Gluteal tendinopathy is an irritated, overloaded TENDON on the outside of your hip. It’s the most common reason for the side-of-hip pain that often gets called hip bursitis.
The tendons belong to your buttock muscles, the ones that keep your pelvis level when you stand on one leg. They attach to the bony point on the side of your hip. When they’re overloaded, and squashed against that bone, they get sore.
What works best is two things together: avoiding the positions that squash the tendon, and exercise that gets gradually HARDER.
Most people improve, but plan on about three months of steady work, sometimes longer.
Tendinopathy or bursitis?
- Same spot, different label: both describe pain over the bony point on the side of the hip. Doctors now often group them together as greater trochanteric pain syndrome. See hip bursitis
- The tendon is usually the main problem: scans more often show tendon changes than an inflamed bursa, the small fluid sac next to it. The bursa can get irritated too, usually as a knock-on effect
- Why the name matters: an inflamed bursa sounds like something to rest and calm down. A tendon needs something different: less squashing now, and more strength over time
- Who gets it: women two to five times more often than men, most often from their 40s on, and especially after menopause. Runners and dancers get it too
Why it hurts: squeeze plus strain
A tendon copes well with being pulled. It copes badly with being pulled while it’s squeezed. On the side of the hip, the squeeze happens whenever your thigh drifts in toward, or across, the middle of your body. The tough band of tissue down the outside of your thigh then presses the tendon against the bone.
That’s why these positions hurt:
- Crossing your legs, sitting or lying
- Standing with your weight hanging on one hip, so the pelvis drops to one side
- Lying on your side: on the sore hip it’s direct pressure. On the good side, the top knee drops onto the bed and squeezes the tendon from above
- Stretching the outer hip, such as pulling your knee across your body. It feels like it should help, but it presses the tendon harder
- Standing on one leg on a slope, such as the edge of a sloping path
A sore tendon can take a pull. It’s the squeeze against the bone that keeps it angry.
Load management: the everyday changes
- Stand evenly: weight on both feet, not leaning into one hip while you wait in line or cook
- Sit with your knees apart, about hip-width, and not higher than your hips. Add a firm cushion to low chairs and car seats
- Sleep with a pillow between your knees on the good side. A long pillow that runs from knee to ankle keeps the top leg level. On your back, a pillow under the knees helps
- Break up long walks and hills for a few weeks, then build back gradually. Two short walks are easier on the tendon than one long one
- Watch the night and next morning: if the hip is worse in bed or the next morning, the day was too much. Scale back a notch rather than stopping
The exercise plan
The goal is a tendon that can handle more. That takes loading that gets harder over weeks, not a few gentle stretches.
- Calm it first: holds without moving. Lie on your back with a belt looped around your thighs just above the knees, press out gently into the belt and hold for about 30 seconds. Rest and repeat a few times
- Build strength: bridges, sit-to-stands from a chair, and side steps. Add a light resistance band when they get easy
- Then stand on one leg: balance with your pelvis level, step-ups, and small single-leg knee bends. These train the job the tendon does every time you walk
- Make it harder over time: more reps, more hold time, or a band or weight, one change at a time
- Go easy on clamshells and hip-drop exercises early on if they flare it. They move the leg toward the squeezed position
- Use the pain rule: mild discomfort during exercise is fine if it settles by the next morning
The Cleveland Clinic’s guide to gluteal tendinopathy notes that about 7 in 10 people improve significantly with eight weeks of physical therapy exercises.
Injection, shockwave or surgery?
- A cortisone shot: often eases pain for the first few weeks. In a large trial, exercise plus advice did better than a shot by one year, and pain often returns after a shot. Use it to get you exercising, not instead of exercising. See cortisone shot side effects
- Shockwave therapy: some studies show benefit, especially alongside exercise, but the evidence is weaker. Treat it as an add-on
- PRP injections (a concentrate made from your own blood): not a standard treatment. The evidence is limited
- Surgery: only for a small number of people with a significant tendon tear that hasn’t improved after months of proper rehab
How long it takes
- First few weeks: night pain is often the first thing to ease once you stop squashing the tendon
- About three months: a realistic time frame for clear improvement with steady exercise
- Long-standing pain: can take six months or more. Flare-ups along the way are normal and don’t mean the plan has failed
- Without treatment: many people improve eventually, but it can take up to a year
Get seen today if
- The hip is hot, red and swollen, or you have a fever or feel unwell
- You fell and can’t put weight on the leg, or the leg looks shorter or turned out
- You have new numbness around your groin or bottom, or trouble controlling your bladder or bowels. Go to the emergency department
Get it checked if
- Pain hasn’t improved after three months of steady exercise
- You have a new limp, or the hip feels weak, not just sore
- Pain is in the groin, or the hip is stiff putting on socks. See hip arthritis
- Night pain doesn’t change with position, or you have a history of cancer, weight loss or night sweats
Take the squeeze off the tendon, then give it load. Rest alone won’t finish the job.