Gluteal muscle tendinitis or tendinopathy

Other names for this condition

• Gluteus medius tendinopathy
• Trochanteric tendinitis
• Greater Trochanteric Pain Syndrome

What is the difference between tendinitis and tendinopathy?

Tendinitis refers to inflammation of a tendon, while tendinopathy refers to tendon pain accompanied by impaired tendon function. It was long believed that all tendon pain was caused by inflammation. Tendinopathy may be accompanied by changes in the tendon’s structure and inflammatory reactions. ^{1, 2} That is why the term “tendinopathy” is used instead, and why treatment does not focus solely on inflammation. Education and exercises form the foundation of treatment, while a cortisone injection may provide short-term pain relief for some people³.

Tendinopathy refers to a painful condition of the tendon that impairs its function and tolerance to physical exertion. Inflammatory processes may or may not be present¹. These terms describe different aspects of the condition. Tendinitis refers to inflammation of the tendon. Tenosynovitis refers to inflammation of the sheath surrounding certain tendons. Tendinosis refers to changes in the structure of the tendon. The term tendinopathy primarily describes pain and reduced function.¹

The physical therapist selects exercises based on the movements that cause you pain and the activities you'd like to resume.

What is a tendon?

A tendon is the structure that attaches a muscle to a bone. ⁴ When a muscle contracts, the force is transmitted to the tendon, and the tendon tightens to move the bones. It’s like a strong rope that transmits the force from your muscles to your skeleton.

What is gluteal tendinopathy?

Gluteal tendinopathy is a painful condition affecting one or more tendons of the gluteal muscles. The most common form is gluteus medius tendinopathy⁵, a muscle located on the side of the hip that plays a key role in stabilizing the pelvis—which we target with a glute-strengthening exercise at the end of the table.⁶

The gluteus medius attaches to the greater trochanter, the bony protrusion you can feel on the side of your hip. When this tendon becomes irritated or painful, it is referred to as gluteus medius tendinopathy.

Gluteal tendinopathy is the most common type of tendinopathy affecting the hip and legs. It is more common than tendinopathy of the Achilles tendon, behind the ankle, and the patellar tendon, in front of the knee. ⁷ Long mistaken for hip bursitis, it is now better recognized. ⁸

It affects women more often⁹. The link to age is less clear-cut than is sometimes thought: abnormalities visible on tendon imaging increase with age¹⁰, but a large-scale population study did not find that the pain syndrome itself increased among people aged 50 to 79⁹.

What are the causes of gluteal tendinopathy?

An increase in the load that the tendon has difficulty tolerating can contribute to gluteal tendinopathy. ^{6, 11} This often occurs when physical activity is increased too quickly, such as when resuming running after the winter or going on a mountain hike without being accustomed to it.

Tendon irritation can be caused by:

• Increasing physical activity too quickly
• Poorly managed repetitive hip movements
• Positions that put pressure on the tendon, especially when the hip shifts inward (swaying the hips, crossing the legs, sleeping on one's side)⁶
• Prolonged overload on the tendon

Some classic examples of how this condition develops:

• Resuming running after winter without properly managing the progression, especially if you do a lot of hills
• Going on a mountain hike without being accustomed to it
• Rapidly increasing leg exercises at the gym

What are the risk factors for developing gluteal tendinopathy?

Women are affected more often than men. In a large population-based study, age was not associated with pain syndrome among adults aged 50 to 79. The role of menopause and hormonal changes remains unclear; studies are exploring this possibility without establishing that it causes tendinopathy.^{13, 14}

A physical therapist can assess the following factors, whose role as a cause is not always established:

• Women
• Postmenopausal women have participated in studies on this condition. These studies do not show that hormonal changes alone cause this tendinopathy.
• A Rapid Increase in Mileage Among Runners
• A return to normal activity after a slower period
• People who are overweight or obese: Some studies have found that people with this condition have a higher weight-to-height ratio. However, the link between weight and this tendinopathy remains unclear when researchers take other^factors into account15^{, 9}
• Weakness in the hip muscles, which may accompany tendinopathy without necessarily being its cause

What are the symptoms of gluteal tendinopathy?

