How to Treat Hip Tendonitis: From Relief to Recovery

Conservative treatment, especially structured exercise combined with education about how to manage load on the tendon, is the most effective first-line approach for hip tendonitis. A recent systematic review found that exercise and education produced a medium-sized improvement in both pain and function in the short term, outperforming corticosteroid injections on those measures.¹ But “hip tendonitis” is an umbrella that covers several distinct tendons and conditions, each with its own quirks, and the path from relief to full recovery depends on which tendon is involved, how long symptoms have persisted, and what you do (or stop doing) along the way.

Which Tendon Is Actually the Problem

The hip joint is surrounded by powerful tendons, and pain labeled “hip tendonitis” can originate from at least three different areas. The most common site is on the outer (lateral) hip, where the gluteus medius and gluteus minimus tendons attach to the bony prominence called the greater trochanter. For years this was diagnosed as “trochanteric bursitis,” but imaging research has shown that the pain is usually caused by tendon injury rather than inflammation of a fluid-filled sac.² The modern term, gluteal tendinopathy, better reflects what is going on and changes how clinicians approach treatment.

At the front of the hip, the iliopsoas tendon can become irritated and sometimes produces an audible snapping or clicking sensation. Dynamic ultrasound studies have shown that in most cases, the snap comes from the tendon flipping abruptly against the pubic bone during hip flexion.³ This anterior form of hip tendonitis tends to bother people who do a lot of hip-flexor-heavy activities and can be tricky to distinguish from problems inside the joint itself.⁴

At the back of the hip, the proximal hamstring tendons anchor to the sitting bone (ischial tuberosity). Proximal hamstring tendinopathy produces deep buttock pain that flares up during running and prolonged sitting.⁵ Getting an accurate diagnosis matters because the exercises, positions to avoid, and timelines for recovery differ depending on which tendon is affected. The rest of this article focuses primarily on gluteal tendinopathy because it has the strongest evidence base, while noting where anterior and posterior hip tendons require a different approach.

Load Management and Everyday Positions

The single most important early step has nothing to do with a treatment table. Tendon pain is driven by how much and how quickly the tendon is loaded, so dialing back aggravating activities while staying active overall is the foundation. For gluteal tendinopathy, clinicians now emphasize reducing sustained or repetitive hip adduction, which is the position where the leg crosses toward or past the midline. That means rethinking how you sit, stand, sleep, and stretch.⁶

Practical examples help here. Crossing your legs while seated compresses the gluteal tendons against the trochanter. Standing with your weight shifted onto one hip does the same. Sleeping on the affected side without a pillow between the knees increases compression all night. Stretches that pull the leg across the body, often recommended by well-meaning friends, can aggravate things rather than help. Swapping these habits for neutral or slightly abducted positions often provides noticeable relief within the first few weeks, before any formal exercise program even begins.

For anterior (iliopsoas) tendonitis, the equivalent advice involves limiting deep hip flexion under load, like aggressive uphill running or repeated high-knee drills, and for proximal hamstring tendinopathy, reducing prolonged sitting on hard surfaces and avoiding deep forward bends under load while the tendon is irritable.

Exercise Therapy

Exercise is the treatment with the most consistent evidence behind it. A systematic review found moderate-strength evidence that exercise combined with education produces meaningful improvements in both pain and function for gluteal tendinopathy.¹ That said, researchers are still sorting out the best type, dose, and intensity. A review of conservative management for hip tendinopathies concluded that exercise therapy seems to provide long-term pain relief, but acknowledged that the evidence on the optimal exercise prescription remains thin.⁷

One question people often have is whether to start with isometric exercises (where the muscle contracts without moving the joint) or isotonic exercises (where the muscle moves through a range). A pilot trial compared the two approaches for greater trochanteric pain syndrome and found broadly similar results: by twelve weeks, just over half of participants in both groups had achieved a meaningful reduction in pain.⁸ Isometric exercises may feel more tolerable in the acute phase because they do not compress the tendon through a full range of motion, making them a reasonable starting point if movement is painful. But the end goal is to progress to loaded, full-range exercises that rebuild the tendon’s capacity to handle real-world demands.

A typical progression looks something like this:

Weeks 1 to 4: Isometric hip abduction holds against a wall or band, performed in a pain-free position, to begin loading the gluteal tendons without provoking symptoms.
Weeks 4 to 8: Slow, controlled isotonic exercises like side-lying hip abduction with light resistance, bridging variations, and step-ups with an emphasis on controlling pelvic drop.
Weeks 8 onward: Heavier loading through single-leg exercises, weighted hip abduction, and sport-specific or activity-specific drills tailored to your goals.

Each phase should be guided by symptoms: a small amount of discomfort during exercise is acceptable if it settles within 24 hours, but a lasting flare suggests the load was too much too soon.

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) uses acoustic pressure waves applied through the skin to stimulate healing in damaged tendon tissue. A systematic review of ESWT for tendinopathies around the hip and pelvis found that it significantly improved pain and functional outcomes across the vast majority of studies evaluated, with only one low-level study showing no improvement.⁹ Several of those studies found ESWT outperformed other conservative treatments and corticosteroid injections.

