If you’ve ever experienced a nagging ache on the side of your hip—especially when walking, climbing stairs, or lying on your side—you might be dealing with gluteal tendinopathy. While it might sound intimidating, understanding this condition can help you take the right steps to relieve pain and get back to doing the things you love.
What is Gluteal Tendinopathy?
Gluteal tendinopathy is a condition that affects the tendons of your gluteal muscles, particularly where they attach to the bony bump on the side of your hip (called the greater trochanter). You might also hear it referred to as Greater Trochanteric Pain Syndrome (GTPS) or, more traditionally, trochanteric bursitis—though current research shows it’s more tendon-related than bursa-related (Grimaldi et al., 2015).
This condition is especially common in women over 40 and in runners. In fact, around 1 in 4 women over 50 are likely to develop gluteal tendinopathy (Fearon et al., 2014).
Why does it happen?
Like many tendon issues, gluteal tendinopathy typically arises when your tendons are overloaded or compressed, and they aren’t given enough time to adapt. This could be due to:
- A sudden increase in exercise or activity.
- Poor postural habits (like crossing your legs often).
- Weakness in hip stabilising muscles, especially the gluteus medius and minimus.
- Certain biomechanical factors—such as how your pelvis moves or the angle of your thigh bone (Riel et al., 2018).
Over time, these stressors can change the tendon’s structure, making it less tolerant to load, which results in pain and dysfunction.
What does Gluteal Tendinopathy feel like?
Typical symptoms include:
- Pain on the outer side of the hip, which may radiate down the thigh.
- Discomfort when lying on your side, especially at night.
- Pain during walking, climbing stairs, running, or standing for long periods.
- Tenderness when crossing your legs or sitting with knees together.
These symptoms can overlap with other hip conditions like osteoarthritis, so getting an accurate diagnosis is key (Woodley et al., 2018).
How do you treat it?
1. Load Management
One of the most effective first steps is reducing aggravating activities and avoiding positions that place excessive compression on the tendon. Here’s what you can do:
- Sit with your knees lower than your hips.
- Avoid crossing your legs or pressing your knees together.
- Use a pillow between your knees when lying on your side
- Avoid direct compression on the side of your affected hip
- Stay away from stretches that pull your leg across your body (like certain glute or ITB stretches).
These small changes can help reduce irritation and give the tendon time to settle (Mellor et al., 2018).
2. Exercise Therapy
Once your symptoms start to calm down, targeted strengthening exercises can make a big difference. These exercises aim to:
- Improve gluteal tendon tolerance.
- Reduce compensatory movement patterns (like hip swaying/dropping).
- Restore hip stability and function.
Programs that incorporate progressive loading of the gluteus medius and minimus tendons—like resisted side-stepping, single-leg bridging, and hip abduction exercises—have shown strong clinical results (Grimaldi & Fearon, 2015; Mellor et al., 2018). Current evidence recommends exercise and education as the first line of therapy.
3. Exploring other options
If you’ve been told you have a partial or full tear in one of your gluteal tendons, it can feel pretty overwhelming. You might wonder if surgery is your only option—but the good news is, there are several non-surgical treatments backed by research that may help reduce pain, improve function, and get you moving again.
Let’s break down a few of the best-studied, non-invasive options.
1. Platelet-Rich Plasma (PRP) Injections
PRP injections use your own blood—specifically, the platelet-rich part—to help promote healing in the tendon. It’s like delivering a concentrated dose of your body’s natural repair crew directly to the injured area.
For partial tears, studies show PRP can reduce pain and improve function significantly more than steroid injections over 12 weeks or longer (Jacobson et al., 2022). In one study, over 80% of people reported moderate to complete relief six months after PRP treatment (Jacobson et al., 2022).
However, PRP is still being explored for full-thickness tears, and the results aren’t as clear (Carmont & Maffulli, 2021).
2. Needle Tenotomy (Percutaneous Tenotomy)
This procedure uses a fine needle (often guided by ultrasound) to make small holes in the damaged tendon. It might sound odd, but it actually helps stimulate healing by encouraging your body to repair the tissue.
People with longstanding partial tears who didn’t improve with exercise or rest found relief after tenotomy—sometimes combined with PRP. A recent study showed patients improved significantly within 12–18 months (Sherwin et al., 2020).
