Gluteal tendinopathy is a common cause of pain on the outside of the hip. It involves irritation, overload and/or degeneration of the tendons that attach the deep gluteal muscles (most commonly gluteus medius and gluteus minimus) to the bony point on the outside of the hip called the greater trochanter.
You may also hear gluteal tendinopathy described as Greater Trochanteric Pain Syndrome (GTPS). This label includes other conditions like trochanteric bursitis, which often co-occur.
Gluteal tendinopathy can be frustrating because pain often flares with everyday activities such as walking, stairs, standing for long periods, getting out of the car, or lying on the sore side. It is particularly common in women over 40 and is also seen in runners and active people who increase training loads quickly.
Physiotherapy for gluteal tendinopathy is one of the most effective and evidence-supported treatments. A physiotherapist helps you settle pain, reduce compressive irritation at the tendon, rebuild hip strength and control, and guide a safe return to walking, work, sport and exercise. A structured approach of education plus exercise has been shown to produce better long-term outcomes than corticosteroid injection for many people.
Key Facts
- GTPS is a common cause of lateral hip pain and is more prevalent in females aged 40 to 60 years, with an incidence around 1.8 per 1000 per year. 🔗
- Education and exercise led to greater global improvement than corticosteroid injection in a large Australian study; however injections may still have a role in many cases. 🔗
Risk Factors
- Female sex and age over 40, particularly around peri-menopause and post-menopause.
- Rapid increases in walking, running, hiking, or stair-based exercise.
- Hip abductor weakness and reduced single-leg control.
- Lumbar spine or pelvic pain coexisting with hip pain.
- Higher body weight, which can increase tendon load during standing and walking.
- Habitual postures that increase hip adduction and tendon compression (standing on one hip, crossed legs).
Symptoms
- Pain on the outer side of the hip, often localised to the bony point (greater trochanter).
- Pain when lying on the affected side, often waking you at night.
- Pain with walking, especially longer distances or on hills.
- Pain going up or down stairs.
- Pain when standing on one leg (for example dressing, brushing teeth, waiting in a queue).
- Pain getting in and out of a car or low chair.
- Tenderness to touch over the outside of the hip.
- Hip weakness or a feeling that the hip “gives way”, sometimes with a limp.
Aggravating Factors
- Lying on the painful side or sleeping with the top knee dropped across the body.
- Prolonged standing, especially with weight shifted onto one hip.
- Walking on hills, uneven ground, or long distances without conditioning.
- Stairs, step-ups, or repeated sit-to-stand from low chairs.
- Sudden increases in running, hiking, or gym loads.
- Crossing legs, sitting with knees together and feet apart, or other positions that compress the outer hip tendons.
Causes
Gluteal tendinopathy develops when the gluteal tendons are exposed to loads they cannot tolerate or recover from. This may include overuse (too much walking or running too soon), compression (pressure on the tendon against the bone), or a combination of both.
The gluteal tendons help stabilise the pelvis when you stand on one leg. Every step you take is essentially a single-leg balance task. If the gluteal tendons are overloaded or irritated, pain tends to flare with walking, stairs and standing.
In many people, the issue is not one single event. It is often a build-up of load over time plus movement habits that increase tendon compression, such as hanging on one hip, crossing legs, or sleeping positions that allow the hip to fall into adduction (the knee drifting inward).
Although imaging may show tendon thickening or degenerative change, the severity on scans does not always match pain. Physiotherapy targets the drivers that you can change, including strength, control, loading patterns, and how you position the hip during daily life.
How Is It Diagnosed?
Gluteal tendinopathy is usually diagnosed clinically by a physiotherapist or doctor using your story, symptom behaviour, and specific physical tests. A key feature is pain over the outer hip that is aggravated by tendon loading (walking, stairs, standing on one leg) and often aggravated by compression (lying on the side, crossed legs, hip dropped inward).
