Gluteal Tendinopathy: The Hidden Cause of Hip Pain in Women

Summary:

Gluteal tendinopathy is one of the most common but misunderstood causes of lateral hip pain in women. Because its symptoms often mimic other hip-related conditions, many women experience unnecessary tests, ongoing discomfort, and delayed treatment. This article explains the key symptoms, why misdiagnosis is so frequent, evidence-based treatment options, and when to seek specialist referral.

Understanding Gluteal Tendinopathy

Gluteal tendinopathy is a condition affecting the tendons of the gluteus medius and gluteus minimus—two important muscles that stabilise the pelvis and support everyday movement. These tendons attach to the greater trochanter, the bony prominence on the outer part of the hip.

Women, especially between the ages of 35 and 65, are significantly more likely to experience this condition due to hormonal influences, pelvic biomechanics, and activity patterns.

Unlike acute injuries caused by a single event, gluteal tendinopathy typically develops gradually from overuse, decreased strength, or increased load placed on the hip tendons.

Key Symptoms to Look Out For

Gluteal tendinopathy presents with a set of symptoms that are often mistaken for other conditions. Women often report:

1. Pain on the outer hip

A deep, aching pain on the side of the hip that may worsen with:

• Lying on the affected side
• Prolonged standing
• Climbing stairs
• Walking uphill
• Sitting with crossed legs

2. Pain at night

Night pain is particularly common. Many women find that lying on the painful side is impossible, and even lying on the opposite side can increase compression and discomfort.

3. Tenderness when touching the outside of the hip

Pressing over the greater trochanter usually reproduces the pain.

4. Pain with certain movements

Movements that combine hip adduction (like crossing the legs) or single-leg loading can aggravate symptoms.

5. Stiffness or weakness

Some women describe a sense of weakness or instability when standing on one leg or when first getting up after sitting.

Why Gluteal Tendinopathy Is Commonly Misdiagnosed

Hip pain can be complex. Many structures sit close together in the lateral hip region, making diagnosis challenging—especially if the assessment focuses too heavily on imaging or assumes arthritis is the only cause of pain.

Common reasons for misdiagnosis include:

• Imaging confusion: Ultrasounds or MRIs may show changes in the tendons even in people without pain. Conversely, scans may appear normal despite significant symptoms.
• Overlap with other conditions: Symptoms often mimic:
• Trochanteric bursitis
• Hip osteoarthritis
• ITB syndrome
• Lumbar spine referral pain
• Sciatic nerve irritation
• Misunderstanding patient history: Many women describe pain that sounds like bursitis, and this can lead to outdated treatment pathways focusing on inflammation rather than tendon load.

The most common misdiagnosis:

Trochanteric bursitis.

While bursitis can occur, research now shows that gluteal tendinopathy is far more common, and the primary cause of lateral hip pain—not the bursa.

Evidence-Based Treatment Options

The good news is that gluteal tendinopathy responds very well to the right treatment approach. The key is reducing compressive load on the tendons while gradually rebuilding strength.

1. Load Management

Avoid movements that compress the tendon, especially in early stages.

Examples include:

• Sitting with crossed legs
• Standing with hip popped to one side
• Sleeping directly on the painful hip

2. Strengthening Exercises

A tailored exercise program is the gold-standard treatment. Exercises typically focus on:

• Hip abductor strengthening
• Pelvic stability
• Gradual return to load-bearing activities

This addresses the root cause—tendon weakness and overload.

3. Manual Therapy

Hands-on treatment may help relieve discomfort temporarily and improve movement patterns when combined with exercise.

4. Shockwave Therapy (If Indicated)

Can be useful for chronic cases that don’t respond to initial conservative treatment.

5. Pain Relief Options

While medication doesn’t fix the underlying issue, it can help manage discomfort alongside the active rehab program. Anti-inflammatory medication may provide short-term relief when inflammation is present.

6. Cortisone Injections

These can reduce severe pain but should be used cautiously as they may weaken tendons in the long term. They are generally recommended only when symptoms are severe and progress is limited.

When to Consider a Referral

A referral to a physiotherapist, sports physician, or orthopaedic specialist may be needed if:

• Pain persists longer than 6–12 weeks despite conservative management
• Night pain becomes severe and affects sleep consistently
• There is marked weakness or difficulty bearing weight
• There is suspicion of a tendon tear (especially following a fall)
• Walking becomes significantly limited
• Previous treatments such as injections or general strengthening programs have not provided relief

A specialist assessment ensures the right diagnosis and may involve advanced imaging or more targeted interventions.

Helpful Tips for Managing Symptoms at Home

Here’s a practical list for everyday management:

• Avoid crossing your legs while sitting
• Place a pillow between your knees while sleeping
• Stand evenly on both legs instead of leaning on one hip
• Start gentle strengthening exercises recommended by a professional
• Avoid high-impact or repetitive activities until symptoms improve
• Use an ice pack after flare-ups to reduce discomfort

Frequently Asked Questions

1. Can gluteal tendinopathy heal on its own?

Mild cases may improve with rest and reduced aggravating activities; however, most cases require targeted strengthening to properly restore tendon health.

2. Is it the same as bursitis?

No. While bursitis can occur, gluteal tendinopathy is far more common and often the primary cause. Both may present with similar symptoms, which is why accurate assessment is key.

3. Should I keep exercising?

Yes, but the right type of exercise is essential. Overloading the tendon can worsen symptoms, whereas a structured strengthening program helps recovery.

4. Why is the pain worse at night?

Night pain is often due to increased pressure on the tendons from certain sleeping positions. Using a pillow between your knees or avoiding lying on the affected side may help.

5. Do I need a scan?

Not always. Diagnosis is primarily clinical, and many people with tendon changes on imaging have no symptoms. Your practitioner may only recommend imaging if symptoms are severe or not improving.

6. Who is most at risk?

Women aged 35–65 are most affected, especially those who sit cross-legged often, have reduced hip strength, or experience hormonal changes.

7. How long is recovery?

With consistent treatment, many people improve within 8–12 weeks. Chronic cases may take longer, especially if the tendon has weakened over time.