Gluteal Tendinopathy: Symptoms, Causes, Treatment & Exercises

Key Takeaways

Gluteal tendinopathy affects the tendons attaching to the greater trochanter, causing lateral hip pain that often radiates down the thigh and worsens during activities like climbing stairs or lying on the affected side.
Treatment, including activity modification and targeted exercises, is highly effective when implemented early.
Specific exercises targeting glutes strength, hip stability, and movement control form can reduce the risk of recurrence.
Avoiding positions and activities that compress the affected tendons (like crossing legs or lying directly on the painful hip) can reduce symptoms during the recovery process.
With MSK Doctors, you get access to advanced AI-powered movement assessment technology combined with the specialised knowledge of our orthopaedic consultants.

Gluteal Tendinopathy Overview

Gluteal tendinopathy is a common condition that affects the tendons of the gluteal muscles, particularly the gluteus medius and minimus.

These tendons attach to the greater trochanter, the bony prominence on the outside of your hip. When these tendons become irritated, inflamed, or damaged, it results in pain and dysfunction in the lateral (outer) hip region.

This condition is often characterised by pain on the outside of the hip that can radiate down the thigh. The discomfort typically worsens with activities like walking, climbing stairs, standing on one leg, or lying on the affected side.

Previously, this condition was often misdiagnosed as trochanteric bursitis, but research now shows that tendon pathology is the primary issue in most cases.

Symptoms of Gluteal Tendinopathy

Pain When Lying on the Affected Side

Many individuals with gluteal tendinopathy experience significant discomfort when lying on the affected hip during sleep. This occurs because this position directly compresses the already irritated tendon against the greater trochanter.
The pain can be severe enough to wake you from sleep or force you to change positions frequently throughout the night, leading to disrupted sleep patterns and subsequent fatigue.
Some patients develop adaptive behaviors like placing a pillow between their knees or sleeping exclusively on their unaffected side.

Pain With Prolonged Sitting

Sitting for extended periods, especially on hard surfaces or in low chairs, often exacerbates symptoms. This occurs because sitting can compress the gluteal tendons and increase tension on these structures, particularly when the hips are flexed beyond 90 degrees.
Many patients report increased pain after long car rides, airplane travel, or while working at a desk. The discomfort typically worsens the longer one sits and may cause a noticeable limp when standing up after prolonged sitting.

Pain Walking Up Stairs or Inclines

Ascending stairs or walking uphill frequently triggers or intensifies pain because these activities require greater activation of the gluteal muscles, placing additional load on the affected tendons.
The single-leg stance phase of stair climbing is particularly problematic as it increases compressive forces on the lateral hip structures.
Patients often report grabbing handrails for support or developing compensatory movement patterns - such as leading with the unaffected leg when climbing stairs.

Pain With Single-Leg Weight Bearing

Activities that require standing on the affected leg alone can be particularly painful. This includes movements like putting on pants or shoes while standing, stepping in or out of a bathtub, or certain exercises.
During single-leg stance, the gluteal muscles must work harder to maintain pelvic stability, increasing strain on the irritated tendons. This symptom often leads individuals to adopt compensatory strategies, such as sitting down to dress or leaning against walls for support.

Visible Limping or Altered Gait

Many people with gluteal tendinopathy develop a noticeable limp or altered walking pattern as they unconsciously try to reduce pressure on the painful hip. This typically manifests as a shortened stance phase on the affected side, reduced stride length, or a Trendelenburg gait (where the pelvis drops on the unaffected side during walking).
These compensatory movements can eventually lead to secondary issues in the lower back, knee, or opposite hip due to biomechanical imbalances.

Causes of Gluteal Tendinopathy

The primary cause of gluteal tendinopathy is overuse, which typically occurs in individuals who engage in activities that require repetitive hip movements. These activities can include running, cycling, or even prolonged periods of standing or walking. Because the tendons are repeatedly stressed, they can become damaged over time.

In some cases, an acute injury, such as a fall or direct blow to the hip, can also lead to tendinopathy. This type of injury may cause immediate pain and inflammation, leading to the deterioration of tendon tissue.

Other contributing factors may include age-related wear and tear, improper footwear, or poor posture, which can exacerbate the condition by placing additional strain on the tendons.

Diagnosis of Gluteal Tendinopathy

Diagnosing gluteal tendinopathy typically involves a physical examination by a healthcare professional. They will assess your symptoms, medical history, and perform specific tests to identify the source of the pain.

Imaging tests such as an MRI or ultrasound may be used to confirm the diagnosis and evaluate the extent of tendon damage.

Treatment Options

Conservative Methods

Conservative treatment methods are typically the first line of defense against gluteal tendinopathy as these methods focus on reducing pain and inflammation while promoting healing through non-invasive techniques.

Rest is essential in allowing the affected tendons to heal. Avoid activities that exacerbate pain and give your body time to recover. Applying ice to the affected area can help reduce inflammation and alleviate pain.

Compression and elevation may also be beneficial in managing symptoms. By supporting the affected area and reducing swelling, you can enhance comfort and promote healing.

Physical Therapy

Physical therapy in the treatment of gluteal tendinopathy is significant because a physical therapist can design a personalised exercise program for your specific needs and goals. These exercises should focus on strengthening the hip and gluteal muscles, improving flexibility, and enhancing overall function.

