Gluteal Tendinopathy: What the Evidence Shows About Lateral Hip Pain, Diagnosis and Treatment

Key Takeaways

Gluteal tendinopathy of the gluteus medius and minimus tendons is now recognised as a primary local source of lateral hip pain, and it affects both athletes and people who do not exercise regularly.[1]
Despite the old label “trochanteric bursitis”, most patients with greater trochanteric pain in a large ultrasound series had no bursitis, and gluteal tendon changes were more common than bursitis.[2]
In a small diagnostic study, pain within 30 seconds of standing on the affected leg made MRI-detected tendinopathy very likely, while no tenderness over the greater trochanter made it unlikely.[3]
In a randomised trial of 204 people, education plus exercise outperformed a single corticosteroid injection and a wait-and-see approach on global improvement at both 8 and 52 weeks.[4]
Corticosteroid injections give short-term relief, but their advantage over usual care had disappeared by 12 months in a primary care trial.[5]
In my clinical experience, many patients with gluteal tendinopathy have a background of prolonged sitting or standing in monotonous work postures, and the pain is often mistaken for non-specific low back pain.
In my practice, many patients rely on passive treatments that give quick but temporary relief, and some stop exercising altogether, which in my view may worsen the condition in the long term.

Introduction: Why Gluteal Tendinopathy Is Often Misread

Gluteal tendinopathy is often referred to as greater trochanteric bursitis or greater trochanteric pain syndrome.[4] Greater trochanteric pain syndrome (GTPS) is, however, a broader clinical term, and research has shifted the picture of what lies behind it. Tendinopathy of the gluteus medius and gluteus minimus tendons is now recognised as a primary local source of lateral hip pain. It mostly appears in mid-life, in athletes as well as in people who do not regularly exercise, and women are affected more often than men.[1]

The condition is not trivial. The same review notes that the condition interferes with sleep, particularly lying on the side, and with common weight-bearing tasks.[1]

This article covers how common the condition is, what drives it mechanically, how it is assessed, and what randomised trials show about injections, exercise and other treatments.

From a clinical perspective, lateral hip pain from gluteal tendinopathy is often filed under non-specific low back or hip pain, and in my clinical experience this mix-up happens among clinicians as well as patients. Treatment practices for this kind of localised musculoskeletal pain also vary considerably. In my interpretation, Finland has no dedicated national Current Care guideline for it that is as clear as those available for many other conditions, although the Current Care guideline on pain includes an evidence summary on education and exercise for greater trochanteric pain syndrome.

How Common Is Gluteal Tendinopathy?

Population data often use the broader umbrella term GTPS. Because GTPS is a clinical syndrome, its prevalence is not the same as the prevalence of confirmed gluteal tendinopathy. In a cross-sectional study of 3,026 community-dwelling adults aged 50 to 79, drawn from a cohort at high risk of, or already with, knee osteoarthritis, GTPS was defined as greater trochanteric tenderness in people with hip pain and no signs of hip osteoarthritis or generalised myofascial tenderness. In this cohort, unilateral GTPS was found in 15.0% of women and 6.6% of men, and bilateral GTPS in 8.5% of women and 1.9% of men.[6] The odds ratio for women was 3.37. Age and race were not significantly associated with GTPS in that sample.[6]

Ultrasound data suggest why “bursitis” is often the wrong word. In a retrospective review of 877 patients referred for ultrasound because of greater trochanteric pain, 700 (79.8%) had no bursitis. Only 177 (20.2%) had trochanteric bursitis, whereas 438 (49.9%) had gluteal tendinosis, four (0.5%) had gluteal tendon tears and 250 (28.5%) had a thickened iliotibial band.[2] The authors concluded that the pain usually reflects some combination of gluteus medius, gluteus minimus and iliotibial band pathology, with bursitis present in only a minority.[2]

The burden can be substantial. In a small case-control study comparing 42 people with GTPS, 20 with severe hip osteoarthritis and 23 asymptomatic controls, the GTPS group reported disability and quality of life similar to end-stage hip osteoarthritis. They were also the least likely to be working full time (probability 0.29, versus 0.52 in the osteoarthritis group and 0.68 in controls).[7]

In my clinical experience, gluteal tendinopathy is fairly common at the practice, perhaps partly because many of my patients are occupational health clients. Their work often involves long periods of sitting or standing in monotonous postures, which in my view may place considerable load on the gluteus medius and minimus. Perhaps the most common background in the patients I see is prolonged sitting. Most of them already have height-adjustable desks at work, so the problem often lies elsewhere: many of my patients who work remotely sit at a kitchen table on a kitchen chair, which is rarely the most ergonomic option. Others stand for much of their working day, and this brings its own problems.

