Gluteus Medius Tendinopathy: Understanding Causes, Symptoms, and Pain Management

Gluteus medius tendinopathy is a common but often underdiagnosed source of hip pain, particularly in active individuals and older adults. The condition arises when the gluteus medius tendon—a key stabiliser of the hip—undergoes degeneration or irritation, leading to pain and functional limitations.

If you’ve been experiencing persistent hip pain during activities like walking, climbing stairs, or lying on your side, gluteus medius tendinopathy may be the culprit. In this guide, we’ll explore what gluteus medius tendinopathy is, its causes, symptoms, and the most effective strategies for pain relief and long-term recovery.

What Is Gluteus Medius Tendinopathy?

The gluteus medius is one of the three gluteal muscles and plays a crucial role in hip stability and movement. Located on the outer surface of the pelvis, it functions to abduct the hip (move the leg away from the body) and stabilise the pelvis during walking or running.

Gluteus medius tendinopathy refers to the degeneration or irritation of the tendon where the muscle attaches to the greater trochanter of the femur (the bony prominence on the outer hip). Unlike acute tendon tears, tendinopathy develops gradually due to overuse, leading to microtrauma and weakening of the tendon over time.

This condition is a leading cause of Greater Trochanteric Pain Syndrome (GTPS) and is commonly seen in runners, dancers, and middle-aged women.

What Causes Gluteus Medius Tendinopathy?

The primary cause of gluteus medius tendinopathy is repetitive overuse or excessive strain on the tendon, often combined with poor biomechanics or muscle imbalances.

Common Causes and Risk Factors:

• Overuse and Repetitive Movements:

  • Activities like running, walking long distances, or climbing stairs can place repetitive stress on the gluteus medius tendon.

• Muscle Weakness or Imbalance:

  • Weak gluteal muscles can lead to compensation from surrounding muscles, overloading the gluteus medius tendon.

• Poor Biomechanics:

  • Hip drop during walking or running (due to weak hip abductors) increases strain on the tendon.

• Leg Length Discrepancy:

  • Even minor differences in leg length can lead to uneven loading on the hips, contributing to tendinopathy.

• Age-Related Degeneration:

  • Tendons lose elasticity with age, making them more susceptible to microtears and degeneration.

• Sudden Increases in Activity:

  • Rapidly increasing training intensity or mileage without proper conditioning can overload the tendon.

• Postural Issues:

  • Poor pelvic alignment or excessive anterior pelvic tilt can increase gluteus medius strain.

Pro Tip: Gradual progression in training and incorporating strength and mobility work can help prevent gluteus medius tendinopathy.

Recognising the Symptoms of Gluteus Medius Tendinopathy

Gluteus medius tendinopathy typically presents as a gradual onset of lateral hip pain, often worsened by specific movements or positions.

Common Symptoms Include:

• Lateral Hip Pain:

  • Pain over the outer hip, often near the bony prominence (greater trochanter).

• Pain When Lying on the Affected Side:

  • Discomfort during sleep due to pressure on the inflamed tendon.

• Pain with Weight-Bearing Activities:

  • Walking, running, climbing stairs, or standing on one leg can provoke pain.

• Tenderness to Touch:

  • Pressing on the greater trochanter typically elicits tenderness or sharp pain.

• Weakness in Hip Abduction:

  • Difficulty lifting the leg to the side or maintaining balance during single-leg exercises.

• Pain During Hip Movements:

  • Side-lying leg lifts, crossing legs, or prolonged sitting can exacerbate symptoms.

If left untreated, gluteus medius tendinopathy can progress to tendon tears or lead to chronic hip pain.

Diagnosing Gluteus Medius Tendinopathy

A proper diagnosis is essential to develop an effective treatment plan and differentiate gluteus medius tendinopathy from other hip conditions like trochanteric bursitis or hip osteoarthritis.

Evaluation Process:

• Medical History & Physical Exam:

  • The clinician will ask about the onset of pain, activity levels, and aggravating movements.
  • Special tests like the Trendelenburg Test (observing pelvic drop during single-leg stance) and resisted hip abduction can help identify weakness or pain.

• Palpation:

  • Pressing over the greater trochanter will often elicit tenderness if the gluteus medius tendon is involved.

• Imaging Studies:

  • Ultrasound: Useful for visualising tendon thickening, tears, or inflammation.
  • MRI: Provides detailed images to assess the extent of tendon degeneration and rule out other conditions.

Effective Pain Management and Treatment Options

The goal of treatment is to reduce pain, restore tendon strength, improve hip stability, and address contributing factors to prevent recurrence. Most cases of gluteus medius tendinopathy respond well to non-surgical treatments.

1. Initial Pain Management

• Activity Modification:

  • Reduce or temporarily stop activities that aggravate symptoms, such as running or high-impact exercises.

