Gluteal Tendinopathy (GT) is a painful condition resulting from the overloading and degeneration of the tendons that attach the gluteus medius and gluteus minimus muscles to the outer hip bone. This condition is often grouped under the term Greater Trochanteric Pain Syndrome. The pain is typically felt on the side of the hip, often worsening with activity or when lying on the affected side. Healing GT requires a structured, long-term approach focused on conservative management and a progressive rehabilitation program to restore the tendon’s capacity to handle load.
Stopping Aggravation and Reducing Acute Pain
The first step in managing gluteal tendinopathy is to immediately modify daily activities that compress or overload the sensitive tendons through simple postural adjustments. Activities like standing with weight shifted to the painful hip should be avoided entirely, as should sitting with legs crossed.
Sleeping posture is a common aggravator, so avoid lying directly on the affected side. If side-sleeping, lie on the unaffected side with a thick pillow placed between the knees to maintain a neutral hip and prevent the top leg from compressing the tendon. Short-term use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may provide temporary pain relief during the most symptomatic phase. Reliance on these medications should be brief, as prolonged use may interfere with the long-term healing process.
Phased Approach to Tendon Loading and Strengthening
Healing a tendon requires a gradual increase in the load it can tolerate, moving from gentle, static holds to complex, functional movements. This progressive loading program is considered the most effective long-term treatment for gluteal tendinopathy. The process must be guided by pain, which is acceptable only if it remains below a five out of ten on a pain scale and does not persist into the following morning.
Phase 1 (Isometrics)
The initial phase focuses on isometric exercises, which involve tensing the muscle without changing the joint angle or tendon length. This static loading helps reduce pain by stimulating the tendon tissue without the irritation caused by movement or excessive compression. An example is a gentle glute squeeze or an isometric side leg lift using a pillow to keep the hip neutral. Holds should be sustained for 30 to 45 seconds and repeated several times a day. This phase aims to calm the pain and establish a baseline level of muscular activation. Progression occurs when the pain is consistently manageable and the tendon tolerates the static load.
Phase 2 (Isotonics/Early Strengthening)
Once isometric holds are tolerated, the program advances to low-load isotonic exercises, which involve controlled movement through a limited range of motion. These exercises introduce dynamic loading to the tendon. Common exercises include glute bridges, side-lying clamshells, and side-lying hip abduction, often performed with a resistance band.
Movement must be slow and deliberate, taking several seconds for both the lifting and lowering portions of the exercise. The goal is to perform three sets of 10 to 15 repetitions, ensuring the hip does not drop or rotate excessively during the movement.
Phase 3 (Functional/High Load)
The final strengthening phase transitions to weight-bearing and functional movements that mimic real-life activities. This is where the tendon is prepared for higher demands like running, jumping, and prolonged walking. Exercises include single-leg squats, step-ups, and lunges, which challenge the gluteal muscles to stabilize the pelvis during single-leg stance.
This stage requires increasing the load or resistance, such as by adding dumbbells or using a higher step, to build genuine tendon strength and resilience. Single-leg stance exercises are important as they directly address the tendon’s role in managing the high forces experienced during walking and running. Working closely with a physical therapist to ensure proper form and progressive loading is recommended throughout all three phases.
Advanced Medical Interventions
For individuals whose symptoms persist despite several months of consistent conservative treatment, a specialist may recommend advanced medical interventions. Corticosteroid injections can provide significant short-term pain relief by reducing local inflammation. However, research indicates these injections are not superior to exercise-based rehabilitation long term, and repeated use risks weakening the tendon structure.
Newer treatments include Platelet-Rich Plasma (PRP) therapy, which involves injecting a concentration of the patient’s own platelets into the affected tendon. The aim is to stimulate the natural healing process and tissue repair. Early evidence suggests PRP may be beneficial for lower-grade tendinopathy, but it is still considered experimental, requiring more robust studies to confirm its long-term efficacy.
Surgery is generally reserved as a last resort for chronic, debilitating cases that have failed all non-operative management, typically those involving a significant tear. Surgical options may include a bursectomy or a gluteal tendon repair. Surgery is usually only considered after at least six months of unsuccessful, dedicated physical therapy.
Maintaining Recovery and Preventing Future Injury
Once acute pain has subsided and the tendon has regained significant strength through the structured rehabilitation phases, the focus shifts to long-term maintenance. It is important to continue a regular strength routine to maintain the tendon’s load capacity and prevent relapse. A strength program, incorporating exercises from Phase 3, should be performed two to three times per week.
Addressing biomechanical factors is also a significant part of prevention, as imbalances can place undue stress on the hip tendons. This may involve assessing footwear for proper support or undergoing a gait analysis to identify and correct faulty movement patterns. Maintaining healthy body weight is another factor, as excess weight increases the load the gluteal tendons must manage.
A gradual return to high-impact activities, such as distance running or plyometrics, should be carefully managed to avoid overloading the recovered tendon. The volume and intensity of activity must be increased incrementally. Consistent adherence to these maintenance strategies is the best defense against the recurrence of gluteal tendinopathy.