The main symptom is pain on the outer side of the hip, near the greater trochanter. This pain may radiate down the thigh and is often worse at night or when lying on the affected side.

The most common symptoms are:

• Pain or tenderness on the side of the hip that develops gradually
• Pain that may radiate down the side of the thigh
• Pain that is worse at night, especially when lying on the affected side
• Difficulty finding a comfortable sleeping position

Pain is generally increased by:

• Walking, especially over long distances
• Standing on one leg
• Swaying your hips (putting weight on one hip)
• Going up or down stairs
• Running or cycling
• Sitting with crossed legs
• Getting up after sitting for a long time

How is gluteal tendinopathy diagnosed?

The diagnosis is based primarily on the history of symptoms and a physical examination. In some cases, pain provocation tests and imaging may be necessary. ¹

Your physiotherapist or doctor will ask about:

• The exact location of your pain
• Movements or activities that make it worse
• How long you've had pain
• Your recent sports or work activities
• Your sleeping habits

The physical exam includes specific tests to replicate your pain and assess the strength of the muscles that stabilize your pelvis. Clinical tests are part of the examination, but no single test alone confirms the diagnosis; rather, it is a combination of tests—such as applying pressure to the gluteal tendon and moving the leg outward against resistance—that increases or decreases the likelihood of the^{condition.¹⁶, ⁶}

Ultrasound, which produces images using sound waves, or magnetic resonance imaging (MRI), which produces images using a magnetic field, can be useful in certain cases—for example, to confirm a partial tendon tear or when symptoms persist despite non-surgical treatment—but the exact role of imaging in diagnosis remains a subject of debate in the^{literature1, 16}.

When should I see a physiotherapist for gluteal tendinopathy?

You can see a physical therapist when pain on the side of your hip limits your ability to walk, sleep, exercise, or perform daily activities.

You do not need to see a doctor before starting physical therapy. The physical therapist may refer you to a doctor if the evaluation reveals a problem that requires medical attention.

Consult quickly if:

• Pain limits your daily activities
• You have difficulty walking normally
• Pain keeps you from sleeping

What physiotherapy treatments are available for gluteal tendinopathy?

Treatment for gluteal tendinopathy combines progressive strengthening exercises with guidance on how to adapt your activities to manage your pain. Studies show that this approach leads to greater overall improvement than cortisone injections, especially in^the long^{term17, 3}. After 52 weeks, however, pain levels were similar between the two approaches in the landmark clinical trial on this condition¹⁷.

Your physiotherapist will first conduct a complete assessment to determine the factors contributing to your tendinopathy. This assessment includes:

• Hip Mobility
• Movements that trigger your pain
• Strength and Control of the Muscles Around the Hip
• Your walking pattern
• Recent Growth in Your Business

Based on the assessment results, your physiotherapist will be able to:

• Providing you with specific exercises to progressively strengthen your gluteal muscles
• Teaching you how to modify your activities to reduce tendon irritation
• Helping you gradually increase your return to activities
• Gently move your hip with your hands, if that helps relieve your pain
• Advising you on positions to avoid and to favor

Gradually strengthening the gluteal muscles helps the tendon better tolerate physical activity and helps the hip avoid certain painful positions. ^{6, 3} See also our article on the trochanteric bursa, a small fluid-filled sac located on the side of the hip.

A strengthening program requires consistency and regular reassessment over time.

The initial treatment options generally include progressive strengthening exercises tailored to your abilities. In the long term, cortisone injections are less effective than exercises, and their benefits—if any—are mostly short-lived.^{1, 3, 17}

What can I do at home for gluteal tendinopathy?

Temporarily avoid positions that compress the tendon, such as crossing your legs or sleeping on the painful side. Opt for low-impact activities and do strengthening exercises regularly.

• Swimming
• Stationary bike with a properly adjusted seat
• Moderate walking on flat ground
• Aqua fitness

• Standing with your weight shifted to one hip
• Sitting with your legs crossed
• Sleeping on the side that hurts. If you sleep on your side, choose the side that doesn't hurt and place a pillow between your legs to support them
• Stretching the iliotibial band—a band of tissue located on the side of the thigh—because it can increase pressure on the tendon

• Incorporate walking breaks into your running sessions
• Temporarily reduce your mileage and intensity.
• Avoid sloped or side-sloping surfaces
• Do glute strengthening exercises regularly

What is the recovery time for gluteal tendinopathy?