Your physiotherapist will ask about the onset (gradual vs sudden), changes in activity, sleep positions, and work demands. They will then assess hip strength, control and reproduce symptoms with targeted tests such as single-leg stance, step tests, palpation at the greater trochanter, and other hip-loading tests.
It is also important to rule out other sources of lateral hip pain such as hip osteoarthritis, lumbar referral, stress fractures, or systemic inflammatory conditions. If your symptoms do not behave like typical gluteal tendinopathy, your physiotherapist may recommend medical review or imaging.
Investigations & Imaging
- Ultrasound
- Can identify tendon thickening, tears, or associated bursal irritation, and can guide injections if required.
- MRI
- Provides detailed assessment of gluteal tendon pathology and can help rule out other hip or pelvic conditions.
- X-ray (if indicated)
- Does not show tendons well, but may be used to assess for hip osteoarthritis or other bony causes of pain.
Physiotherapy Management
Physiotherapy management for gluteal tendinopathy targets two key problems:
- The tendon is irritated by loads and positions it cannot tolerate, and
- The hip muscles and movement patterns are not distributing forces well. The most effective approach usually combines load management education plus a progressive strength and control program.
Recovery is rarely about one magic exercise. It is about reducing tendon compression, improving hip capacity, and gradually returning to the activities you value.
Exercise
Exercise is the main active treatment for gluteal tendinopathy and is a major part of “gluteal tendinopathy rehab”. Early on, your physiotherapist will choose exercises that strengthen the hip abductors while keeping pain and compression controlled. This often begins with low-irritation isometrics and supported strengthening, then progresses to heavier slow resistance and functional loading.
Examples of early-phase exercises include side-lying or standing isometrics (pushing the knee outward into a wall), bridging variations, and controlled hip abduction work that keeps the knee from dropping inward. As symptoms settle, progression may include step-ups, split squats, single-leg deadlift patterns, and loaded hip abduction work (cables or bands). The aim is to rebuild tendon capacity without repeated flare-ups.
Runners and active people need sport-specific progression. Your physiotherapist will often build strength first, then reintroduce impact and speed gradually. A key principle is monitoring tendon “reaction” after exercise. A mild increase in symptoms during training can be acceptable, but pain that significantly spikes or does not settle within 24 hours suggests the tendon was overloaded and the program needs adjusting.
Activity Modification
Activity modification is essential early in treatment because gluteal tendinopathy is often aggravated by compressive positions. Your physiotherapist will help you identify your biggest triggers and then modify them without stopping life completely.
Common modifications include avoiding side-lying on the painful hip (or using a pillow between the knees and a thick mattress topper), avoiding crossed legs, avoiding prolonged standing with weight on one hip, and reducing hill walking, long walks, and stairs temporarily. For some people, changing how they sit (keeping knees slightly apart and feet under knees) reduces tendon compression. For others, short walking bouts spread across the day are better tolerated than one long walk.
Modification is not forever. It is a short-term strategy to calm the tendon so strengthening can actually work.
Manual Therapy
Manual therapy may be used to reduce pain and help you move more comfortably while your strengthening program builds capacity. This might include soft tissue techniques for the gluteal muscles, hip flexors or lateral thigh, and gentle joint techniques if stiffness is contributing to poor load distribution.
Manual therapy works best when paired with targeted exercise and load management strategies.
Postural Retraining
Postural retraining focuses on reducing sustained hip adduction and pelvic “hang” positions that increase tendon compression. Your physiotherapist may coach you to stand with weight evenly distributed, avoid pushing the hip out to the side, and improve single-leg alignment during walking, stairs and gym work.
For runners, this may include technique coaching and graded exposure to speed, hills and cadence changes as strength and control improve.
Bracing & Taping
Bracing and taping can provide short-term symptom relief for gluteal tendinopathy by improving hip awareness and reducing painful movement patterns. Some people benefit from supportive taping to cue better pelvic control during walking or exercise, particularly early in rehab when pain is easily triggered.
Taping is usually temporary and is most useful when it helps you keep moving safely while your strengthening program builds longer-term stability.
