Gluteal Tendinopathy: Causes, Symptoms, and How We Can Help

All information in this blog is supported by peer-reviewed research. There is currently no dedicated NICE guideline for this condition, so current evidence is used throughout. Reference numbers appear throughout, with the full list at the bottom of the page.

What Is Gluteal Tendinopathy?

Gluteal tendinopathy is pain arising from the tendons of the gluteal muscles, the large muscles that make up your buttock, where they attach onto the outer part of the hip bone (the greater trochanter). It is now widely recognised as the primary cause of pain on the outer side of the hip, a condition previously labelled "trochanteric bursitis." ¹

As we discussed in our Greater Trochanteric Pain Syndrome blog, research has shown that true bursitis is actually present in fewer than 10% of people with this presentation. The tendons themselves are almost always the real source of the problem. Gluteal tendinopathy is actually the correct, more specific term for when the gluteus medius and gluteus minimus tendons are the primary source of pain.

Who Gets It?

Gluteal tendinopathy is three times more common in women than men, and affects up to 25% of women over the age of 40. ² It is particularly common around and after menopause, and the hormonal changes of this period are thought to be a genuine contributing factor to tendon health. ¹ That said, it can affect anyone, and it is also seen in male and younger athletic populations, particularly runners.

What Is Actually Happening in the Tendon?

A tendon becomes "tendinopathic" when the normal balance between tendon tissue breakdown and repair is disrupted, usually by overloading the tendon faster than it can adapt. Rather than simple inflammation, this is more accurately understood as a failure of the tendon cells to keep up with the repair demands being placed on them, leading to a build-up of disorganised, weaker tissue. ³

In gluteal tendinopathy specifically, compression of the tendon against the greater trochanter plays a particularly important role alongside tensile (pulling) load. This means that certain positions and movements place the tendons under a squashing force as well as a stretching one, and avoiding these positions while the tendon is irritated is a genuine and important part of recovery.

Common Signs and Symptoms

• Pain on the outer side of the hip, sometimes spreading into the outer thigh

• Tenderness when pressing directly over the outer hip bone

• Pain that is often worse lying on the affected side at night

• Pain with walking, particularly on uneven ground, stairs, or uphill

• Pain that builds during activity and lingers afterwards

• Stiffness and discomfort first thing in the morning that eases with gentle movement

• Pain that comes on during or after running, particularly with higher mileage

Risk Factors

• Female sex and menopause, with oestrogen thought to play a role in gluteal tendon health ¹

• Age, most common from the 40s onward ²

• Excessive or sudden increases in loading, such as dramatically increasing running mileage or hill training ³

• Prolonged sitting or habitual postures that compress the tendon, such as crossing your legs, sitting with your weight shifted to one side, or standing with one hip dropped out ¹

• Weakness in the gluteal muscles, which can lead to altered load distribution through the tendon

• Biomechanical factors, including a wide pelvis, reduced hip external rotation, and an adducted (crossing midline) walking pattern, all of which increase compressive load on the tendon ¹

• Smoking and certain medications, recognised as modifiable risk factors across tendinopathies generally ³

The Compression Problem: Why Certain Positions Make It Worse

This is one of the most practically useful things to understand about gluteal tendinopathy. Compressive load, the squashing of the tendon against the underlying bone, is a key driver of symptoms, and some everyday positions produce significant compression on the tendon. ¹

Positions that tend to aggravate gluteal tendinopathy include:

• Crossing your legs when sitting

• Sitting with your weight shifted to the affected side

• Standing with your hip dropped out to one side (hip hitching)

• Stretching aggressively across the body, such as a cross-body hip stretch

• Walking with your legs crossing your midline (a narrow, adducted gait pattern)

One of the most immediately helpful things you can do, even before treatment, is become aware of these positions and avoid them. This is not about permanent restriction, it is about reducing the compressive irritation on the tendon while it is healing.

Red Flags to Watch For

Gluteal tendinopathy is a benign condition. Please seek prompt medical assessment if you experience:

• Sudden, severe outer hip pain following a fall or trauma (possible fracture)

• Inability to bear weight

• Fever or warmth around the hip

• Significant, unexplained weight loss alongside hip pain

How Is It Diagnosed?

Gluteal tendinopathy is a clinical diagnosis, meaning it can usually be identified through a thorough history and hands-on examination without the need for imaging. ¹ Research has shown that combining findings from the patient interview, palpation, and specific active tests improves diagnostic accuracy significantly compared to any single approach alone. ¹

A 30-second single-leg stance test (standing on the affected leg for 30 seconds to see if it reproduces the familiar hip pain) has been specifically shown to have a strong association with MRI-confirmed gluteal tendinopathy. ⁴ Ultrasound or MRI can be useful where the diagnosis is unclear or where the person isn't progressing as expected, but routine imaging isn't needed to get started with treatment.

Myths vs Facts

"I should stretch my hip to ease the pain." This is one of the most common and counterproductive things people do with gluteal tendinopathy. Cross-body hip stretches place compressive load directly on the tendon and can significantly aggravate symptoms. Stretching the area is not recommended in the early stages of treatment.