• Pain Relief:

  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Help reduce inflammation and alleviate pain.
  • Ice Therapy: Apply ice to the affected area for 15–20 minutes post-activity to manage inflammation.
  • Heat Therapy: Can help relax surrounding muscles and improve blood flow during later stages.

• Avoid Side-Lying on the Affected Hip:

  • Use a pillow between the knees if lying on the opposite side to reduce hip strain.

2. Physical Therapy and Rehabilitation

Physical therapy is the cornerstone of treatment for gluteus medius tendinopathy, focusing on strengthening, mobility, and correcting biomechanics.

• Isometric Exercises (Early Stage):

  • Gentle isometric contractions help reduce pain while activating the gluteus medius.
  • Example: Side-lying isometric hip abductions – hold for 30–45 seconds, 4–5 reps.

• Eccentric Strengthening (Mid Stage):

  • Eccentric exercises (lengthening under tension) promote tendon healing and resilience.
  • Example: Side-lying hip abductions with slow lowering.

• Progressive Loading (Late Stage):

  • Introduce weight-bearing and functional exercises as pain decreases.
  • Examples: Clamshells, single-leg bridges, and lateral band walks.

• Core and Pelvic Stability Work:

  • Strengthening the core and pelvic stabilisers reduces compensatory movements.
  • Examples: Planks, bird-dogs, and side planks.

• Gait and Posture Training:

  • Correcting faulty gait patterns (e.g., hip drop) reduces tendon overload.

3. Manual Therapy and Adjunct Treatments

• Soft Tissue Mobilisation:

  • Deep tissue massage or myofascial release can relieve muscle tightness around the hip.

• Dry Needling or Acupuncture:

  • Targeting trigger points in the gluteal muscles can help alleviate pain.

• Shockwave Therapy:

  • Non-invasive treatment that uses sound waves to stimulate tendon healing and reduce chronic pain.

4. Injection-Based Treatments

For persistent cases that don’t respond to conservative care, injection therapies may help.

• Corticosteroid Injections:

  • Reduce inflammation and provide temporary pain relief but should be used cautiously to avoid tendon weakening.

• Platelet-Rich Plasma (PRP) Injections:

  • Uses concentrated platelets from the patient’s blood to stimulate tendon healing and reduce inflammation.

Preventing Gluteus Medius Tendinopathy: Building Hip Resilience

Prevention focuses on maintaining strong and flexible hip muscles, proper biomechanics, and smart training practices.

• Strengthen the Glutes:

  • Incorporate exercises like hip thrusts, lateral band walks, and single-leg deadlifts into your routine.

• Work on Flexibility:

  • Stretch tight hip flexors, hamstrings, and quadriceps to maintain balanced hip mobility.

• Gradual Training Progression:

  • Avoid sudden increases in running mileage or workout intensity.

• Improve Running Form:

  • Focus on proper hip alignment and avoid overstriding, which can strain the glutes.

• Cross-Train:

  • Incorporate low-impact activities (e.g., swimming, cycling) to reduce repetitive stress on the hips.

• Correct Leg Length Discrepancies:

  • Use orthotics or heel lifts if needed to balance load across the hips.

FAQs: Gluteus Medius Tendinopathy and Pain Management

1. How do I know if my hip pain is from gluteus medius tendinopathy?

Pain over the outer hip, particularly near the greater trochanter, that worsens with weight-bearing activities or lying on the affected side is a key indicator. A physical exam and imaging studies can confirm the diagnosis.

2. Can gluteus medius tendinopathy heal on its own?

Mild cases may improve with rest and activity modification, but structured physical therapy is often necessary to restore tendon health and prevent recurrence.

3. How long does it take to recover from gluteus medius tendinopathy?

Recovery varies based on severity and adherence to treatment:

• Mild cases: 6–8 weeks
• Moderate to severe cases: 3–6 months

4. Is walking good for gluteus medius tendinopathy?

Low-impact walking on flat surfaces can be beneficial in later stages of rehab, but avoid uphill walking or uneven terrain during the early stages.

5. Should I stretch my gluteus medius if I have tendinopathy?

Gentle stretching can help, but aggressive static stretching may irritate the tendon. Focus on strengthening first and incorporate light dynamic stretches as symptoms improve.

6. When should I consider PRP or other injections?

Injections like PRP are typically considered after 3–6 months of conservative care without significant improvement or in cases of chronic tendinopathy.

Final Thoughts: Managing Gluteus Medius Tendinopathy for Long-Term Relief

Gluteus medius tendinopathy can be a frustrating source of hip pain, but with early diagnosis, structured rehabilitation, and appropriate pain management strategies, full recovery is achievable. Strengthening the hip stabilisers, improving biomechanics, and addressing contributing factors are key to long-term success.

If you’re dealing with persistent hip pain, consult a healthcare provider or physiotherapist to develop a personalised treatment plan and get back to moving pain-free.