If you’ve been feeling a stubborn ache on the outside of your hip, you are not alone. For years, this pain was almost always dismissed as “bursitis.” However, modern research shows that the real culprit is usually gluteal tendinopathy—a condition in which the tendons of your gluteus medius and minimus muscles struggle to keep up with the load placed on them and become strained.
1. Why Does Your Hip Hurt?
Tendons transmit force from the muscle to the bone and act like springs, storing energy. But they have a breaking point. When the load exceeds their capacity, they begin to change at the cellular level, causing pain. Common mechanisms that lead to this increase in load:
Compression
One of the biggest triggers for gluteal tendinopathy is compression. This happens when the tendon is squeezed against the bony point of your hip (the greater trochanter).
You might be accidentally irritating the tendon by:
• Sitting with your legs crossed.
• Standing with your weight on one hip.
• Sleeping on your side without a pillow between your knees, allowing your top leg to drop across your body.
Anatomy and Hormones
Your biology also plays a role. People with a narrower pelvis often face higher loads on these tendons. We also see a significant spike in this condition among postmenopausal women because reduced oestrogen levels impact tendon health and resilience.
What Does it Feel Like?
Typically, you’ll feel:
• Pain directly on the bony prominence on the side of the hip.
• Discomfort that flares up when walking, running, or climbing stairs.
• Significant pain when lying on the affected side at night.
2. The MOVEMENTPERFECTED Assessment
It is a common mistake to look at the MRI as the only way to get answers. Interestingly, imaging often shows tears or calcifications in people with no hip pain at all.
When you visit our Marylebone or Moorgate clinics, we first confirm the source of the pain. We use specific movement tests rather than just relying on a scan. Our expert physios look at the whole picture: your strength, gait, and unique hip morphology to build a plan that works for you.
Which form of rehabilitation is best for you?
One of the oldest pieces of advice for tendon pain is to just let it rest. However, this is not helpful as tendons become weaker and less resilient with total rest.
The gold standard for recovery is Education plus Exercise. Clinical trials show a structured loading program is far superior to alternatives such as corticosteroid injections or a “wait and see” approach. While a steroid injection might offer quick relief for a few weeks, the benefits usually vanish by six months, whereas exercise provides lasting improvement.
Is Surgery an Option?
We are often asked about surgery for tendon tears. Latest evidence suggests that for most people, a well-managed physiotherapy program is just as effective as surgery, even when tears are present. We recommend at least 12 months of progressive loading before considering surgery.
Strength Strategies
The rehabilitation process is broken down into 3 stages:
Stage 1: Settling the Pain (Isometric Loading)
In the early stages, we use isometrics—holding a muscle contraction without moving the joint. These exercises have an analgesic (pain-numbing) effect on the tendon, allowing you to build strength without a flare-up.
Stage 2: Building Force
Once the pain is manageable, we move to dynamic movements. Research has identified the best exercises for the gluteus medius and minimus activation:
• Side Planks: Excellent for high-level gluteal activation.
• Glute Bridges: We start with double-leg and progress to single-leg variations as you get stronger.
• Pelvic Drops: Standing on a step and controlling the “hitch” of your pelvis is vital for stability in walking and running.
Stage 3: Dynamic Power
For our athletes, we progress to more difficult exercises such as Split Squats and Single-Leg Romanian Deadlifts (RDLs). These prepare your tendons to handle the heavy loads of high-performance activity.
Advanced Rehabilitation: BFRT
For clients seeking an accelerated recovery experience, we offer Blood Flow Restriction Training (BFRT). This involves using a specialised cuff to safely restrict blood flow to the working muscle. It tricks the body into gaining benefits of high-intensity lifting while using light, tendon-friendly weights. It’s particularly effective in the early stages when heavy loads are too painful.
Long-Term Management
Tendons take time, often 12 weeks or more, to completely adapt. To ensure the pain doesn’t return, we often transition our clients into Clinical Pilates or resistance training at our studios. This helps you fix the underlying biomechanical habits that led to the overload in the first place.
3. Common Mistakes We See
• Stretching the “Glutes”: Many people pull their knee across their chest to stretch the hip. This increases compression on the tendon and often worsens the pain.
• Inconsistency: Tendons need frequent, steady input to change. Skipping exercises for a week can set your progress back significantly.
• Ignoring the Early Warning: That “niggle” on the outside of your hip is your tendon asking for help. Addressing it early prevents a chronic 12-month recovery.
4. When to See a Specialist
If your hip pain wakes you at night, stops you from exercising, or makes daily walking tough, it’s time for a professional assessment. Our team provides a personalised, movement-focused approach based on recent evidence.
FAQ Section
Q: Is gluteal tendinopathy the same as hip bursitis?
A: They are often found together, but the tendon is usually the primary source of pain. The treatment is the same: load management and strengthening.
Q: Can I keep cycling or running?
A: Yes! We use a pain monitoring system that allows activity as long as the pain is manageable during the session and doesn’t flare up the following morning.
Q: Why is my hip worse in the morning?
A: Tendons often stiffen up after rest. Also, if you’ve been sleeping on your side without support, you may have been compressing the tendon all night.
