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Gluteal Tendinopathy
Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director
Medically Reviewed: Lauren Egginton MChiro GCC 06282, Registered Chiropractor. Specialist in Pregnancy, Paediatric Chiropractic & Functional Rehabilitation | London.
What is Gluteal Tendinopathy?
A tendon is a strong connective tissue that blends with a muscle at one end and then inserts deep into a bone on the other end, connecting a muscle to a bone. Tendon problems can be acute or chronic and can have different presentations thus different terminology is used. Tendinitis refers to the inflammation of a tendon within the tendon sheath that happens in the acute state. Tendinosis on the other hand refers to the chronically damaged tendon with signs of scar tissue and fiber damage due to degeneration and improper healing.
Gluteal tendinopathy can refer to both tendinitis and tendinosis of all the gluteal muscles (gluteus maximus, gluteus medius and gluteus minimus) together or in isolation, such as a gluteus medius tendinopathy. It is the most common cause for lateral hip pain and greater trochanteric pain syndrome ( the greater trochanter can be felt on the outside of the hip and is the location of the attachments of all the gluteal muscles).
Gluteal tendinopathy is most commonly seen in the inactive population, runners and hikers, and affects people predominantly over the age of 40 and females more than males (Grimaldi and Fearon, 2015).
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What are the symptoms of Gluteal Tendinopathy?
Signs and symptoms of gluteal tendinopathy present very similarly between individuals.
Signs usually include:
- Mild limping when walking.
- Rubbing the outside of the hip and gluteal area after a short walk or after getting up from sitting.
- Difficulty lying onto the affected side, especially in hard and non-cushioned surfaces.
- Difficulty ascending stairs.
Common symptoms include:
- Pain and tenderness when palpating the outside of the hip (greater trochanter) and when pressing on the glutes.
- Pain with walking, running, ascending or descending stairs.
- Irritation of gluteal area with prolonged sitting or standing
- Red, hot and swollen gluteal area and greater trochanter.
- Pain during the night, especially when lying on the affected side.
- Stiffness in the morning, usually lasting less than 30 minutes.
- Pain when crossing legs.
What are the common causes of gluteal tendinopathy?
The gluteal muscles are a powerful group of muscles that are used constantly to allow us to move, stand, and sit. Abnormal loading due to individual skeletal differences, other underlying pathologies, or biomechanical changes—and the overloading of these muscles – can lead to irritation and pain.
Our clinical team is highly experienced in these pathologies, having performed 8,000 specialised musculoskeletal treatments in 2025 alone across our London clinics.
Common causes:
- Skeletal Structure: Each person has a slightly different skeleton with a different structure and muscle mass. A hypermobile individual or someone with a leg length discrepancy can end up loading those muscles in different ways, making them work harder, which can eventually lead to tendon irritation.
- Underlying Pathologies: Conditions such as ankle, knee, hip, or pelvic problems following injuries or operations, or instability in these joints, can lead to abnormal or excessive loading in the gluteal tendons.
- Biomechanical Changes: Changes which alter the gait cycle, running mechanics, and even daily movements can lead to excessive loading. Repetitive activities that involve significant hip flexion, such as long-distance cycling, are a primary driver for this condition. For more information on managing this and other common cycling injuries, visit our clinical guide.
- Muscle Imbalances: Purely muscle imbalances arising from sedentary lifestyles or, conversely, the high demand seen in elite athletes can put the gluteal muscles under excessive stress they are unable to withstand.
Specialist Treatment: Focused Shockwave for Gluteal Tendinopathy
Chronic gluteal tendinopathy (often called Greater Trochanteric Pain Syndrome) is notoriously difficult to treat because the tendons have a poor blood supply. If your hip pain has persisted for more than 3 months, standard exercises may not be enough to stimulate a healing response.
“Weak glutes often lead to lower back compensation; use these back strengthening moves to offload the spine.”
At Bodytonic Clinic, we use Focused Shockwave Therapy to “reset” the tendon’s repair cycle. Unlike standard physical therapy, Focused Shockwave can:
- Penetrate Deeply: Reach the attachment point of the gluteus medius and minimus tendons on the femur.
- Stimulate Neovascularisation: Create new blood flow to the damaged tendon tissue.
- Break Down Fibrosis: Resolve the thickened, painful tissue that causes “flare-ups” during activity.
