Gluteal Tendinopathy: Causes & Treatment for Outer Hip Pain | Victoria BC
Pain on the outside of your hip can be frustrating—especially when it starts interfering with running, walking, climbing stairs, working out, or even sleeping on your side.
One common cause of this type of pain is gluteal tendinopathy.
Sometimes referred to as greater trochanteric pain syndrome (GTPS), gluteal tendinopathy involves irritation and reduced load tolerance of the tendons that attach the gluteal muscles to the outside of the hip.
The good news? For many people, completely resting the hip isn't the answer. Current research supports a combination of understanding and managing aggravating loads, followed by progressive exercise to rebuild the hip's capacity.
What does gluteal tendinopathy feel like?
Gluteal tendinopathy typically causes pain around the bony area on the outside of the hip, called the greater trochanter.
You may notice:
Pain or tenderness on the outside of the hip
Pain when lying on the affected side
Discomfort when walking or running
Pain climbing stairs or hills
Pain during single-leg activities
Symptoms after increasing your running, walking or exercise volume
Pain after sitting or standing with your weight shifted onto one hip
Symptoms can vary considerably. Some people experience pain primarily during exercise, while others notice it more afterward or at night.
Why does it happen?
Your gluteal muscles do much more than simply move your leg.
The gluteus medius and gluteus minimus play important roles in controlling the hip and pelvis during activities such as walking, running, climbing stairs and balancing on one leg.
Their tendons therefore need to tolerate considerable load.
Gluteal tendinopathy can develop when the demands being placed on those tendons exceed what they are currently prepared to tolerate.
This doesn't necessarily mean you've damaged your hip by doing one particular activity.
Often, there has been a change in overall load.
For example:
Increasing running distance or frequency
Adding hills to your running or walking
Starting a new exercise program
Increasing lower-body training volume
Returning to activity after a period of reduced exercise
Suddenly doing substantially more walking while travelling
Combining several demanding activities without enough recovery
Sometimes there isn't an obvious trigger at all.
Why can lying on your side hurt?
One characteristic of gluteal tendinopathy is that the tendon can be sensitive not only to tension, but also to compression.
When you lie directly on the painful hip, the tissues around the outside of the hip are compressed.
Certain positions can also increase compression of the gluteal tendons—for example, standing with your weight hanging into one hip or sitting with your legs tightly crossed.
This is one reason simply stretching a painful outer hip isn't always the solution.
If a stretch places the hip into significant adduction—bringing the thigh across the body—it may actually increase compression around an already sensitive tendon.
Should you stop exercising?
Usually, not completely.
If every aggravating activity is removed for an extended period, the tendon doesn't have much opportunity to build its capacity.
On the other hand, repeatedly pushing through significant pain without adjusting your training can keep symptoms irritated.
The goal is to find the middle ground:
Reduce the loads the hip isn't currently tolerating while maintaining the activity and exercise it can tolerate.
For a runner, for example, this might mean temporarily reducing running volume, hills or speed rather than stopping running altogether.
For someone strength training, it might mean adjusting exercise selection, resistance, range of motion or weekly training volume.
Your response later that day and the following day can provide useful information about whether the current amount of activity is appropriate.
What actually helps gluteal tendinopathy?
One of the strongest studies in this area compared three approaches:
Education about tendon load management combined with exercise
A corticosteroid injection
A wait-and-see approach
Education combined with exercise produced better outcomes than simply waiting for the condition to improve. It also produced better global improvement than corticosteroid injection both in the short term and at one-year follow-up.
More recent systematic reviews continue to support exercise as a first-line treatment for gluteal tendinopathy.
Importantly, exercise isn't simply about finding one magical “glute activation” exercise.
Rehabilitation should gradually rebuild the amount of load your hip can tolerate.
What might exercise look like?
The appropriate starting point depends on your symptoms and current capacity.
Early exercises may involve relatively simple hip-strengthening or isometric exercises that allow you to load the muscles without significantly aggravating symptoms.
As tolerance improves, rehabilitation can progress toward exercises such as:
Side plank variations
Hip abduction exercises
Bridges and single-leg bridges
Squats and split squats
Step-ups
Hip hinges and Romanian deadlifts
Single-leg strength exercises
Eventually, the exercises should reflect what you actually want to return to.
If your goal is running, hiking or sport, rehabilitation shouldn't end with basic activation exercises. The hip needs to progressively tolerate heavier strength training, single-leg loading and eventually the speed, impact and volume required by your activity.
What about stretching?
Stretching isn't automatically bad, but more isn't necessarily better.
If repeatedly stretching the outside of your hip reproduces your symptoms, it may not be what the area needs—particularly during an irritable phase.
Instead of assuming a painful hip is simply “tight,” it can be more useful to determine:
What movements are actually limited?
What positions reproduce symptoms?
How strong is the hip?
How much activity is the tendon currently tolerating?
Has your training load recently changed?
A sensation of tightness doesn't always mean a tissue needs to be stretched.
Do you need a scan?
Not necessarily.
Gluteal tendinopathy can often be identified through your history and a physical assessment.
Imaging such as ultrasound or MRI may sometimes be useful when the diagnosis is unclear, symptoms aren't progressing as expected, or another condition needs to be investigated.
It's also important to remember that outer hip pain isn't always gluteal tendinopathy.
Pain around the hip can sometimes originate from the hip joint, lumbar spine or other surrounding structures. Persistent, worsening or unexplained symptoms deserve an appropriate assessment.
How long does gluteal tendinopathy take to improve?
There isn't one universal timeline.
Tendons adapt gradually, and recovery depends on factors such as how long you've had symptoms, how irritable the hip is, your current activity level, strength, recovery and the demands you're trying to return to.
Rather than focusing only on how many weeks you've been doing rehabilitation, look for trends:
Is everyday activity becoming easier?
Are symptoms becoming less frequent or intense?
Can you tolerate more exercise?
Are you becoming stronger?
Are you able to gradually return to the activities you enjoy?
Progress isn't always perfectly linear. An occasional increase in symptoms doesn't necessarily mean you've caused new damage—it may simply mean the current load exceeded what the hip was ready for.
The takeaway
If you have persistent pain on the outside of your hip, the answer isn't necessarily to stretch more, completely rest, or avoid the activities you enjoy.
Gluteal tendinopathy is often best approached by understanding what is currently aggravating the tendon, modifying those loads when necessary, and progressively rebuilding strength and capacity.
The goal isn't simply to make the hip feel better temporarily.
It's to build a hip that can tolerate the things you want to do—whether that's walking comfortably, getting back to the gym, hiking, running or returning to sport.
If you're experiencing persistent outer hip pain and aren't sure how to modify your activity or progress your exercises, an Athletic Therapy assessment in Victoria, BC can help identify what may be contributing to your symptoms and develop a progressive plan based on your goals.
This article is for general educational purposes and isn't intended to replace an individualized medical assessment.
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