Gluteal Tendinopathy Exercises: Relieve Lateral Hip Pain

Gluteal tendinopathy (formerly called trochanteric bursitis) causes pain on the outside of the hip where the gluteal tendons attach to the greater trochanter. This condition is now understood to be primarily a tendon problem rather than bursal inflammation. These exercises focus on proper tendon loading to promote healing.

Understanding Gluteal Tendinopathy

What's happening:

• Gluteus medius and/or minimus tendons become damaged
• Tendons attach at greater trochanter (bony point on outer hip)
• Previously called "trochanteric bursitis" but bursa rarely the primary issue
• Tendon degeneration and failed healing response

The gluteal tendons:

• Gluteus medius: Primary hip abductor and stabilizer
• Gluteus minimus: Assists with abduction and rotation
• Both attach at greater trochanter
• Critical for single-leg stance (walking, stairs)

Common causes:

• Overload from increased activity
• Compression from lying on side
• Hip adduction postures (crossing legs, standing with hip dropped)
• Training errors
• Weak hip abductors
• Age-related degeneration
• Hormonal factors (more common in perimenopausal women)

Who gets it:

• Women 40-60 (4:1 over men)
• Runners
• People who sleep on their side
• Those with low back pain
• Post-hip replacement

Symptoms of Gluteal Tendinopathy

Classic presentation:

• Pain on outer hip over bony prominence
• Worse lying on affected side
• Pain with walking, especially uphill
• Pain with single-leg stance
• Difficulty with stairs
• Pain sitting with legs crossed

Pain behavior:

• Worse with activity, especially walking
• Night pain when lying on side
• Morning stiffness
• May radiate down outer thigh (not below knee)

Key Principles of Treatment

1. Reduce Compression

Tendon compression at the greater trochanter slows healing.

Avoid:

• Lying on affected side
• Crossing legs when sitting
• Standing with hip hitched/dropped
• Stretching into hip adduction (IT band stretch)
• Deep squats with knees collapsing inward

2. Progressive Loading

Tendons need load to heal—but the right kind and amount.

Progression:

• Isometric → Isotonic → Functional → Sport-specific

3. Patience

Tendon healing takes months, not weeks.

Phase 1: Pain Management and Isometrics

Sleep Position Modification

Setup:

• Sleep on unaffected side
• Or sleep on back

If you must sleep on affected side:

• Place thick pillow or folded blanket under affected hip
• Reduces pressure on greater trochanter

Standing Posture

Avoid:

• Hanging on one hip (hip drop)
• Weight shifted to one side
• Standing with legs crossed

Instead:

• Stand with weight equal on both feet
• Slight activation of gluteals

Isometric Hip Abduction (Wall)

Pain-free strengthening without compression.

Setup:

• Stand sideways to wall
• Affected hip toward wall
• Small pillow between hip and wall

Movement:

1. Push outer hip into wall
2. Hold 30-45 seconds
3. 5 repetitions
4. 2-3 times daily

Key: Should be pain-free (≤3/10)

Isometric Hip Abduction (Standing)

Setup:

• Loop resistance band around both ankles
• Stand with feet hip-width apart

Movement:

1. Press affected leg outward against band
2. Don't actually move—just create tension
3. Hold 30-45 seconds
4. 5 repetitions
5. 2-3 times daily

Phase 2: Isotonic Strengthening

Side-Lying Hip Abduction (Modified)

Setup:

• Lie on unaffected side
• Place pillow under waist to avoid hip adduction
• Bottom leg slightly bent

Movement:

1. Lift top leg toward ceiling
2. Keep leg in line with body or slightly behind
3. Don't let hip rotate
4. Lower slowly
5. 15-20 repetitions
6. 3 sets

Key points:

• Pillow prevents compression on affected hip
• Slow, controlled movement
• Pain should be ≤3/10

Standing Hip Abduction

Setup:

• Hold onto support
• Stand on unaffected leg

Movement:

1. Lift affected leg out to side
2. Keep trunk upright (don't lean)
3. Control the return
4. 15-20 repetitions
5. 3 sets

Progression: Add ankle weight or resistance band

Bridge with Band

Setup:

• Lie on back, knees bent, feet flat
• Resistance band around thighs just above knees

Movement:

1. Push knees out against band
2. Maintain outward pressure
3. Lift hips toward ceiling
4. Hold 3-5 seconds
5. Lower with control
6. 15-20 repetitions
7. 3 sets

Clamshell (Modified)

Setup:

