand or sit for extended periods.
During this year, I initially sought treatment from traditional Chinese medicine for two months, but there was no significant improvement.
I then received treatment at Taichung Veterans General Hospital for six months, where the attending physician diagnosed me with a herniated disc.
After six months of lumbar traction, there was still no significant improvement.
Two months ago, I consulted at National Taiwan University Hospital, but they could not determine if there was a gluteus maximus injury.
X-rays and MRI scans ruled out nerve compression issues in the lumbar spine and pelvis.
Ultimately, the doctor only suggested trying physical therapy.
Doctor, what tests should I request from my physician to help identify my condition? I have been suffering from hip pain for over a year now, and during this time, I have been unable to work or exercise.
If I stand for more than 20 minutes, my gluteus maximus will hurt for an entire day.
Thank you.

Shung, 20~29 year old female. Ask Date: 2017/05/13

Dr. Yin Xinbei reply Rehabilitation

A muscle ultrasound can be performed to check for swelling or inflammation in the gluteus maximus or piriformis muscle.

Reply Date: 2017/05/13

More Info

Understanding gluteal muscle injuries, particularly in the context of your experience, requires a comprehensive approach that includes accurate diagnosis and effective rehabilitation strategies. Given your history of injury while playing basketball and the subsequent treatments you've undergone, it seems that your condition may be more complex than a simple muscle strain.

Diagnosis
From your description, it appears that the initial injury occurred due to an awkward landing, which could have led to a variety of issues, including muscle strains, tendon injuries, or even deeper structural problems such as hip labral tears or sacroiliac joint dysfunction. The fact that you experienced immediate pain in the gluteal region suggests that the gluteal muscles or their tendons may have been affected.

Since you have undergone multiple treatments without significant improvement, it may be beneficial to consider further diagnostic imaging or assessments. Here are some suggestions for tests you might discuss with your physician:
1. MRI with Focus on Soft Tissues: While you have already had an MRI, ensure that it specifically assessed the gluteal muscles, tendons, and surrounding soft tissues. Sometimes, subtle injuries may not be apparent in standard imaging.

2. Ultrasound: This can be particularly useful for evaluating muscle and tendon injuries in real-time. It can help visualize any tears or inflammation in the gluteal muscles.

3. Functional Movement Assessment: A physical therapist can perform a detailed evaluation of your movement patterns to identify any compensatory strategies you may be using due to pain, which could be contributing to your ongoing discomfort.

4. Electromyography (EMG): If nerve involvement is suspected, an EMG can help assess the electrical activity of the muscles and determine if there is any nerve damage or dysfunction.

Rehabilitation Options
Once a thorough diagnosis is established, rehabilitation can be tailored to your specific needs. Here are some general strategies that may help:
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A therapist can design a program focusing on strengthening the gluteal muscles, improving flexibility, and correcting any biomechanical issues that may be contributing to your pain.

2. Gradual Return to Activity: It’s essential to gradually reintroduce activities that you enjoy, such as running or playing basketball, but only after ensuring that your body can handle the stress without exacerbating your symptoms.

3. Pain Management Techniques: Modalities such as ice, heat, ultrasound therapy, or electrical stimulation can help manage pain and inflammation during the rehabilitation process.

4. Strengthening Exercises: Focus on exercises that target the gluteal muscles, such as bridges, clamshells, and hip thrusts. These exercises can help restore strength and function to the affected area.

5. Cross-Training: While recovering, consider low-impact activities such as swimming or cycling to maintain cardiovascular fitness without placing excessive strain on your gluteal muscles.

6. Education and Ergonomics: Learning about proper body mechanics and posture can help prevent further injury. Ergonomic adjustments in your daily activities, especially if you are sitting for long periods, can also be beneficial.

Conclusion
Given that your symptoms have persisted for over a year, it is crucial to advocate for a thorough evaluation and possibly seek a second opinion if you feel your concerns are not being addressed adequately. Persistent pain in the gluteal region can significantly impact your quality of life, and a targeted approach to diagnosis and rehabilitation is essential for recovery. Engaging with healthcare professionals who specialize in sports medicine or musculoskeletal disorders may provide you with the insights and treatment options needed to address your condition effectively.

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