Gluteal tendinopathy is a painful condition affecting the tendons that attach your hip muscles to the bony prominence on the outside of your upper thigh, called the greater trochanter. It’s the most common lower limb tendinopathy, affecting up to 23.5% of middle-aged women. The hallmark symptom is pain over the outer hip that can extend down the side of your thigh, often worse at night or when climbing stairs.
Which Tendons Are Involved
Two muscles on the side of your hip, the gluteus medius and gluteus minimus, do most of the work stabilizing your pelvis when you walk, stand on one leg, or go up stairs. Their tendons attach to the greater trochanter, the bony bump you can feel on the outside of your hip. In gluteal tendinopathy, these tendons develop structural changes from repeated strain and compression. The tendons don’t snap or tear suddenly in most cases. Instead, they break down gradually at the microscopic level, becoming disorganized and painful.
A key driver of this breakdown is compression. The iliotibial band, a thick strip of tissue running down the outside of your thigh, presses the gluteal tendons against the greater trochanter whenever your hip moves inward. Any position that brings your knee toward or across your midline increases this compression. That’s why crossing your legs, standing with your weight shifted onto one hip, or sleeping on your side without a pillow between your knees can all provoke symptoms. When the hip abductor muscles are weak, the pelvis tilts more during walking, which further increases these compressive forces.
Who Gets It
Gluteal tendinopathy overwhelmingly affects women, particularly those in their 40s, 50s, and 60s. Hormonal changes around menopause appear to play a role, as declining estrogen levels affect tendon health and repair. That said, the condition also occurs in men and in younger, active populations. Runners, hikers, and anyone who suddenly increases their training load can develop it. People with wider hips relative to their knee position may be more susceptible because the angle increases compressive forces at the greater trochanter.
What It Feels Like
Pain on the outside of the hip is the most common complaint, reported by about 75% of people with this condition, though some also feel pain in the groin or buttock area. In three out of four cases, the onset is gradual rather than sudden. You might first notice a vague ache after a long walk that slowly becomes more persistent over weeks or months.
Specific activities tend to make it worse: walking, climbing stairs (especially going down), standing for long periods, and lying on the affected side at night. Nighttime pain is one of the most disruptive features. When you lie on the painful side, the tendon gets compressed against the bed. When you lie on the opposite side, the affected hip drops into an adducted position (knee falling inward), which also compresses the tendon. Many people find their sleep significantly disrupted before they even realize the hip is the problem.
Sitting with your knees together or crossed can also flare symptoms. So can the common habit of standing with your weight shifted onto one leg, letting the opposite hip drop.
How It Differs From Hip Arthritis
Gluteal tendinopathy and hip osteoarthritis both cause hip pain, but they behave differently. Osteoarthritis pain typically sits in the groin or deep in the front of the hip and worsens with activities that load the joint, like getting out of a chair or walking longer distances. People with arthritis tend to lean their trunk forward and toward the painful side when walking.
Gluteal tendinopathy pain, by contrast, lives on the outer hip. People with this condition tend to walk with more hip adduction (the knee drifting inward) and internal rotation. The walking patterns are distinct enough that researchers have confirmed these are genuinely different mechanical problems requiring different treatment approaches. If your pain is primarily on the outside of your hip and worse when lying on that side at night, gluteal tendinopathy is more likely than arthritis.
How It’s Diagnosed
A clinician can often diagnose gluteal tendinopathy with a physical exam alone. One of the most reliable tests is simple: standing on the affected leg for 30 seconds. If this reproduces your typical pain, the test has a sensitivity of 100% and specificity of 97% for identifying a gluteal tendon problem. That means it catches virtually everyone who has it and rarely gives a false positive. Another useful test involves resisting rotation of the hip while lying down, which loads the gluteal tendons in a different way.
Imaging isn’t always necessary, but ultrasound or MRI can confirm tendon changes and rule out other problems when the clinical picture is unclear. MRI can also help distinguish tendinopathy (structural disorganization of the tendon) from a partial or full-thickness tear, which matters for treatment planning.
Treatment: Why Exercise Beats Injections
The most important evidence on treatment comes from a landmark trial published in The BMJ that compared three approaches: a structured education and exercise program, corticosteroid injections, and simply waiting. At eight weeks, 77% of people in the exercise group reported improvement, compared to 58% in the injection group. At one year, the exercise group maintained that advantage: 78% reported improvement versus 57% in the injection group.
Corticosteroid injections do reduce pain faster in the short term, but the benefit fades. By one year, pain levels between the exercise and injection groups were similar, yet the exercise group reported better overall outcomes because they had also improved their strength and function. The wait-and-see group fared worst early on but eventually caught up on pain reduction, suggesting that the condition can improve on its own, just more slowly and without the functional gains that exercise provides.
The exercise component typically focuses on progressively strengthening the hip abductor muscles, the very muscles whose tendons are affected. This might seem counterintuitive, but controlled loading actually stimulates tendon repair and improves the tendon’s capacity to handle everyday forces. The key word is “progressive.” Starting with gentle, low-load exercises and building up gradually over months is essential.
What Recovery Actually Looks Like
Patience is non-negotiable with this condition. In one study, only 7% of people doing a home exercise program felt better at four weeks. By four months, that number climbed to 40%, and by 15 months, 80% had improved. Across multiple studies, meaningful improvement takes four months to a year of consistent rehabilitation. This timeline surprises many people who expect quicker results, and it’s one of the main reasons people abandon exercise programs too early or seek out injections instead.
Early in recovery, the focus is less on building strength and more on reducing the compressive loads that aggravate the tendon. That means modifying everyday habits: avoiding crossing your legs, not standing with your weight dumped onto one hip, and being mindful on stairs. As the tendon settles and strength improves, you gradually return to higher-demand activities.
Sleep and Daily Habit Changes
Because nighttime pain is such a common and frustrating symptom, sleep positioning deserves attention. Sleeping on the non-painful side with a pillow between your knees keeps the affected hip from dropping into an adducted position. If you prefer sleeping on your back, placing a pillow under your knees takes tension off the hip. Sleeping directly on the painful side compresses the tendon against the mattress and is best avoided until symptoms settle.
During the day, pay attention to habitual postures. Standing with your legs crossed, leaning on one hip while waiting in line, or sitting with your knees pressed together all increase tendon compression. These are small changes, but they add up. The tendon is irritated by cumulative load, so reducing dozens of minor compressions throughout the day gives it a better chance to recover. Stretching the iliotibial band, which many people instinctively try, can actually make things worse by pressing the band harder against the tendon. If you’ve been doing IT band stretches and your outer hip pain isn’t improving, this may be why.