In my clinical experience, gluteal tendinopathy and gluteal-region pain more broadly are a fairly common reason for sick leave. For many patients the situation may stay stable for a long time, until a small movement makes the back or hip region painful and the muscles go into protective spasm. A fairly typical story I hear is a patient picking up a sock from the floor, and patients are often surprised that such a small movement can cause such a severe spasm. In my understanding, there is usually a prolonged work-related load in the background, and a particular movement then appears to trigger the episode, although the exact tissue mechanism is not always identifiable from the clinical picture. I also see this in athletes, and the same can happen during sport.

What Drives the Pain? Load, Compression and Hip Adduction

Tendons adapt to the loads placed on them. In this condition, the combination of excessive compression and high tensile loads within the tendon is thought to be the most damaging. The available evidence points to joint position, especially excessive hip adduction, together with muscle and bone factors, as key elements in the condition.[1]

Hip adduction means the thigh moving toward or across the midline. The education programme in the LEAP trial, discussed below, was built partly on avoiding movements and positions that compress the gluteus medius and minimus tendons against the greater trochanter.[4] Movement studies add some detail. During walking, people with gluteal tendinopathy show modified activation patterns of the hip abductor muscles compared with pain-free controls, including a more sustained initial burst in parts of the gluteus minimus and gluteus medius.[8] The authors note that these changes may be relevant to how the gluteal tendons are loaded.[8] Because this was a comparison between groups at one point in time, it cannot show whether the altered movement causes the condition or results from it.

Several other features travel with GTPS. In the community study above, iliotibial band tenderness (odds ratio 1.72), knee osteoarthritis on the same side (odds ratio 3.47) and low back pain (odds ratio 2.79) were all positively associated with GTPS after adjustment. Body mass index was not associated with GTPS in the fully adjusted model, and hip internal rotation did not differ by GTPS status.[6] These are associations from cross-sectional data, not proof of cause, but they show that lateral hip pain often coexists with back or knee problems. For pain that sits more in the buttock or low back region, see also our article on whether the SI joint can be “out of place”.

Gluteal Tendinopathy in Athletes: What the Evidence Does and Does Not Show

Gluteal tendinopathy is described as occurring in athletes as well as in less active people.[1] However, it is important to be clear about the limits of the evidence. The two exercise trials discussed below recruited middle-aged and older adults, mostly or entirely women, rather than competitive athletes. The trial of education plus exercise, for example, enrolled people aged 35 to 70 with a mean age of 54.8 years, of whom 167 of 204 were women.[4]

The trials discussed in this article did not study runners, team-sport athletes or combat-sport athletes specifically, so their findings can only be applied to sport with caution.

How Gluteal Tendinopathy Is Diagnosed

At the time of a 2015 review, there was no consensus on which clinical tests give the best diagnostic value, and the reviewers proposed using a battery of tests that combine compressive and tensile loads on the tendons.[1] A later systematic review with meta-analysis of clinical tests for GTPS encouraged clinicians to use greater trochanter palpation followed by a resisted hip abduction test when GTPS is suspected after the patient interview.[9]

The most useful single study comes from a diagnostic accuracy study of 65 people with lateral hip pain, using MRI as the reference standard and a radiologist blinded to the clinical findings.[3] Two findings stand out:

Single-leg stance for 30 seconds. Pain within 30 seconds of standing on the affected leg showed high specificity (100%) for MRI-detected gluteal tendinopathy, and the authors reported a high post-test probability under an assumed 50% pre-test probability. Given the small sample, these estimates should be interpreted with caution.[3]
Palpation over the greater trochanter. No pain on palpation (sensitivity 80%) would make MRI-detected tendinopathy unlikely.[3]

There is an important caveat. Twenty participants (31%) had tendinopathy on MRI but were clinically negative, and the authors themselves note the sample was small and possibly underpowered.[3] A positive single-leg stance test therefore points strongly toward the diagnosis, while a negative clinical examination does not rule out tendinopathy seen on MRI.