• Lie on unaffected side
• Knees bent 45 degrees
• Pillow between ankles
• Hips stacked (don't roll back)

Movement:

1. Keep feet together
2. Lift top knee toward ceiling
3. Don't let pelvis roll backward
4. Lower with control
5. 15-20 repetitions
6. 3 sets

Progression: Add resistance band around thighs

Phase 3: Functional Strengthening

Single-Leg Bridge

Setup:

• Lie on back, knees bent
• Extend unaffected leg

Movement:

1. Drive through affected foot
2. Lift hips until body is straight
3. Keep pelvis level (don't drop to one side)
4. Hold 3-5 seconds
5. Lower with control
6. 10-15 repetitions
7. 3 sets

Step-Up (Lateral Focus)

Setup:

• Stand beside step (affected side toward step)
• Step height appropriate for strength level

Movement:

1. Step up, leading with affected leg
2. Focus on keeping pelvis level
3. Don't push off excessively with bottom leg
4. Step down with control
5. 10-15 repetitions
6. 3 sets

Single-Leg Stance with Band

Setup:

• Band around ankles
• Stand on affected leg
• Light support nearby

Movement:

1. Lift unaffected leg
2. Move lifted leg forward, back, and out against band
3. Keep standing hip level and stable
4. 10 movements each direction
5. 3 sets

Split Squat

Setup:

• Affected leg forward
• Back leg on toes behind

Movement:

1. Lower until front thigh parallel to floor
2. Keep front knee tracking over toes
3. Drive through front heel to stand
4. 10-15 repetitions
5. 3 sets

Focus: Control and stability, not depth

Phase 4: Running and Sport Return

Prerequisites:

• Walking 30 minutes pain-free
• Single-leg squat to 60 degrees with level pelvis
• Single-leg bridge 20 reps each side
• Step-downs from 8-inch step pain-free

Running Return Protocol:

Week 1:

• Walk 4 minutes, jog 1 minute
• Repeat 4-6 times
• Flat terrain only
• Every other day

Week 2:

• Walk 3 minutes, jog 2 minutes
• Repeat 4-6 times

Week 3:

• Walk 2 minutes, jog 3 minutes
• Repeat 4-6 times

Week 4+:

• Progress to continuous jogging
• Increase duration 10% weekly
• Add hills gradually (uphills before downhills)

Sample Weekly Program

Daily:

• Posture awareness
• Avoid compression positions
• Isometrics: 5x45 seconds

Monday/Thursday (Strength A):

• Side-lying abduction: 3x20
• Bridge with band: 3x20
• Clamshell: 3x20
• Single-leg bridge: 3x15

Tuesday/Friday (Strength B):

• Standing abduction: 3x20
• Step-ups: 3x15
• Split squats: 3x15
• Single-leg stance with band: 3x10 each direction

Wednesday/Saturday:

• Light walking
• Stretching (calves, hip flexors—NOT ITB into adduction)

Sunday: Rest

What NOT to Do

❌ IT band stretching into hip adduction

• Compresses tendon against greater trochanter
• Worsens the condition
• Common but harmful advice

❌ Lying on affected side without support

• Compression through the night prevents healing

❌ Crossing legs

• Compression in adducted position

❌ Deep stretching of hip

• Excessive range compresses tendons

❌ Ignoring and pushing through

• Tendons need appropriate load, not overload

When to Seek Help

See a specialist if:

• No improvement after 6-8 weeks of exercises
• Significant night pain
• Unable to walk without pain
• Progressive weakness
• Previous hip surgery

Treatment options:

• Physical therapy
• Shockwave therapy
• Corticosteroid injection (limited use—may weaken tendon)
• PRP injection
• Surgery (rare)

Expected Timeline

• Initial improvement: 4-6 weeks
• Significant improvement: 3-6 months
• Full recovery: 6-12 months
• Some cases require 12-24 months

Key: Tendons heal slowly. Consistency over months is essential.

Key Takeaways

1. It's tendinopathy, not bursitis: Tendon is the primary problem
2. Avoid compression: Sleep position, sitting posture, stretching
3. Load progressively: Isometric → isotonic → functional
4. Strengthen hip abductors: Gluteus medius is key
5. Don't stretch the IT band: Common advice but harmful here
6. Be patient: Months, not weeks, for recovery
7. Maintain during recovery: Continue exercises even as symptoms improve

With proper management, most gluteal tendinopathy resolves completely—but it requires patience and consistent exercise over several months.