Gluteal tendinopathy is a frequent source of pain on the side of the hip, often misdiagnosed as hip bursitis. This condition specifically involves the tendons of the gluteus medius and gluteus minimus muscles, which attach to the outer hip bone. The pain arises from an overload or compression injury to these tendons, often resulting from a sudden increase in activity or excessive compressive forces. Successful recovery requires a two-pronged approach: careful management of the load placed on the tendon and a structured, progressive exercise program. This guide outlines the necessary steps for rehabilitation, moving from immediate pain relief to long-term strength and endurance.
Understanding Gluteal Tendinopathy
Gluteal tendinopathy (GT) describes a breakdown in the structure of the gluteal tendons, typically the medius and minimus, where they insert near the greater trochanter on the side of the hip. This issue is not an inflammatory process like traditional “tendinitis” but rather a failure of the tendon to adapt to the strain placed upon it. The pain is localized to the lateral hip, often radiating down the outer thigh, though usually not past the knee.
Activities that increase compressive load on the tendon are the primary aggravators. Such compression occurs when the hip moves into an adducted position, meaning the leg crosses the midline of the body. This pain is commonly reported with weight-bearing activities like walking up hills or stairs, standing on one leg, and lying directly on the affected side. The goal of treatment is to reduce these irritating compressive forces while gradually increasing the tendon’s capacity to handle weight through specific, controlled exercises.
Phase 1 Immediate Pain Relief and Isometrics
The initial stage of rehabilitation focuses on reducing the high level of pain and sensitivity without introducing further compression or strain to the already irritated tendon. Isometric exercises are the preferred starting point because they activate the muscle without changing the tendon’s length or position, which can provide immediate pain relief. These exercises should be performed daily, or even multiple times a day, as long as they do not increase pain.
Supine Hip Abduction Isometric
A good starting point is the Supine Hip Abduction Isometric, performed lying on your back with a resistance band placed just above the knees. Gently push the knees outward into the band, creating tension in the glutes, but without allowing any hip movement. Maintain this gentle contraction for a hold time of 45 seconds, repeating this for five sets. This sustained hold helps calm the irritated tendon.
Low-Range Glute Bridge
Another suitable exercise is a very low-range Glute Bridge. You lift the hips only a few inches off the floor, focusing purely on a gentle glute squeeze without pushing into a painful range. Hold this light contraction for 10 seconds and repeat for 10 repetitions, ensuring the hamstrings do not cramp. Always stop the exercise if the pain increases beyond a mild, acceptable ache during or immediately after the set.
Phase 2 Building Strength and Endurance
Progression to this phase should only occur once the initial, sharp pain has significantly subsided, and the isometric exercises can be completed pain-free. The objective here is to progressively increase the load on the gluteal tendons so they can adapt and become stronger, allowing them to tolerate daily activities with greater ease. This phase requires consistency and is typically a long-term commitment, often lasting several months. The exercises should be performed every other day, allowing for a day of rest and recovery between sessions.
Single-Leg Stance
The first step in this phase is the Single-Leg Stance, a functional exercise that trains the glutes to stabilize the pelvis. Stand on the painful leg, holding onto a wall or chair for balance, and focus on keeping the pelvis level, avoiding any drop on the opposite side. Aim to hold this position for 30 to 60 seconds, performing three sets per session.
Single-Leg Quarter Squat
Once this is comfortable, transition to the Single-Leg Quarter Squat, which introduces movement and greater load. Stand on the affected leg and slowly bend the knee a small amount, ensuring the kneecap tracks over the second toe and the hip remains level. Perform a slow, controlled descent and ascent, using a count of three seconds down and three seconds up, completing three sets of 10 to 15 repetitions.
Modified Side Plank
Next, introduce the Modified Side Plank, which loads the gluteal tendons dynamically without the high compression of a traditional side-lying leg lift. Lie on your side with your elbow under your shoulder and your knees bent. Lift your hips off the floor until your body forms a straight line from your head to your knees. Hold this position for 30 to 45 seconds, working up to three sets, focusing on feeling the contraction in the side of the hip.
Weighted Clamshell
Finally, incorporate the Weighted Clamshell, using a resistance band placed above the knees to increase the load. Lie on your unaffected side with knees bent and feet together. Lift the top knee against the band while keeping the feet touching. Perform three sets of 10 to 15 slow, controlled repetitions, ensuring the movement is felt in the glute and not the lower back.
Daily Activities That Aggravate Gluteal Tendinopathy
Beyond the structured exercise program, modifying certain daily habits is crucial for reducing tendon compression and promoting healing. The goal is to avoid prolonged positions that force the hip into adduction, where the leg crosses the midline of the body and increases strain on the outer hip tendons. These simple, non-exercise adjustments can significantly impact recovery progress.
A common aggravator is sleeping position; avoid lying directly on the affected side. If you prefer sleeping on your unaffected side, place two or more pillows between your knees to keep your top leg from dropping across your body, which prevents the hip from adducting.
When standing, be mindful of the tendency to “hang” on one hip, which involves pushing the hips out to the side and letting the pelvis drop. Instead, stand with your weight evenly distributed between both feet, keeping your hips level.
Sitting postures also require adjustment to minimize compressive forces on the tendon. Avoid crossing your legs, as this forces the hip into an adducted position. Similarly, prolonged sitting in deep, low chairs can increase hip flexion and compression. Choose chairs that allow your knees and hips to remain at approximately 90-degree angles. Break up long periods of sitting by standing and walking for a few minutes every hour to relieve pressure and maintain mobility.