Gluteal Tendinopathy

What Is Gluteal Tendinopathy? Understanding Lateral Hip Pain

Gluteal tendinopathy is a degenerative overuse condition affecting the tendons of the gluteus medius and gluteus minimus muscles where they insert onto the greater trochanter of the femur. It is the most common cause of lateral hip pain and was historically referred to as "trochanteric bursitis," although research now confirms that the primary pathology lies in the tendons rather than the bursa (Gill et al., 2025, Cureus). Like other tendinopathies, it represents a failed healing response within the tendon characterized by disorganized collagen, increased ground substance, and neovascularization — a process called tendinosis rather than active inflammation.

Prevalence

Gluteal tendinopathy affects approximately 10–25% of the general population and is particularly prevalent among:

• Postmenopausal women aged 40–60, with female-to-male ratios as high as 4:1
• Runners and distance athletes, especially those who rapidly increase training volume
• Sedentary individuals who spend prolonged periods sitting with crossed legs or standing on one leg
• People with concurrent hip osteoarthritis, low back pain, or obesity

The condition has been described as having a comparable impact on quality of life to severe hip osteoarthritis, with significant effects on sleep, mobility, and participation in daily activities.

Common Symptoms

• Pain Location: Pain is felt over the lateral aspect of the hip, directly over or slightly behind the greater trochanter. It may radiate down the outer thigh toward the knee.
• Night pain is a hallmark feature — many patients struggle to sleep on the affected side
• Load-related pain that worsens with walking, stair climbing, single-leg stance, and lying on the affected side
• Pain with prolonged sitting (especially with legs crossed) and when rising from a chair
• The onset is typically gradual and insidious, often without a single identifiable injury event

Anatomy of the Hip: Why the Gluteal Tendons Matter

The gluteal tendons are the primary stabilizers of the pelvis during single-leg activities — which accounts for approximately 85% of the gait cycle.

The Gluteus Medius

The gluteus medius is a fan-shaped muscle that originates from the outer surface of the ilium and inserts onto the lateral and superoposterior facets of the greater trochanter. It has three functional segments: anterior fibers (hip flexion and internal rotation), middle fibers (primary hip abduction), and posterior fibers (hip extension and external rotation). The tendon has a layered, complex insertion similar to the rotator cuff of the shoulder, earning the gluteal tendons the nickname "rotator cuff of the hip."

The Gluteus Minimus

The gluteus minimus lies deep to the gluteus medius, originating from the lower portion of the ilium and inserting onto the anterior facet of the greater trochanter. It works as a hip abductor and stabilizer, and its anterior fibers are important for controlling femoral rotation during gait.

The Greater Trochanter and Compression

The greater trochanter is the bony prominence on the outer upper femur where both gluteal tendons attach. In gluteal tendinopathy, the tendons become compressed against the greater trochanter, particularly during positions of hip adduction. This compressive load is a key driver of pain and pathology (Grimaldi et al., 2025, Archives of Orthopaedic and Trauma Surgery).

Causes and Risk Factors

Biomechanical and Load-Related Factors

• Sudden increases in activity: Rapidly ramping up walking, running, or stair climbing volume
• Compressive loading positions: Crossing legs, standing with hip pushed out, sleeping on the affected side
• Poor pelvic control: Excessive hip adduction (Trendelenburg pattern) during single-leg activities
• Weak hip abductors: Gluteus medius and minimus weakness leads to compensatory loading

Hormonal and Systemic Factors

• Menopause: Estrogen decline significantly affects tendon health, explaining the marked increase in prevalence among women aged 45–60 (Gill et al., 2025, Cureus)
• Metabolic conditions: Diabetes, obesity, and dyslipidemia impair tendon healing
• Medications: Long-term corticosteroid use and fluoroquinolone antibiotics can weaken tendons

Structural and Anatomic Factors

• Wide pelvis increases compressive forces at the trochanteric insertion
• Leg length discrepancy alters pelvic mechanics
• Concurrent hip osteoarthritis or lumbar spine pathology

Why Physiotherapy Is the Best Treatment

The evidence overwhelmingly supports physiotherapy-led exercise as the first-line treatment for gluteal tendinopathy. The landmark LEAP trial (Mellor et al., 2018, BMJ) — a randomized clinical trial of 204 participants — compared education plus exercise, corticosteroid injection, and a "wait and see" approach. At eight weeks, the education-plus-exercise group achieved significantly better outcomes than both other groups. At one year, the exercise group maintained superior outcomes, while the corticosteroid group showed no lasting benefit.

