Gluteal Tendinopathy.
What is gluteal tendinopathy?
Gluteal tendinopathy is a condition characterised by pain and tenderness over the lateral aspect of the hip, caused by damage or degeneration of the tendons that attach the gluteal muscles to the greater trochanter of the femur. Specifically, the gluteus medius and gluteus minimus tendons — which originate on the outer ilium and insert on the greater trochanter — are the structures involved. These tendons are responsible for hip abduction and rotational control of the femur during walking, running and single-leg activities.
Gluteal tendinopathy is the most common cause of lateral hip pain and the primary pathology underlying greater trochanteric pain syndrome (GTPS). The two terms describe related but slightly different things — GTPS is the clinical syndrome of lateral hip pain, while gluteal tendinopathy is the specific tendon pathology that most commonly produces it. For the broader clinical overview including other contributors to lateral hip pain see our GTPS page.
Like other tendinopathies, gluteal tendinopathy involves a failed healing response producing collagen disorganisation and tendon degeneration rather than active inflammation — which is why anti-inflammatory treatments alone are insufficient and progressive tendon loading is the most effective intervention.
Who gets gluteal tendinopathy?
This condition is most common in middle-aged women, but can affect anyone who puts excessive strain on these tendons, such as athletes or those who perform repetitive movements involving the hip. The peak prevalence in perimenopausal women — where the condition is four times more common than in men — is thought to reflect hormonal changes affecting tendon health combined with altered lower limb biomechanics. Runners, walkers who increase their training load rapidly, and people who have recently started a new exercise program are also commonly affected. Obesity, leg length discrepancy, hip osteoarthritis and previous lower back conditions are associated risk factors.
What are the symptoms?
Pain over the lateral hip — at or just posterior to the greater trochanter — that is worse with lying on the affected side, prolonged sitting, walking upstairs, and single-leg activities is the hallmark presentation. The pain may refer into the lateral thigh and sometimes the knee. Positions that involve hip adduction — crossing the legs, standing with weight shifted onto one hip, sleeping without a pillow between the knees — are characteristic aggravating factors because they increase the compressive load on the gluteal tendons over the greater trochanter.
The compressive load mechanism — why old advice fails
Understanding the compressive mechanism is essential to understanding why some commonly given advice actually worsens gluteal tendinopathy rather than helping it. The gluteal tendons are subjected to both tensile load (along their length) and compressive load (perpendicular to their surface, as they are compressed against the greater trochanter) during hip movement. Positions of hip adduction and internal rotation maximally compress the tendons, and sustained compression is one of the primary drivers of tendinopathy pain and degeneration.
This means that ITB stretching — which involves crossing the leg into adduction — and hip flexor stretches in the same position are counterproductive and frequently worsen symptoms. Patients who have been dutifully stretching their "tight hip" and finding their pain is worsening are often experiencing this exact mechanism. The primary load management strategy is avoiding compressive positions, not stretching.
How is it diagnosed?
Diagnosis is typically made based on medical history, physical examination, and imaging studies such as ultrasound or MRI. The physical examination may include tests to assess strength, flexibility, and alignment of the hip and lower limb. Palpation tenderness directly over the greater trochanter, reproduction of pain with single-leg stance, and the FABER position (hip flexion, abduction and external rotation) are key clinical findings. Ultrasound directly visualises tendon degeneration, tears and calcification and is the preferred imaging modality. MRI provides more comprehensive information where full-thickness tears are suspected.
How can physiotherapy help?
Physiotherapy can help manage the pain and symptoms of gluteal tendinopathy through a structured approach built on three foundations: load management, progressive tendon loading, and proximal hip strengthening.
Load management is the immediate priority — identifying and modifying the compressive positions and activities that are provoking reactive tendon pain. Key modifications include avoiding crossing the legs, sleeping with a pillow between the knees, standing symmetrically without hip sway, and avoiding low chairs and deep hip flexion positions. These changes often produce rapid symptom improvement and create the settling of reactive pain needed to begin the loading program.
Progressive tendon loading follows the established tendinopathy loading framework — isometric hip abduction first (providing immediate pain relief through isometric analgesia), progressing to isotonic strengthening in positions that avoid compressive loading, then heavy slow resistance loading, and finally functional and sport-specific loading. The progression is guided by symptom response — a moderate level of discomfort during exercises is acceptable but should settle within 24 hours.
Gluteal and hip abductor strengthening — targeting the gluteus medius and minimus specifically — rebuilds the muscle strength that is consistently deficient in gluteal tendinopathy and that both contributes to and results from the tendon condition. As strength improves, the dynamic stability of the hip during walking reduces the compressive demands on the tendons. Real time ultrasound assists in assessing deep gluteal muscle activation quality.
Soft tissue techniques such as massage or dry needling may be used to help reduce pain and improve mobility. Dry needling of the gluteal musculature assists with pain management. Clinical Pilates provides a controlled environment for progressive hip abductor loading in positions that avoid compressive provocation.