Why Focused Shockwave is Different
As seen in the clinical diagram below, the energy delivery is fundamentally different from standard shockwave:
- Radial Shockwave:
- Primary Target Muscles & Trigger Points
- Penetration Depth Shallow (3–5 cm)
- Energy Source Pneumatic (Air)
- Focused Shockwave:
- Primary Target Deep Tendon & Bone Attachment
- Penetration Depth Deep (Up to 12 cm)
- Energy Source Piezoelectric/Electromagnetic
Does your hip pain feel sharp when you lie on your side or walk up stairs? This is a classic sign of tendon load intolerance where the tissue sits deep against the bone. By using a combination of Radial (for the muscles) and Focused (for the tendon), we provide a comprehensive recovery plan that standard physiotherapy alone cannot match.
Gluteal Tendinopathy Infographic
View our ultimate guide to Gluteal Tendinopathy which covers symptoms, common causes, diagnosis, treatments options and exercises in our Gluteal Tendinopathy exercises pdf.
Clinical Diagnosis: Is it Hip Bursitis or Gluteal Tendinopathy?
To diagnose gluteal tendinopathy, a detailed case history is vital. Many patients confuse this with “Hip Bursitis,” but our specialists look for specific signs of tendon load intolerance. Because lateral hip pain can often be referred from the spine, we also screen for Sciatica and Sciatic Pain to ensure an accurate diagnosis.
Key Diagnostic Indicators:
- Palpation: Tenderness specifically over the Greater Trochanter (the bony bit on the side of your hip).
- 30-Second Single Leg Stance Test: Pain when standing on the affected leg for 30 seconds is a highly reliable clinical indicator.
- FABS Test: Clinical movement tests used to differentiate between the hip joint and the tendon.
To diagnose gluteal tendinopathy a detailed case history must be taken to obtain information about the duration of the discomfort or pain and its progression, any previous or new injuries that could be referring to or causing pain to the lateral side of the hip and finally anything that relieves or aggravates it.
Following the case history, a physical examination will be carried on. The practitioner will palpate the area of discomfort or pain and the surrounding tissues to check for any tissue change and try to recreate the symptoms experienced. The practitioner will then observe you standing and will ask you to do a few active movements to check for any restriction or pain. Finally, a passive physical examination will take place to once again check for any joint restriction or abnormality, activate, stretch and put the muscle under stress to recreate the symptoms.
In certain occasions and when dealing with elite athletes a gait and running analysis may be needed to identify the reason that leads to the irritation of the gluteal tendons.
What are the treatment options for Gluteal Tendinopathy?
Gluteal tendinopathy treatment options may vary depending on the severity and the needs of the individual. For elite athletes a careful rehabilitation program will be formed, aiming to work on the areas of weakness that cause the gluteal tendons to work harder and return the athletes back to sports as soon as possible. For the general population a suitable rehabilitation and treatment program will be formed to help decrease pain and allow the individual to return to their hobbies and daily activities.
“Effective management often requires a mix of structural alignment and muscle release. Learn more about the differences in Chiropractor vs Massage therapy.”
Treatment options may include:
- Rest and contrast bath therapy (hot and cold therapy) followed by rehabilitation of the tendon using progressive loading (starting with isometrics followed by eccentric and concentric loading).
- Physical therapy such as osteopathy, chiropractic and physiotherapy can help release the tension in the muscles and improve mechanics of the joints in order to reduce the tension going through the gluteal tendons.
- Dry needling or acupuncture along with osteopathy, chiropractic and massage may help speed up the healing process of the injured or irritated tissues and reduce the rehabilitation and recovery time needed.
- Steroid injection can be used if symptoms and inflammation are severe.
- Surgery is the last option if all the above treatment approaches have not made a sufficient change in the tissues and a reduction in the symptoms experienced.
- Shockwave Therapy can help to stimulate tissue regeneration and pain reduction by using acoustic sound waves to trigger the body's natural healing process, particularly in chronic conditions such as gluteal tendinopathy. Your practitioner will undergo a thorough case history and physical examination in order to understand whether focused or radial shockwave is best for your condition.
How long does Gluteal Tendinopathy last?
Gluteal tendinopathy can last from a few weeks up to a year or more. An acute state is considered to be anything less than 8 weeks and a chronic state is anything more than 8 weeks.
Depending on how quickly and accurately the problem is picked up by a healthcare practitioner, it can change the rehabilitation program and the recovery time. Understanding what exactly is causing the symptoms and seeking the appropriate help and advice can speed up the process by following a guided treatment and rehabilitation plan formed by a trained professional. Changes in symptoms and pain reduction can be seen following a few treatments and an overall recovery can be achieved once the causation of the problem has been resolved and the individual is able to return pain and symptom free to their activities and sports.
Can Gluteal Tendinopathy be prevented?
Like any other muscle injury, gluteal tendinopathy can be prevented from happening if the body is functioning well. For every individual and most importantly for athletes in both recreational and elite level a check-up is recommended a few times a year in order to check the body for areas that might be compensating for certain reasons, which may eventually, if left untreated, cause further problems and complications such as gluteal tendinopathy. A chiropractor, osteopath or physiotherapist will carefully examine, check and compare both sides and your spine to detect any restrictions that may eventually lead to problems. Through manual therapy and with the right advice these problems could potentially be prevented.
What are the best exercises for Gluteal Tendinopathy*?
A structured rehabilitation program formed by your osteopath, chiropractor or physiotherapist along with hands-on treatment including mobilizations, manipulations, stretches, massage, dry needling, shockwave therapy (radial shockwave / focused shockwave) and K-tape and further advice can help with the overall recovery time.
According to recent evidence from studies on tendon rehabilitation, loading of the tendon as opposed to rest has been proven to lead to better overall management with less pain and quicker recovery and return to functional movements.
The rehabilitation program follows a specific order of loading the tendon starting with isometric contractions, followed by eccentric and concentric, finally going into low and high velocity loading and full functional loading. Some of the exercises will be described below:
- Isometric hip internal rotation: Either standing or seating next to a wall bring the hip closer to the wall to 90 degrees and push for 20 seconds. Relax for 10 seconds and repeat for 5 times.
- Isometric gluteus medius activation: Stand on one leg with your opposite knee bent to 90 degrees and touching the wall. With the bent knee push the knee against the wall, making sure to keep the rest of the body still. Hold for 20 seconds, Relax for 10 seconds and repeat for 5 times.
- Eccentric contraction of gluteus medius: Using an elastic band over your knees abduct both legs until you feel the tension in the band. Then slowly balance on one leg whilst bringing the opposite leg off the floor. Counteract the pull from the band whilst slowly abducting the hip that is off the floor. Repeat 5 times on each side for 3 sets.
- Concentric contraction of gluteus medius: With an elastic band over your knees lie onto your side with hips at 45 degrees and knees at 90 degrees. Both ankles and feet maintain contact with each other. Begin by lifting the top knee up making sure there is no rotation at the pelvis. Return the top knee to the starting position. Repeat on each side for 3 sets of 10-12 repetitions.
- Functional loading of gluteal muscles: Squats, lunges, glute bridges and hip thrusts all work the gluteal muscles in different planes giving strength, mobility and flexibility. These exercises can be done with and without weights, with varying repetitions and sets but the importance is the form and progression.
*It is recommended to get the go ahead from your physical therapist or GP before carrying out any of these exercises.
Do I need to see my local GP or go to the hospital?
The best action for someone who is suspected to have gluteal tendinopathy is to consult their chiropractor, osteopath or physiotherapist and in severe cases a musculoskeletal specialist. However, if the onset of the pain is sudden, if there has been a traumatic event that initiated the pain or there are underlying risk factors such as severe osteoporosis or osteopenia then it is recommended to talk to your GP or go to A&E.
Patient Safety & Suitability
To ensure the best clinical outcomes, we screen all patients for suitability. Shockwave therapy is a non-invasive, highly safe medical treatment, but it may not be recommended if:
- You have had a steroid injection in the hip area within the last 12 weeks.
- You are on blood-thinning medication (e.g., Warfarin).
- You have a cardiac device (Pacemaker) or a diagnosis of cancer in the treatment area.
- You are currently pregnant or have an active skin infection at the site.
Why 6 Sessions? The Path to Permanent Recovery
Clinical research on chronic Gluteal Tendinopathy shows that tendon remodeling is a gradual process. While some relief is often felt after the first session, the biological “reset” of the tissue requires cumulative stimulation.
- The 6-Session Protocol: At Bodytonic Clinic, we provide this treatment as a Package of 6 sessions. This ensures you complete the full clinical course required to stimulate neovascularisation (new blood flow) and long-term tendon repair.
- Consistency: Sessions are spaced approximately one week apart. Skipping sessions can stall the healing response, which is why we commit to a 6-week journey with you.
- Post-Treatment Care: Avoid high-impact activity and anti-inflammatory medication (like Ibuprofen) for 48 hours. Let the natural inflammatory response do its work!
References
Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H. and Vicenzino, B., 2015. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine, 45(8), pp.1107-1119.
Grimaldi, A. And Fearon, A., 2015. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp.910-922
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