Gluteal tendinitis is a painful condition affecting the tendons that connect your gluteal muscles to the bony point on the outside of your hip. It is the most common cause of lateral hip pain, affecting up to 23.5% of middle-aged women. For years, this type of pain was labeled “trochanteric bursitis,” but imaging and surgical studies have shown that the real problem in most cases is damage to the gluteal tendons themselves, not inflammation of the nearby fluid-filled sacs. The current preferred term among clinicians is gluteal tendinopathy.
Which Tendons Are Involved
Two muscles are at the center of this condition: the gluteus medius and the gluteus minimus. Both attach to the greater trochanter, the bony bump you can feel on the outer side of your upper thigh. These muscles stabilize your pelvis every time you walk, climb stairs, or stand on one leg. Their tendons absorb significant compressive and tensile forces at the point where they wrap around the trochanter, which makes that attachment site vulnerable to wear and breakdown over time.
The condition exists on a spectrum. In its mildest form, the tendons look nearly normal on imaging but the surrounding bursa may be irritated. As it progresses, the tendon fibers themselves begin to degenerate, thicken, and lose their organized structure. In severe cases, partial or full-thickness tears develop, similar to what happens with rotator cuff tendons in the shoulder.
What It Feels Like
The hallmark symptom is pain on the outside of your hip, starting right at the greater trochanter. It often radiates down the outer thigh toward the knee, and sometimes into the lower leg. Some people also notice lower back pain or groin pain alongside it. The area over the trochanter typically feels tender to the touch.
Certain activities reliably make the pain worse: climbing stairs, walking uphill, getting out of bed in the morning, lying on the affected side at night, sitting for long periods, sitting cross-legged, or standing on one leg (something as simple as pulling on pants). Night pain is common enough that sleep disruption, fatigue, and irritability often come with the condition. Many people describe it as a deep ache that flares into sharper pain with specific movements.
Who Gets It and Why
Gluteal tendinopathy overwhelmingly affects women, particularly those between their 40s and 60s. Hormonal changes play a direct role. Declining estrogen levels during and after menopause reduce collagen production in tendons, lowering their tensile strength and making them more vulnerable to micro-tears. Advancing age compounds the problem by slowing tendon metabolism and reducing the body’s ability to repair damage.
You don’t need to be an athlete to develop it. In fact, less active perimenopausal women make up a large portion of those affected. That said, runners and people in high-impact sports are also at risk due to the repetitive loading forces on the hip. Biomechanical factors matter too: a wider pelvis (more common in women) increases the angle of compression on the tendons at the trochanter, and habits like standing with your hip shifted to one side or crossing your legs frequently can add compressive load to an already stressed tendon.
How It’s Diagnosed
Diagnosis usually starts with a physical exam, and two tests are particularly useful. The first is simple palpation: pressing on the greater trochanter. If that spot isn’t tender, gluteal tendinopathy is unlikely. Palpation catches about 80% of cases confirmed on MRI. The second test is even more telling. If you stand on the affected leg and develop pain within 30 seconds, the probability of gluteal tendinopathy jumps to roughly 98%. That single-leg stance test has near-perfect specificity, meaning a positive result almost always corresponds with tendon changes visible on MRI.
MRI can confirm the diagnosis and reveal the degree of tendon damage, but it isn’t always necessary. About 31% of people with MRI-confirmed tendinopathy test negative on clinical exams, which means imaging sometimes catches changes that haven’t yet become symptomatic. For most people, a careful physical exam is enough to guide treatment.
Exercise and Education as First-Line Treatment
Structured exercise combined with education about load management is the most effective conservative approach. A 2025 systematic review found that exercise and education had a medium-sized effect on both pain and function in the short term, outperforming other interventions. Those benefits persisted, though at a smaller magnitude, into the medium and long term.
The exercise approach typically follows a progression. Early on, the goal is reducing pain by avoiding positions that compress the tendon (like lying on your side or crossing your legs) and starting with gentle strengthening exercises that load the tendons without provoking sharp pain. Isometric holds, where you contract the muscle without moving the joint, are a common starting point because they can reduce pain while beginning to stimulate tendon repair. Over weeks, you progress to heavier resistance exercises, then to functional movements like step-ups and single-leg activities that rebuild the tendon’s tolerance for real-world demands.
The education piece is just as important as the exercises. Understanding what irritates the tendon, like sustained hip adduction (letting your knee drift inward or hanging on one hip while standing), helps you modify daily habits that unknowingly keep the tendon aggravated.
Injections and Shockwave Therapy
Corticosteroid injections have long been a go-to treatment, but the evidence paints a mixed picture. They provide a small short-term reduction in pain, but their effects don’t match what exercise achieves and they offer no meaningful long-term benefit. There’s also concern that repeated steroid injections can weaken tendon tissue over time.
Platelet-rich plasma (PRP) injections, which use concentrated growth factors from your own blood, showed better short-term improvements in function compared to corticosteroid injections in head-to-head comparisons. Focused shockwave therapy, a non-invasive treatment that delivers acoustic energy to the tendon, demonstrated a dramatic long-term advantage over corticosteroid injections for pain relief. Both PRP and shockwave therapy are increasingly used as supplements to an exercise program rather than standalone treatments.
When Surgery Becomes an Option
Most people improve with conservative management, but surgery enters the conversation when pain persists despite months of dedicated rehabilitation and continues to interfere with daily life. The surgical criteria mirror those used for rotator cuff tears in the shoulder. If imaging shows a full-thickness tendon tear but your only symptom is pain (without weakness or a limp), a trial of non-surgical treatment is still reasonable.
However, if you have noticeable weakness in the hip abductors or a visible limp (a Trendelenburg gait, where the pelvis drops on the opposite side when you walk), the threshold for recommending surgery drops significantly. Traumatic tears in younger patients, such as those caused by a fall or sudden injury, are generally considered for early surgical repair rather than a prolonged conservative approach. Surgery involves reattaching the torn tendon to the bone, and recovery typically requires several months of protected rehabilitation before returning to full activity.
Recovery Expectations
Gluteal tendinopathy is a chronic condition, and tendons heal slowly compared to muscles. Most rehabilitation programs span 12 weeks at minimum, with many people needing 3 to 6 months to see substantial, lasting improvement. Early relief often comes within the first few weeks as you reduce compressive loads and begin isometric exercises, but rebuilding the tendon’s capacity for higher-demand activities takes patience. Setbacks are common if you progress too quickly or return to aggravating habits. The condition responds best to a gradual, consistent approach where loading is increased incrementally based on how the tendon tolerates each stage.