Gluteal tendinopathy - endless pain - losing my mind

I've been living with this since 2020. It's still unresolved. I've had two injections--the first one in 2021 which helped for a few months (did not eliminate the pain... just helped a bit). The second time was in December 2022 and the two injections--one for the gluteal tendinopathy and the other in the hip for bursitis--were excruciating. I needed a cane to walk for several days and for all that, got no relief. I've done three rounds of physical therapy, which help for a while but the pain ends up returning full-force. Yes, I am depressed about it too. Nobody has mentioned shock treatments, although I use a portable tens device at home (I purchased it through Amazon). It does not offer any lasting improvement. Everything is temporary. If I feel good, I try to do things that I haven't done due to pain (deep cleaning, etc.), but I can only do about one hour of activity or I cripple myself for the next week. I take a pain pill nearly every day (Mobic) but I hate taking them because I don't want to ruin my stomach lining. They take the edge off usually, unless I'm really sore after being active the day before. Six years of this! I need to do the PT exercises regularly but I either forget (if I'm feeling reasonably comfortable) or I'm hurting too bad to do them. I just need to get into a routine. Sorry this is so long. People tell me you can be cured from this but I'm not sure at this point. I'm 66. I USED to be very active and fit.

@meterrilee Oh yes, those of us with any kind of chronic pain can empathize with "Six years of this! I need to do the PT exercises regularly but I either forget (if I'm feeling reasonably comfortable) or I'm hurting too bad to do them."

But honestly, what an otherwise forgettable PT said 30 years ago has always stuck with me "Motion is lotion" - so I move every day, in spite of the hurting. Years ago, I had severe hip bursitis after revision surgery. The orthopedic surgeon was definite - "these exercises are forever" - as long as I remember that, it has not flared.

Here is a tip another mentor and I have shared before - start your day with gentle stretches - BEFORE you even get out of bed. This imbeds it in my routine, just like using my inhalers before coffee, or taking my meds before I brush my teeth.

Here is another idea for you to consider - the "spoon theory" - it teaches you to measure your energy output to avoid overdoing. This can end the cycle of feel good, do too much, crash, hurt like mad... For those of us formerly go-getters, it is a hard thing to learn. Finally, in my mid-70's, I am beginning to get it.
https://connect.mayoclinic.org/discussion/how-do-you-plan-your-day-and-conserve-energy-are-you-a-spoonie/

@sueinmn Thank you for this. I've never heard of "spoonie" before. I will look into it further, but at first glance, I understand the concept and it makes sense. I normally make lists of tasks on my calendar with moveable post-it notes (and usually way too optimistic for what I can accomplish these days). If I don't get it done on one day, it gets lifted and stuck to the next day. I've gone weeks and weeks for some items. 😀 I believe you are correct about the motion and exercise requirements. I need to incorporate these into a normal routine. Some nights I'm unable to fall asleep at all, and finally do around 5 a.m. out of complete exhaustion. Then I sleep longer than I want and jump right into the day without any time to stretch or do some of the PT moves. Thank you again for your caring response. I appreciate it.

@sueinmn
Thank you for your thoughtful response. I began hip pain 2 years ago, I have 2 labral tests, tears in gluteus Maximus, the greater trochanter, and pain in IT band. I have had off the charts pain in September. I also have bone on bone pain and once this hip pain is resolved headed for a 3 level fusion, L-3-S-1. The hip pain is a pain I never thought possible. 1.5 years PT. 4 months with current PT who has helped a lot as this is a result of 5 broken metatarsals and improper walking. I take enough pain pills that would kill an ordinary person, however Tylenol seems to be the best actually. Now that cold weather is here, MY Myasthenia Gravis has been acting up though it is well managed.
I have to laugh. Type A personality, only I can do it perfectly, 72 yrs old, refusing to relax when I feel good so I too am on that wheel.
And yes when we feel like we make progress then we throw all the good habits out the Window. My PT is dismissing me end of month due to Medicare limits, so I will have to begin a new habit. Thanks again for this reminder.

I’m having same issue after my lumbar surgery with fusion last year March 2025. Pain started in August and gotten worse, went for MRI and was diagnosed with this. Seeing my Ortho tomorrow and I’m sure he is going to want to do injections which I will not do don’t work for me. Also have issues with Sciatica pressing on periformis muscle. He thinks I’m self disgnosing and says this really isn’t common when I know it is. I’m still doing PT but just a bandaid for the pain, don’t know what I am going to do.