One randomized controlled trial compared focused ESWT to standard ultrasound therapy in patients with greater trochanteric pain syndrome and gluteal tendinopathy. The shockwave group had significantly lower pain scores at both two months and six months, with average pain dropping to under one on a ten-point scale by half a year.¹⁰ The systematic review covering long-term comparisons found that focused shockwave therapy demonstrated a large advantage over corticosteroid injection for pain relief over the long term.¹

ESWT typically involves three to five sessions spaced a week apart. The treatment can be uncomfortable during the session, but serious side effects are rare. It tends to be most useful for people who have not responded well to exercise alone and are looking for something more aggressive than rehab but less invasive than an injection or procedure.

Corticosteroid Versus Platelet-Rich Plasma Injections

Corticosteroid injections have been a go-to treatment for lateral hip pain for decades. They can provide quick relief: the systematic review noted moderate evidence of a small effect on pain in the short term.¹ The problem is that the benefit often fades. A double-blind randomized trial comparing platelet-rich plasma (PRP) to corticosteroid injection for gluteal tendinopathy found that both groups were similar in the first six weeks, but by twelve weeks the PRP group pulled ahead with significantly better pain and function scores. About 82% of PRP patients achieved a meaningful clinical improvement at twelve weeks, compared to roughly 57% in the corticosteroid group.¹¹

A second randomized controlled trial followed patients for two years and reinforced this pattern. A single ultrasound-guided PRP injection resulted in greater improvement in pain and function than a corticosteroid injection, and the PRP benefit was sustained at two years. The corticosteroid improvement, by contrast, peaked at around six weeks and was not maintained beyond about six months.¹² That trial specifically enrolled patients with chronic symptoms lasting more than fifteen months, the kind of stubborn cases where people are running out of options.

This does not mean corticosteroid injections are useless. For someone who needs short-term relief to start a rehabilitation program, or who is unable to participate in exercise therapy without first getting pain under control, a single steroid injection can serve as a bridge. The evidence just argues against using repeated steroid shots as a standalone strategy, since the tendon tissue does not improve and may even weaken over time.

Percutaneous Tenotomy

When exercise, shockwave, and injections have failed, percutaneous ultrasonic tenotomy (PUT) is a minimally invasive option that sits between injections and full surgery. Performed under local anesthesia with ultrasound guidance, it uses a needle-like device to break up damaged tendon tissue and stimulate a healing response. A study of PUT specifically for gluteal tendinopathy showed significant improvements in pain and hip function scores, with the average pain score dropping by about three points on a ten-point scale and no reported complications.¹³

A broader study of percutaneous tenotomy across multiple body regions found that pain was significantly reduced in all regions examined except one.¹⁴ More recent work looking at a combined approach targeting both the gluteus medius tendon and the iliotibial band reported durable pain relief and functional improvement at two years, though responder rates declined somewhat over time.¹⁵ Recovery is typically faster than after open surgery, with most people returning to normal activities within a few weeks.

When Surgery Becomes an Option

Surgery is reserved for cases involving actual tendon tears, particularly full-thickness tears of the gluteus medius or minimus, or for chronic tendinopathy that has failed all conservative and minimally invasive approaches. Options include direct repair (open or endoscopic), reconstruction, and tendon transfer. Both open and endoscopic repair techniques have shown similar outcomes, with improvements in patient-reported scores and low complication and retear rates for both partial and full-thickness tears.¹⁶

An early study of endoscopic gluteus medius repair followed patients for a minimum of two years and found that fourteen of fifteen patients improved across all outcome measures, with average score improvements of more than thirty points and satisfaction ratings ranging from good to excellent.¹⁷ A larger study comparing outcomes between men and women after gluteus medius repair found that both sexes achieved significant improvements at a minimum of two years, with pain scores roughly cut in half or better.¹⁸ These results are encouraging, but surgery carries its own recovery timeline, typically three to six months before full return to activity, and is best viewed as a last resort rather than a shortcut.

Why Biomechanics Matter for Long-Term Recovery

Treating the tendon itself is only half the equation. If the movement patterns that overloaded the tendon in the first place do not change, the problem tends to come back. Research has identified excessive hip adduction, the inward collapse of the hip during weight-bearing activities, as a key factor in gluteal tendinopathy.¹⁹

A gait analysis study found that people with gluteal tendinopathy walk with greater contralateral trunk lean and pelvic drop compared to healthy controls, and that pelvic drop was significantly correlated with the forces pushing the hip into adduction.²⁰ In plain terms, when the pelvis tips sideways during each step, the gluteal tendons have to work harder to stabilize the hip, and they are doing that work at an angle that compresses them against the bone. This creates a vicious cycle where the weakened tendon cannot control the pelvis properly, leading to more compression and more pain.