"A steroid injection is the quickest fix." Research has shown that steroid injections are no better than a wait-and-see approach in the longer term, and may even be inferior. Education and targeted exercise produced better outcomes than injection at both 8 weeks and at 1 year in the landmark LEAP trial. ¹

"Rest is the best thing I can do." Tendons need appropriate load to heal and strengthen. Complete rest leads to further deconditioning of the tendon and the surrounding muscles. A graded, progressive loading programme is what the evidence consistently supports. ⁵

How We Can Help

Exercise and education are the recommended first-line treatment for gluteal tendinopathy, and the evidence behind this is genuinely strong. Research published in 2025 found that exercise and education together produced a meaningful improvement in both pain and function in the short term. ⁵ When combined with the right load management advice, this approach outperforms steroid injection at every follow-up point studied. ¹

Osteopathic manual techniques and manual therapy: used to address restriction in the hip, pelvis, and lumbar spine, and to support the overall treatment programme. Manual therapy works best alongside exercise rather than as a standalone treatment for tendinopathy.

Deep tissue and sports massage: targeted soft tissue work for the gluteal muscles and surrounding hip and pelvis, helping to reduce the muscle tension that can alter load distribution through the tendons.

Medical acupuncture and cupping: used as part of a broader treatment plan to support pain management during rehabilitation.

Load management education: one of the most immediately useful things we cover at your first appointment is helping you understand which positions and movements compress the tendon and how to modify these during your recovery, without unnecessarily restricting your life.

Exercise: The Most Important Part of Recovery

Progressive loading exercise, building up the tendon's capacity to tolerate load over time, is the cornerstone of gluteal tendinopathy recovery. ⁵ Research on heavy slow resistance training combined with education for gluteal tendinopathy found it was both feasible and showed promising improvements in pain and function over a 12-week programme. ⁶

Phase 1: Settling the tendon down

Before progressing to strengthening, it is important to reduce the compressive irritation on the tendon. This means:

• Avoiding the positions listed above that compress the tendon

• Modifying walking distance or running volume temporarily

• Gentle isometric (static) gluteal exercises to maintain some tendon load without aggravating it

Isometric wall press: standing side-on to a wall with the affected hip facing it, press the outer hip gently into the wall and hold for 30 to 45 seconds. This provides pain-free loading of the gluteal tendon without any compressive movement.

Phase 2: Progressive strengthening

• Side-lying hip abduction: lying on your side with your leg straight, slowly lift the top leg to around 30 degrees and lower slowly. Builds gluteus medius strength directly

• Clam shells: lying on your side with knees bent, slowly open the top knee like a clamshell. Good early-stage activation of the deep gluteal rotators

• Glute bridges: lying on your back with knees bent, squeeze the glutes and lift the hips slowly. Builds overall gluteal strength

• Single-leg glute bridge: a progression once the basic bridge is comfortable, loading each side independently

Phase 3: Functional loading

• Side-stepping with a resistance band: walking sideways with a band around the ankles, building gluteus medius strength in a more functional pattern

• Step-ups: a controlled step up and down, progressing height gradually as strength improves

• Single-leg stance progressions: building the ability to stand and load through one leg confidently, which is fundamental for walking, stairs, and running

Your practitioner will guide the pace of progression, since moving through the phases too quickly is one of the most common reasons symptoms return.

What to Expect at Your First Appointment

We will take a thorough history of your symptoms, including when and how they started, what positions and activities aggravate them, and your activity levels. We will carry out a hands-on assessment using specific clinical tests for gluteal tendinopathy, alongside a broader assessment of your hip strength, movement patterns, and posture. We will explain clearly what we find, cover the key load management advice specific to your lifestyle, and build a progressive exercise programme tailored to your stage of recovery.

Frequently Asked Questions

Do I need a scan? Not usually. Gluteal tendinopathy is a clinical diagnosis, and imaging is generally only needed where the diagnosis is unclear or you're not progressing as expected.

Will a steroid injection fix it? Research shows that steroid injections are no better than a wait-and-see approach in the long term, and that exercise and education consistently outperform injection at the 1-year mark. We would recommend starting with a structured exercise programme rather than relying on injection as a first step.

Can I keep running? Possibly, with modification. Reducing volume, avoiding hills and uneven ground in the early stages, and addressing your running mechanics can allow you to continue at a modified level whilst your tendons adapt. Your practitioner will guide what is appropriate for you.

How long will it take to get better? This varies depending on how long symptoms have been present and how irritable the tendon currently is. Most people see meaningful improvement over 8 to 12 weeks of structured treatment and exercise, though full recovery, particularly for runners wanting to return to high mileage, may take longer.

Recognise these symptoms? Get in touch using the contact form and we will assess and build the right treatment plan for you.

References

1. Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter DJ. Current and future advances in practice: tendinopathies of the hip. Rheumatology Advances in Practice. 2024;8(2):rkae022. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11003818/

2. LEAP-Ireland Feasibility Trial of Exercise and Education for Gluteal Tendinopathy. ClinicalTrials.gov. 2026. Available at: https://clinicaltrials.gov/study/NCT05516563

3. Understanding Gluteal Tendinopathy: Diagnosis and Treatment. A Narrative Review. European Journal of Musculoskeletal Diseases. 2024;13(3):47-59. Available at: https://www.researchgate.net/publication/388397037

4. Load Modification Versus Standard Exercise for Greater Trochanteric Pain Syndrome. ClinicalTrials.gov. Available at: https://cdn.clinicaltrials.gov/large-docs/71/NCT03571971/Prot_SAP_000.pdf

5. Bremer T, Nicklen P, Fearon A, Morrissey D. The efficacy of gluteal tendinopathy treatments: a systematic review. Clinical Rehabilitation. 2025. Available at: https://journals.sagepub.com/doi/10.1177/02692155251327298

6. Heavy slow resistance training combined with patient education in patients with gluteal tendinopathy: a feasibility study. ScienceDirect. 2025. Available at: https://www.sciencedirect.com/science/article/pii/S2468781225001730