@abdamurph
So sorry. I'm not the doctor, but with my L5/S1 issue that led to all of this, my doctor said the piriformis is spasming. It is common.
I'm into my 8th month of daily pain. I manage it better - i ice a lot - but it's too long.
Getting an epidural in 2 weeks - had one 6-7 months ago.
Fingers crossed. Next step a microdiscectomy or whatever it's called.
Key problem - after all this time, a piece of the disc is still pressing on the nerve.
Good luck to you.

@abdamurph I also had L5-S-1 fused 1 years ago. I was better for a couple years and then it’s downhill. I did tons of PT, water therapy, acupuncture with no improvement. 7 years ago I worked with a Pain Specialist at Rush, a reputable hospital in Chicago. He tried 10 minimally evasive procedures with the last being the spinal stimulator with no luck. Every pain starts on my left back and sciatica too. Until he finds something new, Norco is my only relief. I live alone in a big house. I would like to downsize one day.

Has any of you tried "shock therapy?" - EPAT (Extracorporeal Pulse Activation technology)?
That helped me tremendously when I couldn't walk at all from high grade tendon tears of my Left glut med and min, with tears, atrophy, and fatty infiltration of the muscles themselves. This was a post-COVID affliction since I'm a big exerciser and the "squat queen," so there's no way those muscles could have atrophied on their own.
Anyway, I'm now able to take walks in the hills where I live, so have hope and see if shock therapy would be useful for you.

Current - long-term pain localized to the upper hamstring / ischial tuberosity. Pain is aggravated by walking, sitting, or prolonged driving and has persisted despite:
• Physical therapy
• Massage
• Shockwave / softwave therapy
• Injections (various)
• Scrambler therapy

April 11, 2024, ultrasound-guided right quadratus femoris muscle corticosteroid
injection which helped about 20% to 30%, but then the symptoms returned back to
baseline.

November MRI

Significant findings include
there is no significant disk herniation or central canal stenosis. There are changes consistent with right L4-5
laminectomy/partial facetectomy. There are edematous degenerative endplate changes demonstrated left at L4-L5 as
well as a new Schmorl's node at L4 and inferiorly at L2. There is mild-to-moderate left and mild right L5-S1 and
mild-to-moderate left L4-L5 facet arthrosis in addition as well as ongoing synovitis at the left L4-L5 facet joint.

Late 2025 - Twin Cities Pain Clinic and had an ischial bursa or potential trochanteric
bursa corticosteroid injection performed.
helped somewhat but overall did not make a huge difference with respect to pain
difference with respect to his pain.

Current symptoms are very similar to those in the past -
primarily gluteal pain, right greater the left. This is directly at the "hip bones."
Not having any significant low back pain

Symptoms radiate distally into the posterior thigh on the right and into the posterior leg at times and also can experience numbness in the dorsum of the foot on the right greater than the left.

In morning, not having any discomfort. The pain will then intensify throughout the
day. Typically around noon take Ativan and Aleve which has been helpful,
and if he lies down meditates for a period of time that does help his symptoms as well.

ASSESSMENT
#1 Right greater than left inferior gluteal pain
#2 MRI evidence of bilateral ischial femoral impingement, right greater than left
#3 History of right L4-L5 diskectomy and synovial cyst resection on March 7, 2018

Diagnosis: Sciatic nerve tethering / entrapment at the ischial tuberosity WITH proximal hamstring tendinopathy

Currently considering :

Sciatic Nerve Hydrodissection at the Ischial Tuberosity (ultrasound-guided)

What it does:
• Gently separates the sciatic nerve from the hamstring tendon
• Breaks adhesions that formed over years
• Reduces nerve “burning” almost immediately
• Restores sliding of the nerve during walking and sitting
• Often improves car sitting and forward bending the same day or within a few days

Hydrodissection targets:
• Burning (nerve)
• Deep ache (tendon)
• Radiation down thigh (nerve)
• Pain bending forward (nerve tension)
• Pain getting out of car (nerve adhered)
• Localized pain at sit bone (tendon origin)

Go to an MFR therapist. (try a couple). They will definitely help. I have piriformis dysfunction, degenerative disc disease and much more. You NEED to strengthen your back & core (do pilates - get into yoga). I also will take a stab at - you sit a lot, don't you? Stop sitting and walk. I did P.T. for thirty 30 years, didn't help a thing. Have your SI joints looked at too. Also notice if the weather changes bother you. it could be your hips. Go for an eval with a hip surgeon. I had mine replaced. The cushion in the joints deteriorated by my 50's and it threw my gait off and it messed with my lower back, gluts, and SI joints. Things helped in the beginning but after 15 years of trying so many things (including trying shoe/heel inserts) I got into see a good orthopedic surgeon and it was my hips!!!!