Whats it all about?
Gluteal tendinopathy is one of the most common causes of persistent outer hip pain, particularly in women aged 40–60. Yet many people put it down to ‘tight hips’, sciatica, or simply getting older. In reality, it’s a very manageable condition once understood properly.
The gluteal tendons attach the bottom (glut) muscles to the outside of the hip and play an important role in pelvic stability, walking, climbing stairs, and single leg balance. When these tendons become irritated, everyday activities can become uncomfortable.
It’s also worth noting that some people may have been told they have Trochanteric Bursitis. The bursa is a small fluid filled sac that sits over the outside of the hip and helps reduce friction. In some cases, both the tendon and the bursa can become irritated at the same time. This broader condition is often referred to as Greater Trochanteric Pain Syndrome (GTPS), which is an umbrella term covering pain arising from the gluteal tendons, the bursa, or both.
Why are perimenopausal women more commonly affected?
Research shows gluteal tendinopathy disproportionately affects perimenopausal women. During this stage of life, hormonal changes – particularly fluctuating and declining oestrogen levels – can influence tendon health, muscle mass, recovery, and the body’s ability to tolerate load.
At the same time, many women are juggling busy work and home lives, spending long periods sitting, sleeping less, and finding it harder to maintain regular physical activity. Often, activity levels become quite “stop-start” – a long walk at the weekend followed by several days sitting at a desk.
The tendons around the hip generally cope best with regular, progressive loading. Too much load too quickly, or too little load for too long, can both contribute to symptoms developing.
What are the symptoms?
Gluteal tendinopathy usually presents as pain around the outside of the hip, sometimes spreading into the outer thigh or buttock. Symptoms often develop gradually over time rather than after one specific injury.
What can aggravate it?
- Lying on the affected side at night
- Walking uphill or upstairs.
- Long periods of standing.
- Getting up after sitting.
- Crossing the legs.
- Standing with weight shifted onto one hip.
- Long walks, particularly if activity has suddenly increased
Many people also report disturbed sleep because rolling onto the affected side becomes painful. The condition can sometimes be mistaken for lower back pain or sciatica due to the spread of symptoms into the leg, but true gluteal tendinopathy tends to stay around the outer hip and thigh rather than travelling below the knee.
Why does it happen?
The gluteal tendons sit in a position where they can become compressed as well as overloaded. Repeated compression combined with reduced strength and reduced load tolerance can gradually irritate the tendon.
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Common contributing factors include
- Reduced glute strength.
- Prolonged sitting.
- Poor recovery between exercise
- Reduced single leg control
- Hip stiffness.
- Reduced general strength training.
This does not mean exercise is harmful – in fact, the opposite is usually true. Tendons often become more sensitive when they are underprepared for the demands placed upon them.
Should you rest?
Complete rest is rarely the answer.
While highly aggravating activities may need temporarily modifying, long-term improvement usually comes from gradually rebuilding strength and tendon capacity.
Many people understandably stop activity completely because movement becomes painful. However, prolonged rest can reduce strength further and lower the tendon’s tolerance even more.
What does management focus on?
- Reducing highly aggravating movements temporarily.
- Avoiding prolonged compressive positions.
- Gradually reintroducing strength work.
- Improving pelvic and hip control.
- Building confidence with movement again.
What can I do to help?
- Use a pillow between the knees at night.
- Avoid sitting cross-legged.
- Try not to “hang” on one hip when standing.
- Break up long periods of sitting.
- Modify walking distances temporarily if needed.
What is the role of strengthening?
Progressive strengthening is one of the most evidence-based treatments for gluteal tendinopathy. The aim is not simply to “stretch the hip”, but to improve the ability of the muscles and tendons to tolerate load effectively again.
Early exercises may include
- Bridge variations
- Sit to stand
- Gluteexercises
- Step ups
- Single leg balance work
As symptoms improve, exercises are usually progressed towards
- Split squats
- Weighted strenghening
- Lateral movement control
- Single leg functional exercises
Importantly, exercises should feel manageable and progressively challenging without causing a major flare in pain afterwards.
What about shockwave therapy?
For some people, symptoms can persist despite following a well-structured strengthening and loading programme. In these cases, shockwave therapy may be considered.
Shockwave therapy uses sound waves to stimulate healing within the tendon and can be particularly helpful for stubborn or long-standing tendon problems that have not responded to exercise-based rehabilitation. It is typically used alongside, rather than instead of, a progressive loading programme to help improve outcomes.
Education and self-management
One of the biggest parts of recovery is understanding that tendons usually improve gradually rather than overnight. Symptoms often fluctuate, and occasional discomfort during rehab does not necessarily mean damage is occurring. Consistency is key
Some of the most helpful long-term strategies include
- Building regular strength training into the week
- Progressing activity gradually
- Prioritising recovery and sleep
- Maintaining general activity level
- Avoiding long periods of complete inactivity
So, what’s the verdict?
Gluteal tendinopathy can be frustrating, particularly when it affects sleep, walking, and day-to-day activity. However, it is a very treatable condition with the right approach.
Understanding the relationship between tendon health, strength, hormonal changes, and load management is often the first step towards improvement.
Physio can help identify contributing factors, guide exercise progression, and support a gradual return to comfortable movement and activity.
How can we help?
Here at North Yorkshire Physiotherapy, we can assess your symptoms to confirm the diagnosis, guide you through an individualised loading programme, and help you modify activities so you can get back to doing what you love.
We also provide shockwave therapy for stubborn tendon problems that are struggling to respond to a loading programme alone.
If you’re experiencing ongoing outer hip pain and would like expert advice from one of our clinicians, please get in touch with our team to find out more.