Recovery from gluteal tendinopathy can take several months, although improvement may be noticeable after a few weeks. An eight-week program resulted in improvement in about three out of four participants, and progress may continue for several months.

Your physical therapist will tailor your program based on the following factors:

• How long you have had symptoms
• Your usual level of physical activity
• Your ability to do the suggested exercises on a regular basis
• Activities or postures you can adjust to reduce your symptoms

Most people with this condition can improve with non-surgical care and appropriate exercises, although the exact proportion varies depending on the study¹⁸: In one clinical trial, about three out of four people in the education and exercise group reported improvement after eight weeks¹⁷. Some people respond less well and may need additional treatment options.⁷

Sources

The sources for this article include the following studies.

Links open in a new tab.

1. Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7(1):1. (Back to sections: 1, 2, 3, 4, 5, 6)
2. Mosca MJ, Rashid MS, Snelling SJ, Kirtley S, Carr AJ, Dakin SG. Trends in the theory that inflammation plays a causal role in tendinopathy: a systematic review and quantitative analysis of published reviews. BMJ Open Sport Exerc Med. 2018;4(1):e000332. (Back to section: 1)
3. Bremer T, Nicklen P, Fearon A, Morrissey D. The efficacy of gluteal tendinopathy treatments: A systematic review. Clin Rehabil. 2025;39(5):600-617. (Back to sections: 1, 2, 3, 4)
4. Canosa-Carro L, Bravo-Aguilar M, Abuín-Porras V, Almazán-Polo J, García-Pérez-de-Sevilla G, Rodríguez-Costa I, et al. Current understanding of the diagnosis and management of tendinopathy: An update from the laboratory to clinical practice. Dis Mon. 2022;68(10):101314. (Back to section: 1)
5. Connell DA, Bass C, Sykes CA, Young D, Edwards E. Sonographic evaluation of gluteus medius and minimus tendinopathy. Eur Radiol. 2003;13(6):1339-47. (Back to section: 1)
6. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment, and Management. Sports Med. 2015;45(8):1107-19. (Back to sections: 1, 2, 3, 4, 5)
7. Ladurner A, Fitzpatrick J, O'Donnell JM. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation. Orthop J Sports Med. 2021;9(7):23259671211016850. (Back to sections: 1, 2)
8. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083-6. (Back to section: 1)
9. Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88(8):988-92. (Back to sections: 1, 2, 3)
10. Chi AS, Long SS, Zoga AC, Read PJ, Deely DM, Parker L, et al. Prevalence and pattern of gluteus medius and minimus tendon pathology and muscle atrophy in older individuals as assessed by MRI. Skeletal Radiol. 2015;44(12):1727-33. (Back to section: 1)
11. Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in the management of tendinopathy. Best Pract Res Clin Rheumatol. 2019;33(1):122-140. (Back to section: 1)
12. Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010;6(5):262-8. (Back to section: 1)
13. Mary McMillan R, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial. Am J Sports Med. 2022;50(2):515-525. (Back to section: 1)
14. Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. J Orthop Sports Phys Ther. 2015;45(11):910-22. (Back to section: 1)
15. Plinsinga ML, Ross MH, Coombes BK, Vicenzino B. Physical findings differ between individuals with greater trochanteric pain syndrome and healthy controls: A systematic review with meta-analysis. Musculoskelet Sci Pract. 2019;43:83-90. (Back to section: 1)
16. Kinsella R, Semciw AI, Hawke LJ, Stoney J, Choong PFM, Dowsey MM. Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther. 2024;54(1):26-49. (Back to sections: 1, 2)
17. Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, et al. Education plus exercise versus corticosteroid injections versus a “wait-and-see” approach on global outcome and pain from gluteal tendinopathy: a prospective, single-blind, randomized clinical trial. BMJ. 2018;361:k1662. (Back to sections: 1, 2, 3, 4)
18. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis, and treatment. Anesth Analg. 2009;108(5):1662-70. (Back to section: 1)