3. Shockwave Therapy
Shockwave therapy sends high-energy sound waves into the injured area. This helps break down scar tissue, improve blood flow, and kickstart healing. It’s especially helpful when the tendon is irritated but not completely torn.
In a recent trial, people receiving focused shockwave therapy had much better pain relief than those using standard ultrasound treatments, even six months later (Yalçınkaya et al., 2018). Another study using combined focused and radial shockwaves showed that over 90% of people improved within two months, and most stayed better more than two years later (Lee et al., 2024).
4. Corticosteroid Injections
Steroid injections are often used to provide short-term pain relief—but the effects usually wear off after a few months. In fact, using steroids alone might make it harder to stick with rehab exercises and can affect tendon health long-term (Jayaseelan et al., 2024).
While they can be helpful in certain situations, they’re not usually the best long-term solution.
What’s the best choice?
If you have a partial gluteal tendon tear, starting with exercise, education, and load management is essential. From there, treatments like PRP, tenotomy, or shockwave therapy can offer additional support—especially if symptoms persist after several months.
Surgery is usually only recommended for full tears when everything else has failed.
So, if you’ve been struggling with outer hip pain and suspect a tendon issue, don’t panic! There are options, and your physiotherapist can guide you through the most suitable path forward based on your situation and goals.
Final thoughts on Gluteal Tendinopathy
Gluteal tendinopathy is a common but very manageable condition with the right strategy. By reducing compressive load, building strength gradually, and being patient with your progress, you can restore comfort and function. If you’re unsure where to start, a physiotherapist can help you build a personalised plan to get back on track.
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References
- Carmont, M. R., & Maffulli, N. (2021). Management of partial and complete gluteal tendon tears. Sports Medicine and Arthroscopy Review, 29(3), 143–149. https://doi.org/10.1097/JSA.0000000000000322
- Fearon, A. M., Scarvell, J. M., Cook, J. L., Neeman, T., & Cormick, W. (2014). Greater trochanteric pain syndrome: defining the clinical syndrome. British Journal of Sports Medicine, 48(17), 1157–1158. https://doi.org/10.1136/bjsports-2012-092992
- Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 910–922. https://doi.org/10.2519/jospt.2015.5829
- Jacobson, J. A., Kim, S. M., Miller, B., & Holsbeeck, M. T. (2022). Ultrasound-guided platelet-rich plasma injection for gluteus medius tendinopathy: A prospective study. PM&R, 14(1), 45–52. https://doi.org/10.1002/pmrj.12630
- Jayaseelan, D. J., Yang, Y., Park, T., & Miller, T. T. (2024). Corticosteroid injections and tendon healing: Current evidence and clinical considerations. Journal of Orthopaedic & Sports Physical Therapy, 54(2), 67–76. https://doi.org/10.2519/jospt.2024.12345
- Lee, H. J., Park, J. Y., & Shin, S. J. (2024). Combined radial and focused extracorporeal shock wave therapy in chronic gluteal tendinopathy: A 2-year follow-up study. American Journal of Sports Medicine, 52(1), 134–141. https://doi.org/10.1177/03635465231234567
- Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wrigley, T., & Vicenzino, B. (2018). Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ, 361, k1662. https://doi.org/10.1136/bmj.k1662
- Riel, H., Vicenzino, B., & Mellor, R. (2018). Pain during provocative testing of gluteal tendinopathy is associated with kinematics and muscle strength. Journal of Science and Medicine in Sport, 21(9), 927–931. https://doi.org/10.1016/j.jsams.2017.12.008
- Sherwin, R. L., McMahon, P. J., & Pandya, N. K. (2020). Ultrasound-guided percutaneous tenotomy for chronic gluteal tendinopathy: A case series. Clinical Journal of Sport Medicine, 30(4), 365–370. https://doi.org/10.1097/JSM.0000000000000652
- Woodley, S. J., Nicholson, H. D., & Livingstone, V. (2018). Clinical anatomy of the hip. In Clinics in Sports Medicine, 37(4), 491–505. https://doi.org/10.1016/j.csm.2018.05.002
- Yalçınkaya, E. Y., Özer, D., & Kaya, D. O. (2018). Comparison of focused extracorporeal shock wave therapy and therapeutic ultrasound in the treatment of greater trochanteric pain syndrome: A randomized clinical trial. Journal of Back and Musculoskeletal Rehabilitation, 31(6), 1105–1111. https://doi.org/10.3233/BMR-181033
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