Patricio Cordeiro et al. (2024, Scientific Reports) confirmed that structured exercise programs produce significant improvements in pain and function. Wang et al. (2025, Journal of Orthopaedic Surgery and Research) found that exercise-based approaches ranked highest for both short- and long-term pain reduction.

Why Injections Fall Short

Corticosteroid injections provide short-term relief (4–6 weeks) but the LEAP trial demonstrated they offer no benefit beyond one year and may impair long-term tendon healing (Mellor et al., 2018, BMJ).

How We Treat Gluteal Tendinopathy at Vaughan Physiotherapy

Phase 1: Education and Pain Management (Weeks 1–4)

• Load management education to modify provocative positions
• Isometric hip abduction exercises for pain relief and initial tendon loading
• Sleep posture modification with pillow strategies

Phase 2: Progressive Strengthening (Weeks 4–12)

• Isotonic hip abduction in side-lying and standing with progressive resistance
• Bridging progressions from double-leg to single-leg
• Functional exercises: sit-to-stand, step-ups, lateral band walks

Phase 3: Functional Loading and Return to Activity (Months 3–6+)

• Single-leg loading: squats, deadlifts, lateral step-downs
• Running retraining for athletes
• Sport-specific and occupation-specific drills

Recovery Timeline

• Weeks 1–4: Pain reduction through education and load management
• Weeks 4–12: Significant functional improvement with progressive strengthening
• Months 3–6: Substantial symptom resolution with functional loading
• Months 6–12: Full optimization for complex or longstanding cases

Prevention

• Maintain hip abductor strength with 2–3 sessions per week
• Avoid crossing legs, hanging on one hip, and deep adduction stretches
• Follow the 10% rule for training progression
• Address hormonal health during menopause
• Maintain a healthy body weight

Frequently Asked Questions

Is gluteal tendinopathy the same as trochanteric bursitis?
Not exactly. Research shows the primary pathology is in the gluteal tendons, not the bursa (Gill et al., 2025, Cureus). The more accurate term is gluteal tendinopathy or greater trochanteric pain syndrome.

Should I get a cortisone injection?
The LEAP trial showed injections offer no benefit beyond one year compared to doing nothing (Mellor et al., 2018, BMJ). Exercise therapy produced superior outcomes at both 8 weeks and 12 months.

Can I still exercise?
Yes — the key is modifying exercise selection to avoid compressive activities while progressively loading the tendon under physiotherapy guidance.

Why does my hip hurt more at night?
Lying on the affected side compresses the gluteal tendons against the greater trochanter. Sleep on your back or unaffected side with a pillow between your knees.

Is stretching good for gluteal tendinopathy?
Stretches that pull the leg across the body compress the tendon and can worsen the condition. Focus on strengthening exercises instead.

How long until I can return to running?
Most patients begin a graduated walk-run program between 8–16 weeks, provided they can perform single-leg exercises pain-free.

Do I need imaging?
Usually no. Gluteal tendinopathy is a clinical diagnosis. Grimaldi et al. (2025, Archives of Orthopaedic and Trauma Surgery) found imaging findings did not reliably predict treatment outcomes.

Ready to Resolve Your Lateral Hip Pain?

At Vaughan Physiotherapy, our experienced team uses the latest evidence-based approaches to help you overcome gluteal tendinopathy. Book your appointment today:

• Phone: 905-669-1221
• Location: 398 Steeles Ave W, Unit 201, Thornhill, ON
• Website: vaughanphysiotherapy.com