The ultrasound data above also show that bursitis was present in only a minority of patients with greater trochanteric pain.[2]

In practice, gluteal tendinopathy is usually a clinical diagnosis made by the physician, and it can be difficult to confirm fully objectively. Trochanteric bursitis is a common differential diagnosis, and in my clinical experience some patients have both tendinopathy and trochanteric bursitis. Among the patients I see, trochanteric bursitis has more often been diagnosed in women.

In older patients, I also consider hip osteoarthritis as a possible cause. In my clinical experience, hip osteoarthritis now appears even in patients who are still working, and these patients often describe pain around the groin. Their pain is not always clearly located in the gluteal region, although it can be, and osteoarthritis and gluteal tendinopathy can of course coexist. Some patients also describe pain radiating down the leg. When radiating symptoms are clear, I consider sciatica as a possible cause, and with clear radiculopathy I usually refer the patient to an orthopaedic surgeon for a one-off assessment. Deep gluteal syndrome with sciatic nerve compression is another possibility, but in my experience it is less common than radicular sciatica, which usually originates from the spine.

Gluteal Tendinopathy Treatment: What the Trials Show

Management has commonly involved corticosteroid injection, exercise or shockwave therapy, with surgery reserved for cases that do not respond. At the time, the review authors noted a lack of evidence for any of these treatments.[1]

Education plus exercise: the LEAP trial

The LEAP trial randomised 204 people with lateral hip pain for more than three months and MRI-confirmed gluteal tendinopathy to one of three approaches: a physiotherapist-led education and exercise programme of 14 sessions over eight weeks, a single corticosteroid injection, or a wait-and-see approach.[4]

The success rates on global rating of change were:

Approach	8 weeks	52 weeks
Education plus exercise	77.3%	78.6%
Corticosteroid injection	58.5%	58.3%
Wait and see	29.4%	51.9%

At eight weeks, all three groups differed from each other on global improvement and pain. At 52 weeks, education plus exercise remained better than both other groups for global improvement, while the injection group no longer differed from wait and see. For pain intensity at 52 weeks, however, education plus exercise and injection did not differ, and both were better than wait and see.[4]

The education component focused on avoiding positions and movements that compress the tendons against the greater trochanter, and on gradually progressing tendon load. The authors suggested that the mechanism behind the benefit may lie more in the education part of the programme than in strength gains, although the trial did not separate the effects of education and exercise. Changes in hip abductor strength were small, with a small but significant difference in torque between education plus exercise and wait and see.[4] Readers interested in loading strategies more broadly may find our articles on isometric exercise for pain and eccentric training for tendinopathy useful context, keeping in mind that the LEAP trial tested a combined education and exercise programme rather than isometric or eccentric training as separate interventions.

I have experienced gluteal tendinopathy-type pain myself from time to time, and isometric exercises have given me the most benefit. Many of my patients have had a similar experience and benefited from isometric training. From a clinical perspective, this remains individual experience rather than trial evidence.

Does the specific exercise matter?

A second trial adds nuance. In 94 postmenopausal women with GTPS, all participants received education on avoiding tendon compression and were randomised to either a 12-week targeted gluteal loading programme or sham exercises. Intention-to-treat analysis showed no between-group differences, although both groups improved significantly on the VISA-G score at 12 and 52 weeks.[10] Taken together with LEAP, these trials raise the possibility that education and load management contribute importantly to outcomes, although their independent effects have not been established. For hormonal context in this age group, see our article on menopause in female athletes.

A 2024 systematic review and meta-analysis of randomised trials concluded that, in the long term, exercise slightly reduces hip pain and disease severity and slightly improves function and global rating of change compared with a control condition. Compared with corticosteroid injection, exercise improved the likelihood of a meaningful long-term global improvement. The authors rated the certainty of this evidence as low to moderate, owing to the low number of trials and the resulting inconsistency and imprecision of the estimates.[11]

Corticosteroid injections

In a primary care trial of 120 patients, 55% of those given a corticosteroid injection had recovered at three months, compared with 34% receiving usual care (number needed to treat 5). At 12 months, recovery was 61% versus 60%, with no significant difference.[5]

An earlier trial of 229 patients with refractory GTPS, in which patients were assigned sequentially to treatment groups, showed a similar pattern. At one month, success was 75% after a single corticosteroid injection, compared with 7% after home training and 13% after shockwave therapy. By 15 months, success was 48% after injection, 80% after home training and 74% after shockwave therapy.[12] The home exercise programme in that trial did not specifically target the gluteal tendons or include the same load-management education, which may have contributed to the differences between the two trials.[4]

