Gluteal tendinopathy is a common source of chronic pain felt on the outside of the hip, often previously misdiagnosed as trochanteric bursitis. This condition involves the degeneration and irritation of the gluteus medius and gluteus minimus tendons, which attach to the greater trochanter. The underlying issue is a mismatch between the load placed on the tendon and its capacity to handle that load. Recovery centers on a two-part strategy: immediately reducing compressive load and irritation, and gradually rebuilding the tendon’s strength and tolerance through a structured exercise program.
Immediate Steps for Acute Pain Relief
Managing acute pain requires understanding that gluteal tendons are sensitive to compression. Activities that push the tendon against the bone must be temporarily avoided, such as crossing the legs or standing with all weight shifted onto one hip. Sleep on the opposite side with two or more pillows between the knees to keep the hips parallel and prevent compression of the affected tendon.
Short-term pain relief may involve non-steroidal anti-inflammatory drugs (NSAIDs), if medically appropriate, to reduce pain and sensitivity. Applying ice to the lateral hip area for 10 to 15 minutes can also provide temporary relief. Avoid aggressive stretching or deep tissue massage, as this often increases tendon compression and aggravates symptoms. The primary goal of this initial phase is to calm the irritated tendon by removing all sources of mechanical stress.
The Foundation of Recovery: Progressive Strengthening
Recovery relies on a gradual, progressive strengthening program guided by pain tolerance. This process focuses on increasing the tendon’s capacity to handle load, which can take many months to achieve full recovery. The first step in this strengthening journey focuses on pain-free isometric contractions.
Phase 1: Isometrics
Isometrics involve holding a muscle contraction without changing the muscle length or moving the joint. A starting point is the supine gluteal bridge performed with a resistance band looped above the knees, focusing on a gentle, sustained outward push. Alternatively, a side-lying isometric hold can be performed by pressing the top leg against a wall or pillows for 30-to-45 second holds, repeated four to five times. These holds should be performed multiple times daily with minimal or no pain, signaling readiness for more dynamic movement.
Phase 2: Low-Load Isotonics
Once isometric holds are tolerated, the program progresses to low-load isotonic exercises, which involve movement. These exercises must be controlled and slow, as rapid movements can increase tendon irritation. Examples include the double-leg gluteal bridge, where the hips are slowly lifted and lowered, focusing on a strong gluteal contraction without excessive lower back arching.
Standing hip abduction uses a resistance band around the ankles while holding onto a stable object for balance. The movement should be small, controlled, and focused on maintaining a level pelvis. Clamshells can also be introduced, provided they are performed with strict form, avoiding hip compression or twisting, and do not provoke pain.
Phase 3: High-Load/Functional Exercises
The final phase introduces higher-load exercises that mimic daily and athletic activities, preparing the tendon for full functional return. Single-leg exercises train the gluteal muscles to stabilize the pelvis during walking and running. Controlled step-ups onto a low box or stair, focusing on pushing through the heel of the standing leg, build strength and endurance.
Single-leg squats, performed slowly and deliberately, or single-leg hip hikes, which train pelvic control, should also be incorporated. These high-load exercises are typically performed two to three times per week, allowing for rest and recovery. This ensures the tendon can manage the demands of an active lifestyle.
When Conservative Treatment Isn’t Enough
Most gluteal tendinopathy cases respond well to an exercise-based rehabilitation program, often with physical therapist supervision. If symptoms persist beyond three to six months despite consistent adherence, other medical interventions may be considered. Corticosteroid injections offer short-term pain relief but have limited long-term success and risk weakening the tendon tissue.
For resistant cases, advanced options exist. Platelet-rich plasma (PRP) injections use the patient’s own blood components to stimulate healing and have shown sustained long-term results compared to corticosteroids. In rare and severe refractory cases, typically involving a significant tendon tear, surgical procedures like tenotomy may be considered as a last resort.
Preventing Future Flare-ups
Preventing recurrence requires integrating rehabilitation lessons into daily habits. Maintain the strength gained by continuing a gluteal strengthening routine two to three times a week. The focus shifts from intense rehabilitation to muscular endurance and stability.
Attention to standing and sitting posture supports tendon health. Avoid standing with all weight on one leg, which compresses the tendon. Ensure your chair allows you to sit with feet flat and knees at a 90-degree angle.
For athletes, specific biomechanical adjustments reduce stress. Runners should increase their running cadence, targeting 170 to 180 steps per minute, which reduces overstriding and hip impact forces. Cyclists must optimize bike fit, especially saddle height, as a high saddle causes pelvic rocking and excessive strain. Breaking up long periods of sitting or standing every 30 minutes with short movement breaks helps prevent compressive overload.