Gluteal Tendinopathy: Management Made Simple

What Is Gluteal Tendinopathy?

Gluteal tendinopathy is a condition where the tendons on the outside of your hip become irritated or overloaded. These tendons help you walk, climb stairs, stand on one leg, and keep your pelvis steady. When they become irritated, everyday activities like walking, sleeping on your side, or sitting for long periods can become painful.

One of the main reasons these tendons get irritated is compression, meaning the tendon gets squashed or pressed against the hip bone. This often happens in positions like crossing your legs, standing with your hip pushed out, or lying on your side without support. These postures increase pressure on the tendon and make it more sensitive.

Because of this, early and mid-stage rehabilitation focuses on strengthening your hip without adding compression. This allows the tendon to become stronger and healthier without being irritated again. Once pain has settled and you’ve built a good strength foundation, you move into the late phase of rehab. This phase helps you build stronger hips so you can return to normal activities and sport without flare-ups.

How Gluteal Tendons Become Compressed

Two gluteal muscle tendons, the gluteus medius and gluteus minimus, sit on the outer side of your hip, just under the bony point known as the greater trochanter. When certain positions or movements squeeze these tendons against this bone, irritation gradually builds.

Common positions that increase compression include:

• Sitting with legs crossed
• Standing with your weight hanging on one hip
• Knees dropping inward during squats, single-leg tasks, or stair climbing
• Lying on your side without a pillow between the knees
• Sitting with the hip bent past 90 degrees

Understanding these positions helps you avoid the habits that slow tendon healing.

Simple Pain Management Tips

• Use a wedge cushion to avoid sitting at 90 degrees
• Take a wider stance when standing or climbing stairs
• Avoid sleeping on the painful side and use a pillow between your knees
• Reduce activities that flare symptoms, but keep moving based on irritability of symptoms

How Exercise Fits Into Your Rehab Journey

Non-compression exercises are used during the mid-phase of recovery, after the initial pain settles but before adding harder, more demanding movements. Your rehab pathway usually looks like this:

1. Early Phase: Pain management, gentle movement, reducing compression (avoiding crossed legs, modifying sleeping positions).
2. Mid Phase: No-compression strengthening to build stability, control, and muscle activation.
3. Late Phase: Adding exercises that include some compression to prepare for daily movements and sport.
4. Return-to-Sport Phase: Adding impact, agility, and sport-specific drills once the tendon is strong enough.

Early-Phase Exercises 

Early-phase rehabilitation for gluteal tendinopathy focuses on gently re-activating the gluteal muscles while allowing the tendon to settle and should be guided by your physiotherapist, as individual load tolerance varies and is essential for accurate exercise prescription. Isometric exercises help reduce pain and improve muscle engagement without overloading the tendon, while simple gluteal activation exercises such as bridges restore hip stability.

Mid-Phase Exercises

Exercises that avoid excess pressure on the gluteal tendon allow you to:

• Strengthen the hip safely
• Improve muscle control
• Build balance and stability
• Increase confidence in movement
• Prepare for more advanced exercises

Pilates reformer and trapeze table exercises such as scooter, standing hip abduction, and trapeze table squats help you control your pelvis and trunk while keeping strain on the tendon low. These exercises improve glute activation, coordination, and movement quality, which are essential before progressing to tougher tasks.

Late-Phase Exercises

Once your hip is coping well, compressive exercises are gradually added. These include clams, side-lying hip abduction, step-ups, crab walking and lunges. They are essential because activities like sitting, stair climbing, walking, and running naturally place some compression on the tendon.

However, compressive exercises must be introduced slowly and carefully, because adding too much pressure too soon can cause flare-ups.

Why monitoring is important:

1. The tendon is still sensitive: even when pain improves.
2. Tendons adapt slowly, so loading must increase gradually.
3. Pain can be delayed, appearing hours or the next day.
4. Compression + load together can irritate the tendon if progressed too fast.
5. Technique matters: poor form increases compression.

You’re ready to progress when:

• Pain stays mild during exercise
• No soreness lingers the next morning
• You can perform non-compression exercises with control
• Your physiotherapist confirms your technique is stable

Returning to Sport

A safe return to sport includes:

1. Building strength first
2. Starting with low-impact activities (walking, cycling)
3. Adding light impact (jogging, small hops)
4. Progressing to sport-specific drills (side-stepping, faster running)
5. Gradually returning to full training and competition

With the right exercises and simple lifestyle changes, most people recover well from gluteal tendinopathy. A physiotherapist can guide you through each stage safely and confidently. 

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Written by Shreya Balakrishnan, Physiotherapist