Platelet-rich plasma and shockwave therapy

In a double-blind randomised trial of 80 patients with chronic gluteal tendinopathy, a single platelet-rich plasma (PRP) injection and a single corticosteroid injection performed similarly at 2 and 6 weeks. At 12 weeks, the mean modified Harris Hip Score was 74.05 in the PRP group and 67.13 in the corticosteroid group (P = .048), and 82% versus 56.7% reached the minimal clinically important difference.[13] In the 2-year follow-up of the same trial, the authors reported that the PRP benefit persisted at 2 years, whereas the corticosteroid benefit was not maintained beyond 24 weeks. Patients in the corticosteroid group could, however, switch to PRP after 3 months, and 27 patients deemed to have failed corticosteroid treatment at 16 to 24 weeks did so, so the long-term comparison was no longer between the original randomised groups.[14]

A later double-blind trial compared leukocyte-rich PRP with a saline placebo injection in 79 patients with refractory GTPS; the trial protocol specified referral to physiotherapy for all participants after the injection.[15] Both groups improved, but there was no significant difference between them at any follow-up, and the authors did not support the routine use of PRP for this condition.[16]

A network meta-analysis of 13 randomised trials and 1,034 patients found that PRP and shockwave therapy improved pain at 1 to 3 months compared with no treatment. However, no therapy significantly outperformed no treatment for pain at 6 to 12 months, and structured exercise was the only treatment that significantly improved function compared with no treatment at 1 to 3 months.[17]

In practice, injections are part of the everyday management of lateral hip pain. I give injections for trochanteric bursitis fairly often, and in my clinical experience the response varies: sometimes they work well, sometimes less well.

What This Means for Active People

The evidence points in a fairly consistent direction, although a 2024 meta-analysis rated the certainty of the exercise evidence as low to moderate:[11]

Terminology matters. In a large ultrasound series, most patients with greater trochanteric pain had no bursitis.[2]
Load and position matter. Excessive hip adduction and the combination of compressive and tensile tendon loads are thought to be key factors.[1]
Education combined with exercise has the most convincing trial support among the options reviewed here. In LEAP, a programme built around education and progressive exercise produced the best long-term patient-reported global improvement.[4]
Injection evidence is mixed. Corticosteroid benefit faded by 12 months in primary care,[5] pooled data showed PRP and shockwave pain benefits at 1 to 3 months but not at 6 to 12 months,[17] and PRP outperformed a corticosteroid injection at 12 weeks in one trial,[13] but did not outperform placebo in a later double-blind trial.[16]
Athlete-specific data are thin. Participants in the main exercise trials were middle-aged adults rather than athletes, so applying these findings to sport requires judgement.[4]

In my clinical experience, patients with lateral hip pain often manage it with painkillers, massage or stretching, and some attend regular passive treatment, for example with a chiropractor. These rarely seem to bring lasting relief. Active physiotherapy can be harder to stick with, because in some situations it may initially make the area more painful, and patients may stop early. Passive treatments, by contrast, often give quick but only temporary relief, and in my experience some patients then come to prefer them over active rehabilitation. In practice, I explain to patients that active approaches are often better in the long term. Passive treatment does not have to be excluded, but I try to guide patients away from relying on passive treatment alone.

Some patients conclude from this that they should not exercise at all, because exercise makes the area painful. In my clinical experience, the situation can then spiral: patients start avoiding physical activity and simply stay still, which in my view may worsen their condition in the long term.

Conclusion: A Tendon Problem, Not Usually a Bursa Problem

Gluteal tendinopathy is a recognised local source of lateral hip pain,[1] and patients with it are often misdiagnosed.[3] Data from a large community cohort aged 50 to 79 show that GTPS affects a meaningful share of these adults, particularly women,[6] and its impact on disability and quality of life can resemble that of severe hip osteoarthritis.[7] A simple 30-second single-leg stance test and trochanteric palpation offer useful diagnostic information.[3] Among treatments, education about load management combined with exercise has the most convincing long-term trial data for patient-reported global improvement, while corticosteroid injections show clearer benefits in the short term than in the long term.[4][5] For athletes, a major limitation of the trials discussed here is the lack of sport-specific outcome data.

In my clinical experience, many patients I see with the condition have a background of prolonged work-related load; the condition is frequently mistaken for non-specific back pain, and it can lead patients to avoid physical activity altogether. In my practice, I explain to patients that active approaches are often better in the long term, without ruling out passive treatment.