Our physiotherapists Eliane Machado and Bethany Kippen both have experience in gluteal tendinopathy management and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait and hip loading analysis that underpins gluteal tendinopathy rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Gluteal tendinopathy is a condition characterised by pain and tenderness over the lateral aspect of the hip, caused by damage or degeneration of the tendons that attach the gluteal muscles to the greater trochanter of the femur. Specifically, the gluteus medius and gluteus minimus tendons — which originate on the outer ilium and insert on the greater trochanter — are the structures involved. These tendons are responsible for hip abduction and rotational control of the femur during walking, running and single-leg activities.
Gluteal tendinopathy is the most common cause of lateral hip pain and the primary pathology underlying greater trochanteric pain syndrome (GTPS). The two terms describe related but slightly different things — GTPS is the clinical syndrome of lateral hip pain, while gluteal tendinopathy is the specific tendon pathology that most commonly produces it. For the broader clinical overview including other contributors to lateral hip pain see our GTPS page.
Like other tendinopathies, gluteal tendinopathy involves a failed healing response producing collagen disorganisation and tendon degeneration rather than active inflammation — which is why anti-inflammatory treatments alone are insufficient and progressive tendon loading is the most effective intervention.
Who gets gluteal tendinopathy?
This condition is most common in middle-aged women, but can affect anyone who puts excessive strain on these tendons, such as athletes or those who perform repetitive movements involving the hip. The peak prevalence in perimenopausal women — where the condition is four times more common than in men — is thought to reflect hormonal changes affecting tendon health combined with altered lower limb biomechanics. Runners, walkers who increase their training load rapidly, and people who have recently started a new exercise program are also commonly affected. Obesity, leg length discrepancy, hip osteoarthritis and previous lower back conditions are associated risk factors.
What are the symptoms?
Pain over the lateral hip — at or just posterior to the greater trochanter — that is worse with lying on the affected side, prolonged sitting, walking upstairs, and single-leg activities is the hallmark presentation. The pain may refer into the lateral thigh and sometimes the knee. Positions that involve hip adduction — crossing the legs, standing with weight shifted onto one hip, sleeping without a pillow between the knees — are characteristic aggravating factors because they increase the compressive load on the gluteal tendons over the greater trochanter.
The compressive load mechanism — why old advice fails
Understanding the compressive mechanism is essential to understanding why some commonly given advice actually worsens gluteal tendinopathy rather than helping it. The gluteal tendons are subjected to both tensile load (along their length) and compressive load (perpendicular to their surface, as they are compressed against the greater trochanter) during hip movement. Positions of hip adduction and internal rotation maximally compress the tendons, and sustained compression is one of the primary drivers of tendinopathy pain and degeneration.
This means that ITB stretching — which involves crossing the leg into adduction — and hip flexor stretches in the same position are counterproductive and frequently worsen symptoms. Patients who have been dutifully stretching their "tight hip" and finding their pain is worsening are often experiencing this exact mechanism. The primary load management strategy is avoiding compressive positions, not stretching.
How is it diagnosed?
Diagnosis is typically made based on medical history, physical examination, and imaging studies such as ultrasound or MRI. The physical examination may include tests to assess strength, flexibility, and alignment of the hip and lower limb. Palpation tenderness directly over the greater trochanter, reproduction of pain with single-leg stance, and the FABER position (hip flexion, abduction and external rotation) are key clinical findings. Ultrasound directly visualises tendon degeneration, tears and calcification and is the preferred imaging modality. MRI provides more comprehensive information where full-thickness tears are suspected.
How can physiotherapy help?
Physiotherapy can help manage the pain and symptoms of gluteal tendinopathy through a structured approach built on three foundations: load management, progressive tendon loading, and proximal hip strengthening.
Load management is the immediate priority — identifying and modifying the compressive positions and activities that are provoking reactive tendon pain. Key modifications include avoiding crossing the legs, sleeping with a pillow between the knees, standing symmetrically without hip sway, and avoiding low chairs and deep hip flexion positions. These changes often produce rapid symptom improvement and create the settling of reactive pain needed to begin the loading program.
Progressive tendon loading follows the established tendinopathy loading framework — isometric hip abduction first (providing immediate pain relief through isometric analgesia), progressing to isotonic strengthening in positions that avoid compressive loading, then heavy slow resistance loading, and finally functional and sport-specific loading. The progression is guided by symptom response — a moderate level of discomfort during exercises is acceptable but should settle within 24 hours.
Gluteal and hip abductor strengthening — targeting the gluteus medius and minimus specifically — rebuilds the muscle strength that is consistently deficient in gluteal tendinopathy and that both contributes to and results from the tendon condition. As strength improves, the dynamic stability of the hip during walking reduces the compressive demands on the tendons. Real time ultrasound assists in assessing deep gluteal muscle activation quality.
Soft tissue techniques such as massage or dry needling may be used to help reduce pain and improve mobility. Dry needling of the gluteal musculature assists with pain management. Clinical Pilates provides a controlled environment for progressive hip abductor loading in positions that avoid compressive provocation.
Our physiotherapists Eliane Machado and Bethany Kippen both have experience in gluteal tendinopathy management and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait and hip loading analysis that underpins gluteal tendinopathy rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
