Gluteal Tendinopathy

What is Gluteal Tendinopathy?

The hip is surrounded by several important muscles that help stabilise the pelvis and move the leg. Two key muscles, the gluteus medius and gluteus minimus, sit on the outer side of the hip. Their tendons attach onto a bony area called the greater trochanter (the prominent part of the thigh bone you can feel at the side of your hip). These muscles and tendons play a major role in keeping the pelvis level during walking, supporting balance, and allowing sideways leg movement. Gluteal tendinopathy is a condition where the gluteus medius and/or minimus tendons become irritated, weakened, or overloaded. It develops when the tendons are unable to cope with the stress being placed on them, leading to pain and reduced function around the outer hip. It is one of the most common causes of lateral hip pain and is sometimes referred to as Greater Trochanteric Pain Syndrome (GTPS). Most cases improve with the right combination of targeted exercise, load management, and supportive treatments.

Understanding Gluteal Tendinopathy

Gluteal tendinopathy typically causes pain around the outer side of the hip, but the discomfort can vary widely, from a mild ache to sharp, activity-limiting pain. Symptoms often develop gradually and may fluctuate depending on activity levels and posture. Common symptoms include:

• Pain on the outer side of the hip: The key symptom. This pain may spread down the outer thigh but usually doesn’t go below the knee.
• Pain when lying on the affected side: Many people find the pain disrupts sleep because pressure on the tendon increases discomfort.
• Pain with walking, climbing stairs, or standing on one leg: Activities that load the tendon can aggravate symptoms, especially prolonged walking, uphill walking, or running.
• Pain when crossing legs or sitting with legs together: Positions that compress the gluteal tendons against the hip bone often worsen symptoms.
• Tenderness over the greater trochanter: Pressing on the outer hip bone typically reproduces the familiar pain.
• Weakness or stiffness around the hip: Some people notice reduced hip strength, difficulty with balance, or a feeling of tightness in the outer hip or buttock.

Causes and Risk Factors

Gluteal tendinopathy develops when the gluteus medius or minimus tendons become overloaded or irritated, often due to a combination of mechanical stress, muscle weakness, and compressive forces around the outer hip. It’s especially common in active individuals and in people whose day-to-day postures place strain on the tendons.

• Activity related • Overuse or sudden increases in walking/running • Tendon compression (crossed legs, standing with hip out, lying on one side)
• Biomechanical • Weak gluteal muscles • Poor hip/knee alignment during walking or running • Tight IT band causing friction
• Individual factors • Age over 40 • Female sex • Long periods of standing or walking • Running or high-impact exercise • Back pain, hip/knee arthritis, or higher body weight

Diagnosing Gluteal Tendinopathy

Diagnosing gluteal tendinopathy is usually straightforward and is based on a combination of your symptoms, a physical examination, and, when needed, imaging to confirm the diagnosis or rule out other causes of lateral hip pain. A clinician will begin by asking about your symptoms, physical activity, daily habits, and anything that makes the pain better or worse. During the examination, they will check for tenderness over the outer hip (particularly over the greater trochanter) and assess hip strength, posture, and gait. Specific movements or positions that reproduce your pain, such as standing on one leg or hip abduction tests, help confirm tendon involvement.

• Ultrasound An ultrasound is often the first imaging choice because it can visualise the gluteus medius and minimus tendons in real time. It can identify tendon thickening, tears, or associated bursitis, and can also help rule out other issues such as trochanteric bursitis or IT band problems. Ultrasound is also useful for guiding targeted injections if needed later.
• MRI An MRI provides a more detailed view of the tendons and surrounding soft tissues. It may be recommended if symptoms are severe, longstanding, or not responding to early treatment. MRI is particularly helpful in identifying partial or full-thickness tendon tears and in ruling out other hip joint or lower back causes of pain.

Treatment Options

Gluteal tendinopathy usually improves with the right combination of activity changes, targeted exercises, and supportive treatments. Recovery can take several weeks to months, but most people respond well without needing surgery.

Conservative Treatments

• Activity modification Reducing or avoiding activities that place excessive load on the outer hip, such as long periods of walking, running, or standing on one leg, can help settle irritation. Small adjustments to daily habits (like avoiding crossing your legs or sleeping on the painful side) can also make a noticeable difference.
• Pain relief & anti-inflammatories Simple analgesics or anti-inflammatory medication can help during painful flare-ups. Ice or heat may also ease discomfort, depending on what feels best for you.
• Physiotherapy A structured strengthening programme is the core of treatment. Physiotherapy focuses on improving the strength and control of the gluteal muscles, stabilising the pelvis, and gradually increasing tendon load. Exercises typically begin gently and progress as your symptoms improve.

Procedural Options

• Steroid injections A steroid injection, usually guided by ultrasound, can help reduce pain and inflammation, particularly if bursitis is contributing to symptoms. Although helpful for short-term relief, injections are generally used alongside physiotherapy rather than as a standalone treatment.
• Shockwave therapy Some people benefit from extracorporeal shockwave therapy (ESWT), which uses targeted sound waves to stimulate tendon healing and reduce pain. This is usually considered if symptoms haven’t improved with exercise-based therapy.
• Surgery (rare) Surgical options are only considered if symptoms persist despite comprehensive conservative treatment or if imaging shows a significant tendon tear. Most people do not require surgery.