2007 AUG 14  -- "Greater trochanteric pain syndrome is commonly due  to gluteus minimus or medius injury rather than trochanteric bursitis.  Gluteal tendinopathy most frequently occurs in late-middle aged  females," scientists writing in the journal European Radiology

report.

While  that statement is based on scientific analysis, the simple question is  to ask why you may have this problem in the first place. Do you just  run, or do you bike as well?  Do you spend a lot of your day seated?   Can you stand comfortably on one leg? If your answers are Bike, Yes, and  No, you have a lot of work to do before hitting the road. We'll take it  from there. (pic from washington.edu)...

One thing to bear in mind is that problems with your spine do not   always result in back pain. After reviewing hundreds of scan results   versus pain symptoms, I can tell you that there is no direct   correlation. Many people with junk in the back have no back pain, and   many people with clean scans have plenty of back pain. Where spinal   problems usually matter is when there is direct pressure on the nerve   roots exiting the spine, due to bulging or herniated disks. Disk   degeneration and dehydration are normal as we age.

But how do we tie this in with the Glutes?   Look again at the picture above, and imagine... What happens if the   pelvis, in the horizontal center of the picture, were to rotate, so the   Lumbar spine shown at the top would shift to the rear of the   longitudinal axis of the Femur and Hip socket, which would be thrust   forward? Your spine, in order to keep your back erect, would flatten the   normally inward Lumbar curve, and the disks (one shown above the  pelvis  in the pic) would be  compressed as a result. Any bulge here would  worsen, possibly putting  pressure (depending on where the bulge occurs)  on the nerve root as it  exits the neural foramen (small hole near bottom  center of vertebra as  pictured).

If you also had tight  hip flexors which  attach to the lumbar spine), there would be  additional pressure on  these disks, whether standing or not. Putting  your knees up while lying  down relieves this pressure.

One  tie-in with the glutes is the likelihood that the pelvis is not neutral  and your disks are  compromised. Symptoms of Sciatica, or pain running  down the legs, can  result from this scenario if the sciatic nerve roots  are impinged in  any way. Another connection is that portions of these  nerves pass  between the minor glutes,  where swelling or chronic  contraction can pressure them as well. In  this case, It is more likely  to be pain down the legs without tingling  and numbness, which is  normally associated with the spinal version of  sciatica.

In  other words, your symptoms can result from gluteal pressure alone,  though it appears there may be a connection to a  degenerated spine. The  important thing to check for is the rotation of  the pelvis, which is a  sign of glutes in spasm. Other signs of gluteal problems are the pain  you feel when the affected hip is on top when  you are lying down, which  causes the femur to drop and stretch the  tight gluteal muscle,  resulting  in a burning pain that wakes you up. If this were from your  back, you  could expect it to intensify when the ful weight of your body is  compressing it while standing, which also brings tight hip flexors into  play.

While  pain from a forward bend could be from either cause, it is a helpful  clue when considered in conjunction with the above signs.  The way to  tell would be to flex the spine forward without stretching  the glutes.  To do this you would have to immobilize the pelvis with  respect to the  hips, bending forward only at the spine to check for  symptoms, glutes mostly out of the picture. Outside of clamping yourself  into a vise this is hard to do, but you may find a way.

Normally, exercise is far better for the gluteals than sitting, but  you have certainly been getting some exercise. Each time you take a  step, these muscles keep your hips level. They have to carry about twice  your weight to do this, because the muscle pulls on the short end of  the hip to balance the other (longer) end. When you run, the pressure  increases by a factor of how many Gs of impact your running  produces.  In most people this is about triple the normal force of just standing on  one leg, so you can see how the added impact of running can irritate  these muscles when they are already in spasm. In fact, almost any  exercise can potentially make them worse. They may even be reacting to  over-exercise at this time.

The irony is  that an  over-exercised muscle can become stiffer or less active, depending on  the muscle and its location. This might be restated, as  too much or too  little tone. Tone is controlled by your brain in response to the  perceived health of the muscle. In your case, I would guess stiff (too   much) and resistant to movement. Neither state bodes well for exercise   of any kind, even though they may appear weak and in need of   strengthening. The best time for strengthening is before an injury to  prevent injuries from happening, and after injuries begin to heal, to  condition them for use. In between, during injury, bad timing of the  exercise can delay your progress. Just resting them, on the other  hand,  is of little benefit.

The ideal therapy at this  point  is to stimulate circulation in the muscle without loading it. This can  be done with a combination of contrasting hot and cold packs, and static  massage of the muscles in between the hip and rim of the  pelvis as  pictured above, best accomplished at home by laying on a  tennis ball  and rolling it into that area. Pause on sensitive spots to interrupt  circulation, then release the pressure to stimulate blood flow. You  don't have to smash the area around to irritate it further, just apply  strategic control of circulation to encourage vasodilation. It's easy,  but is not a magic bullet; you still need to heal, but  increased  circulation creates the ideal conditions for healing to occur. Plan on  spending a few days to a few weeks facilitating repair. Painkillers  and/or targeted exercise at this point can be counterproductive, even  though drugs can deaden pain and exercise can stimulate the production  of natural painkilling endorphins. It's not about the pain, it's about  the healing, and about restoring proper function to these very important  muscles. Properly treated, they will improve. Otherwise, they will  continue to malfunction under heavy use.

To  answer  your question fully, this can be done professionally, or under the  supervision of your Dr. or P.T..  The principles on which this type of  therapy is based were developed over years by physicians, and have come  into wider use since the 1990s. I perform this kind of work for a living  by prescription, and can tell you it works quite well. It's hard to  find an elite athlete who does not use it to their advantage. I also  work on myself, as anyone can - as long as they know where to work to  acheive the desired results. Once things are on the mend, it will be  time to conclude the rehab process, by completing a course of  targeted  exercises. Then, if all goes well, you can run injury-free!