Addressing this involves targeted strengthening of the hip abductors combined with conscious gait retraining. Cues like “keep your hips level” during walking, using a mirror or video feedback during single-leg exercises, and practicing controlled pelvic stability on steps all help re-establish proper frontal-plane control. Runners dealing with hip tendonitis should be especially attentive to this, since running amplifies pelvic mechanics by a factor of several times body weight with each stride. A history of prior hip injuries already raises the risk of subsequent ones, making biomechanical correction part of injury prevention as well as treatment.

Metabolic Health and Tendon Risk

Tendon problems are not purely mechanical. A growing body of research has connected metabolic syndrome, the cluster of conditions including high blood sugar, elevated blood pressure, excess abdominal fat, and abnormal cholesterol, to tendon disease. A comprehensive review found that metabolic syndrome is an important risk factor for the early onset, progression, and poor outcomes of tendon diseases broadly.²¹ The mechanisms involve chronic low-grade inflammation, impaired blood supply to tendon tissue, and changes in how collagen is produced and repaired.

This has practical implications. If you are dealing with hip tendonitis that seems slow to heal, and you also have poorly managed blood sugar, significant weight around the midsection, or high cholesterol, those metabolic factors could be contributing to the tendon’s inability to recover. Addressing them through diet, exercise, and medical management may improve your tendon outcome in ways that no injection or shockwave session can replicate. Clinicians who treat tendinopathy are increasingly screening for these conditions, recognizing that tendon health is not separate from overall metabolic health.

The Psychological Side of Persistent Hip Pain

Chronic hip pain does not just affect the body. A qualitative study of people seeking care for persistent hip pain found that most participants believed their pain was caused by damaged structures, often based on imaging results and interactions with healthcare providers. All of them described ineffective management strategies and multiple failed treatments, and for nearly half, the sense of having no control over their symptoms was threatening both their physical and mental health.²²

The framing of “damage” can become a trap. Imaging often shows tendon changes in people who have no pain at all, meaning that what looks alarming on an MRI may not be the actual pain driver. When people are told they have a tear or degeneration without proper context, they tend to catastrophize, avoid movement, and lose confidence in their body’s ability to heal. Effective treatment includes explaining that tendon changes are common, often manageable, and do not necessarily mean the tendon is falling apart. Clinicians who combine exercise therapy with clear education about the condition produce better results than those who focus on passive treatments alone, in part because informed patients are more willing to push through the discomfort of rehabilitation rather than avoiding it out of fear.

Conditions That Mimic Hip Tendonitis

Not all lateral or posterior hip pain comes from a tendon. Deep gluteal syndrome, sometimes called piriformis syndrome, involves irritation of the sciatic nerve in the deep gluteal space and can produce pain that overlaps significantly with tendinopathy. The pain may radiate down the leg, worsen with sitting, and be accompanied by tingling or numbness, symptoms that straight tendinopathy typically does not produce. Lumbar spine problems, hip joint arthritis, and stress fractures of the femoral neck can also refer pain to the hip region. If exercise-based treatment for tendinopathy is not producing improvement after several weeks, it is worth reconsidering the diagnosis rather than simply escalating treatment intensity.

One clue that can help distinguish these conditions: gluteal tendinopathy tends to produce pain that is sharply localized to the bony outside of the hip and worsens specifically with side-lying, standing on one leg, or climbing stairs. Pain that is deeper, more diffuse, radiates past the knee, or is accompanied by stiffness in the morning often points toward a different source. A thorough clinical exam and, when needed, imaging can clarify whether you are treating the right problem.

1
PubMed. The efficacy of gluteal tendinopathy treatments: A systematic review
2
PubMed. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome
3
PubMed. The snapping iliopsoas tendon: new mechanisms using dynamic sonography
4
PubMed Central. Understanding and Treating the Snapping Hip
5
PubMed Central. Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy
6
PubMed Central. Current and future advances in practice: tendinopathies of the hip
7
PubMed Central. Conservative management of tendinopathies around hip
8
PubMed Central. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study
9
PubMed Central. Extracorporeal Shockwave Therapy for Tendinopathies Around the Hip and Pelvis: A Systematic Review
10
PubMed. Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial
11
PubMed. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection
12
PubMed. Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up
13
PubMed Central. Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy
14
PubMed Central. The Effects of Ultrasound-Guided Percutaneous Tenotomy on Patients’ Pain and Satisfaction Levels
15
Interventional Pain Medicine. 2-Year clinical outcomes following combined iliotibial band and gluteus medius percutaneous ultrasound tenotomy in refractory GTPS
16
PubMed Central. Surgical Treatment and Outcomes for Gluteal Tendon Tears
17
PubMed. Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up
18
PubMed. Differences in Clinical Presentations and Surgical Outcomes of Gluteus Medius Tears Between Men and Women
19
PubMed. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management
20
PubMed. Kinematics and kinetics during walking in individuals with gluteal tendinopathy
21
PubMed Central. Metabolic Syndrome and Tendon Disease: A Comprehensive Review
22
BMJ. ‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain