Gluteal Tendinopathy- what is it?

Is a painful condition affecting the tendons of the gluteus medius and gluteus minimus
muscles, which attach to the greater trochanter of the femur (the bony prominence on the
outer side of the hip). It is one of the most common causes of lateral hip pain and is often
associated with what is known as Greater Trochanteric Pain Syndrome (GTPS).

Although this condition was previously attributed mainly to bursitis (inflammation of the
bursa), current evidence shows that pain frequently originates from the tendon itself
(tendinopathy), with or without associated bursal involvement.

The tendon undergoes metabolic and structural changes that reduce its ability to adapt to load. The collagen becomes less organised and mechanically weaker, changes in vascularity, and a low-grade inflammatory response. As a result, the tendon has a reduced tolerance to load and compression,
becoming more sensitive to pain even during everyday activities.

Who is most affected?
Gluteal tendinopathy can affect different populations, but it is more prevalent in:

● Women (40-60 years old), who have a higher risk compared with men;
● Athletes, particularly runners and individuals performing repetitive or high-load
activities involving the hip.
– In younger athletes, the condition may develop due to repetitive loading and
compressive forces acting on the tendon.

Common symptoms:

● Pain on the outer side of the hip, especially when touched or pressed;
● Pain when lying on the affected side, climbing stairs, or walking long distances;
● Weakness or discomfort when lifting the leg sideways or standing on one leg;
● Pain that may radiate down the outer thigh.

Why does it happen? 
Gluteal tendinopathy develops when there is an imbalance between the load applied to
the tendon and its capacity to tolerate and adapt to that load.

Key mechanisms include:
● Repetitive overload of the gluteal tendons without adequate recovery time;
● Excessive compression of the tendons against the bony structures of the hip,
particularly during activities involving hip adduction;
● Biomechanical alterations, such as muscle weakness or suboptimal movement
patterns.
Contributing factors may include:
● Weakness or imbalance of the hip musculature;
● Sudden increases in training load or physical activity;
● Metabolic or systemic conditions (such as diabetes or hormonal changes).

How is it diagnosed?
Diagnosis is primarily clinical and is based on:

● The patient’s history and reported symptoms;
● Physical examination, including specific tests that reproduce pain under load or
compression.
In some cases, imaging studies such as ultrasound or magnetic resonance imaging (MRI)
may be used to confirm tendon changes or exclude other causes of hip pain.

Important: Imaging findings may be present in people without symptoms and should always
be interpreted alongside the clinical presentation.

Evidence-based treatment
Conservative management (first-line treatment)
The strongest evidence supports physiotherapy and progressive exercise programmes
as the cornerstone of treatment.

Key components include:
● Patient education regarding load management and pain behaviour;
● Progressive therapeutic exercises to improve strength, control, and the tendon’s
capacity to tolerate load;
● Movement and biomechanical retraining to reduce excessive tendon compression
and strain.
Findings from recent studies indicate that:
● Exercise combined with education leads to moderate to good improvements in
pain and function;
● Interventions such as corticosteroid injections may provide short-term pain relief
but show limited long-term benefit;
● Extracorporeal shockwave therapy (ESWT) may offer additional
benefits when combined with an exercise programme.

What should be avoided or modified initially?
● Activities that consistently increase pain without improvement after rest;
● Repetitive movements or sudden high loads without appropriate preparation or
gradual progression.
Recovery expectations
Recovery varies between individuals, but many people experience significant
improvement within weeks to a few months when appropriate treatment is followed.

Gradual progression of exercise under professional guidance is essential to restore tendon
capacity and reduce the risk of recurrence.

Key take-home messages
💡 Gluteal tendinopathy is a common cause of lateral hip pain, often related to tendon
overload and repetitive compression. 💪 Progressive exercise and education are the most
effective treatment strategies.
󰝊 Repetitive movements, sustained postures, and poorly managed loads can
aggravate symptoms.
📅 Recovery takes time and consistency, with gradual improvement through a structured
and individualised plan.