Gluteal tendinopathy is the leading cause of persistent pain on the outside of the hip. It’s more common in women over 40, though it affects runners and active people of all ages too. It shows up as an ache over the bony point of the hip that’s worse lying on that side, climbing stairs, standing on one leg or sitting cross-legged. It’s frequently misdiagnosed as a hip joint problem or a back issue, and it responds well to the right treatment.
Understanding gluteal tendinopathy
The gluteus medius and minimus tendons attach to the bony point on the outside of the hip. When they’re repeatedly squeezed against the bone, particularly with positions that cross the leg over the body, or overloaded by a change in activity, they become painful and less able to handle load. Compression is a key part of the problem, which shapes both the advice we give and the exercises we choose.
Contributing factors include:
- A sudden increase in walking, running or standing
- Positions and habits that compress the tendon: crossing legs, standing with weight on one hip, lying on the painful side
- Weakness of the hip muscles
- Hormonal and age-related changes in tendons, particularly around and after menopause
- Previous hip or back problems
Symptoms we commonly see
- Aching pain over the outside of the hip that sometimes spreads down the outer thigh
- Pain lying on the affected side, and sometimes on the other side
- Pain climbing stairs, getting up from a chair, or walking uphill
- Pain standing on one leg, putting on socks or dressing
- Tenderness when pressing over the bony point of the hip
Our evidence-based approach
A randomised trial of 204 people with gluteal tendinopathy compared a program of education plus exercise with a corticosteroid injection and with a wait-and-see approach. At eight weeks, 77% of the education-plus-exercise group reported meaningful improvement, compared with 58% after injection and 29% with no treatment. At 52 weeks, education plus exercise still did better than injection for overall improvement. Our approach includes:
- Assessment to confirm gluteal tendinopathy and rule out hip joint, lower back and other causes of outer hip pain
- Education about compression, including sleeping positions, sitting, standing and everyday habits that irritate the tendon
- Load management, so you can stay active without flaring the tendon
- Progressive strengthening of the hip abductors and the muscles around the hip, starting at a level the tendon tolerates and building up
- Gradual return to walking, hills, running and sport, as capacity improves
- Supervised strength work in our private gym as you progress
- Hands-on treatment or dry needling where it eases symptoms alongside the rest of your plan
See our hip and groin pain page for other causes of hip pain and our tendon pain page for how tendon problems are managed in general.
What to expect: recovery timeline
- First two to four weeks: pain often starts easing as you change compressive habits and begin gentle loading
- Around eight weeks: many people notice clear improvement with consistent exercise
- Beyond: strength continues to build over a few months, and long-standing cases can take longer
When to seek help urgently
Seek prompt assessment if your hip pain follows a fall or injury, you can’t put weight through the leg, or you have hip pain with fever, redness, warmth or feeling unwell. Constant severe night pain unrelated to position also needs review.
References
- Mellor R, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662.
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910-922.
- Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7:1.