Gluteal tendinopathy is a common source of chronic pain felt on the outside of the hip, often interfering with daily activities and sleep. This condition affects the tendons connecting the gluteal muscles to the thigh bone. It is frequently misdiagnosed as simple hip bursitis, but the underlying issue relates to the health and capacity of the tendon tissue itself. Understanding the nature of this condition and the path to recovery is the first step toward lasting relief.
Defining Gluteal Tendinopathy and Its Symptoms
Gluteal tendinopathy involves the tendons of the gluteus medius and gluteus minimus muscles, which attach to the greater trochanter (a bony prominence on the upper thigh). Unlike acute tendon inflammation (tendinitis), tendinopathy is a chronic condition characterized by the degeneration of the tendon’s collagen structure. This structural change reduces the tendon’s ability to handle forces, leading to pain.
The primary symptom is a deep, aching pain centered on the outer side of the hip, directly over the greater trochanter. This discomfort often radiates down the outside of the thigh, sometimes reaching the knee. The pain is aggravated by activities requiring the gluteal muscles to work hard or by postures that compress the tendon.
Patients commonly report sharp increases in pain when climbing stairs, walking up hills, or standing on one leg (such as when dressing). Night pain is also frequent, especially when lying on the affected side, as this position directly compresses the tendons. Prolonged sitting, particularly in low chairs or with the legs crossed, can also exacerbate the symptoms.
Why Tendinopathy Develops
Gluteal tendinopathy develops fundamentally from tendon overload, where physical demands exceed the tendon’s capacity for repair. This overload often results from repetitive strain over time, rather than a single, sudden increase in activity (like starting a new running program too quickly). Repeatedly stressing the tendons beyond their limit leads to micro-damage that the body cannot fully repair, causing the tissue to degenerate.
Specific biomechanical factors significantly increase the load on these tendons. Weakness in the gluteal and core muscles can lead to poor control of the hip and pelvis during movement, forcing the tendons to absorb excessive stress. Furthermore, positions that compress the tendon against the greater trochanter are major contributing factors. Examples include habitually standing with the hip “hanging” out to the side or sitting with crossed legs.
Age-related changes also play a role, as tendons naturally lose elasticity and capacity for self-repair over time. This partially explains why the condition is more common in women over 40. Other systemic factors can affect overall tendon health and contribute to risk, including being overweight, hormonal changes, or having underlying conditions like diabetes.
Confirming the Diagnosis
Diagnosis typically begins with a detailed clinical assessment, focusing on the patient’s history and the exact location and nature of the pain. The medical professional performs a physical examination, including palpation (pressing directly on the greater trochanter). This often reproduces the characteristic tenderness, which is considered a cardinal sign of the condition.
Specialized movement tests confirm the diagnosis and distinguish it from other causes of lateral hip pain, such as hip joint issues. The single-leg stance test is highly specific: pain reproduction within 30 seconds of standing on the affected leg strongly suggests tendinopathy. Other provocative tests, like the FADER-Resisted test, involve specific hip movements combined with resistance to apply compressive and tensile forces to the tendons.
While a clinical examination is often sufficient, medical imaging can confirm the diagnosis, assess severity, and rule out other conditions. Ultrasound is often the first-line choice because it clearly visualizes the tendons and detects structural changes, such as thickening or partial tears. Magnetic Resonance Imaging (MRI) is also effective, providing detailed images of the tendon structure and surrounding soft tissues, helping to differentiate tendinopathy from trochanteric bursitis.
Treatment and Recovery Pathways
Successful treatment relies on conservative management, centered on two main principles: modifying activities to reduce tendon compression and implementing a progressive strengthening program. Initial steps involve temporary load management, meaning limiting activities and postures that trigger pain (e.g., sleeping on the painful side or sitting with crossed legs). This period of relative rest allows the irritated tendon to settle down without total inactivity causing weakness.
Pain relief can be managed using short-term over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), but medication is not the long-term solution. The most impactful component of recovery is physical therapy, which focuses on progressively strengthening the gluteal muscles, not stretching. The exercise program often begins with gentle isometric exercises to engage the muscles without excessive movement, helping to reduce pain and build foundational strength.
As the tendon adapts, the program progresses to dynamic exercises that gradually increase the load on the gluteal tendons, such as single-leg squats, side-lying leg lifts, and lateral band walks. This progressive loading stimulates the tendon to rebuild its structural integrity and increase its capacity to handle everyday stresses. A typical rehabilitation program lasts 8 to 12 weeks, with consistent effort leading to significant long-term improvement in seven out of ten people.
For cases that do not respond to several months of diligent physical therapy, advanced interventions may be considered.
Injections
Corticosteroid injections can provide short-term pain relief, but they are avoided as a primary treatment because they may weaken the tendon over the long term. More contemporary options include platelet-rich plasma (PRP) injections, which use the body’s own growth factors to potentially stimulate tendon healing, though evidence is still emerging.
Surgery
Surgical intervention is rare and is reserved for the most severe cases involving large tendon tears that have failed to improve after 6 to 12 months of non-operative care.