Dry Needling
Dry needling may be considered when there is significant protective muscle tightness or trigger points in surrounding muscles such as gluteus maximus, tensor fascia latae, or lumbar muscles. For some people, this can reduce pain sensitivity and improve tolerance to exercise.
It is used as an adjunct to help you participate in your gluteal tendinopathy physiotherapy exercises with less flare-up.
Shockwave
Shockwave therapy (extracorporeal shockwave therapy, ESWT) is sometimes used for persistent gluteal tendinopathy that has not responded to a well-structured loading program. It may help reduce pain and support tendon rehabilitation when combined with exercise.
If shockwave is used, your physiotherapist will typically continue progressive strengthening and load management because shockwave alone is less likely to produce lasting change in function.
Education
Education is a major part of treatment because gluteal tendinopathy is highly influenced by load and positioning. Your physiotherapist will explain which postures compress the tendon, how to modify sleep and standing habits, and how to use “24-hour pain response” to guide safe progression.
You will also learn what level of pain is acceptable during rehab. Many people do best with a “tolerable discomfort” approach rather than complete pain avoidance, but the exact target depends on your irritability and flare pattern. Education also includes pacing strategies so you can stay active without repeatedly setting the tendon back.
Other
Other considerations include footwear advice, graded return to running or sport, and coordination with your GP if pain is significantly limiting sleep or function. If there is suspected lumbar contribution or hip joint involvement, physiotherapy may include additional assessment and management of those regions so the gluteal tendon is not overloaded by compensation.
Other Treatments
Other treatments for gluteal tendinopathy may include medications for short-term pain relief (discussed with your GP), or injection options guided by a doctor. Corticosteroid injections can provide short-term pain reduction for some people, but benefits may reduce over time and are generally not a substitute for a progressive strengthening and load management plan. Decisions about injections should consider your overall health, symptom duration, and goals, and are best made with your medical team.
Some people ask about PRP or other regenerative injections. Evidence is still evolving, and the best-supported long-term approach remains education plus progressive exercise.
Surgery
Surgery is rarely required for gluteal tendinopathy. It may be considered in a small number of cases where there is a significant gluteal tendon tear, persistent disability, and failure to improve with an appropriate period of conservative treatment.
If surgery is needed, rehabilitation is still essential. Physiotherapy guides post-operative strengthening, gait retraining, and a staged return to daily activities and sport.
Prognosis & Return to Activity
Most people improve with appropriate physiotherapy and load management, but timeframes vary based on symptom duration, irritability, and how consistently you can follow the plan. Early improvements are often seen within weeks, particularly when sleep positions and high-irritation activities are modified. Building strength and resilience typically takes longer and may require months of progressive rehabilitation.
Gluteal tendinopathy can flare if loads increase too quickly or compressive positions return without adequate strength. A physiotherapist helps you build a return-to-activity plan that reduces recurrence risk.
Complications
- Persistent night pain and disrupted sleep due to side-lying intolerance.
- Reduced walking capacity and avoidance of exercise due to flare-ups.
- Ongoing hip weakness and limping, which can overload the lower back, knee or the other hip.
- Reduced quality of life and reduced participation in work, sport and social activities.
Preventing Recurrence
- Avoid repeated hip compression positions: limit crossed legs, avoid standing with the hip pushed out, and use a pillow between knees when side sleeping.
- Progress walking, running and gym loads gradually, especially hills, stairs and speed work.
- Maintain hip abductor strength with ongoing gluteal tendinopathy physiotherapy exercises even after pain settles.
- If you sit for long periods, stand and move regularly to avoid sustained hip positions that irritate the tendon.
When to See a Physio
- Outer hip pain is limiting walking, stairs, sleep, or exercise and has persisted longer than 2 to 3 weeks.
- You keep getting flare-ups with walking or running and need a clear load progression plan.
- You are unsure whether your pain is coming from the hip, tendon, bursa, or lower back.
- You have weakness, a limp, or trouble with single-leg tasks and want structured gluteal tendinopathy rehab.