Surgical Interventions

If conservative treatments and physical therapy fail to alleviate symptoms, surgical interventions may be considered. Surgery is usually reserved for severe cases of gluteal tendinopathy where there is significant tendon damage or tearing.

Surgery may involve debridement, which is the removal of damaged tissue, or tendon repair to reattach the tendon to the bone. Recovery from surgery can take several months and involves a comprehensive rehabilitation program to regain strength and mobility.

Exercises

Bridge Exercise

The bridge exercise targets the gluteal muscles and helps in building strength and stability in the hip area (image courtesy of PhysioPedia).

To perform this exercise:

Lie on your back with your knees bent and feet flat on the floor.
Keep your arms at your sides.
Slowly lift your hips towards the ceiling, squeezing your glutes as you rise.
Hold the position for a few seconds before lowering back down.
Repeat this exercise for 10-15 repetitions, ensuring that you maintain a controlled and steady movement throughout.

Clamshells

Clamshells are excellent for targeting the hip abductors, which are crucial for stabilising the hip joint (image courtesy of PhysioPedia).

To perform clamshells:

Lie on your side with your legs stacked and knees bent at a 90-degree angle.
Rest your head on your arm and keep your feet together.
Slowly lift your top knee towards the ceiling while keeping your feet in contact.
Hold the position for a moment before returning to the starting position.
Aim for 10-15 repetitions on each side, focusing on a slow and controlled movement.

Hip Abduction

Hip abduction exercises help strengthen the muscles on the outer thigh and hip, which support the hip joint and improve balance.

To perform this exercise:

Stand upright with your feet hip-width apart and hold onto a sturdy surface for support.
Lift one leg out to the side, keeping it straight and your toes pointing forward.
Hold for a few seconds before lowering it back down.
Perform 10-15 repetitions on each side, ensuring that you maintain proper posture throughout the exercise.

Leg Raises

Leg raises are beneficial for strengthening the hip flexors and core muscles (image courtesy of PhysioPedia).

To perform leg raises:

Lie on your back with your legs straight and arms at your sides.
Slowly lift one leg towards the ceiling while keeping the other leg flat on the ground.
Hold the raised position for a moment before lowering it back down.
Alternate between legs for 10-15 repetitions each.
Focus on controlled movements to maximise the benefits of this exercise.

Prevention Strategies

Activity Modification

Modifying activities that place excessive strain on the hip tendons is crucial for prevention. This may involve adjusting your exercise routine, reducing high-impact activities, or incorporating rest days to allow for recovery. Listening to your body and recognising signs of overuse can help prevent further damage.

Proper Warm-Ups

Engaging in proper warm-up exercises before physical activity can significantly reduce the risk of tendon injuries. Warm-ups increase blood flow to the muscles, improve flexibility, and prepare the body for more intense movements..

Long-Term Management Tips

Managing gluteal tendinopathy in the long term involves a combination of lifestyle modifications and ongoing rehabilitation. Stay active and avoid activities that aggravate symptoms. Incorporate low-impact exercises such as swimming or cycling, this will provide cardiovascular benefits without placing excessive strain on the tendons.

The MSK Doctors Approach to Gluteal Tendinopathy

Through our personalised rehabilitation plans, expert guidance, and ongoing support, you can trust MSK Doctors to help you overcome gluteal tendinopathy and return to pain-free movement with confidence.

At MSK Doctors, we understand the frustration and limitations that persistent hip pain brings. Our approach to treating gluteal tendinopathy combines precise diagnosis with evidence-based interventions for your specific needs.

Our direct-access service allows you to consult with experienced orthopaedic consultants without GP referrals. This means faster diagnosis and more immediate relief from your symptoms. Our innovative MAI-Motion AI platform provides detailed insights into your movement patterns, allowing us to identify the exact mechanical factors contributing to your condition.

Offering comprehensive care that addresses the symptoms and the underlying causes of gluteal tendinopathy is our priority. From targeted loading programmes and activity modifications to advanced regenerative treatments when needed, our specialists will guide you through every step of your recovery journey.

Allow yourself to move freely and confidently with a spring in your step. Book your consultation with MSK Doctors today for our expert care and top-tier hip treatment.

Frequently Asked Questions (FAQ)

What causes gluteal tendinopathy?

Gluteal tendinopathy is primarily caused by overuse or repetitive strain on the tendons that connect the gluteal muscles to the hip bones. Activities that involve repetitive hip movements, such as running or cycling, can lead to tendon damage over time.

How is gluteal tendinopathy diagnosed?

Diagnosis of gluteal tendinopathy typically involves a thorough physical examination by a healthcare professional. They will assess your symptoms, medical history, and perform specific tests to pinpoint the source of pain.

Are exercises effective for treatment?

Yes, exercises are highly effective in treating gluteal tendinopathy. They help strengthen the gluteal muscles, improve flexibility, and enhance hip joint stability.

When should I consider surgery?

Surgery should be considered only in severe cases of gluteal tendinopathy where conservative treatments and physical therapy have failed to alleviate symptoms.

How can MSK Doctors help with treatment?

At MSK Doctors, we emphasise a well-rounded approach, incorporating both conservative and rehabilitative methods to ensure optimal hip health.