Gluteal Tendinopathy (and Other Outer Hip Pain)

Gluteal tendinopathy is one of the most common causes of pain on the outer side of the hip. It involves irritation or degeneration of the gluteal tendons - most often the gluteus medius or gluteus minimus - at the point where they attach to the greater trochanter, the bony prominence felt on the outer hip.

Gluteal tendinopathy is sometimes referred to as greater trochanteric pain syndrome (GTPS), a term that acknowledges that the pain in this region can arise from a number of structures, including the tendons themselves, as well as associated bursae. In most cases, the primary driver of pain is the tendon rather than the bursa, which has important implications for treatment.

Like other tendinopathies, this condition often reflects a problem with tissue load and adaptation rather than simple inflammation, particularly when symptoms have been present for several weeks or months.

The pain associated with gluteal tendinopathy is typically localised to the outer hip, though it may radiate into the outer thigh. Common features include:

• Pain over the outer hip, often worse when lying on the affected side

• Discomfort when sitting with legs crossed or in low, soft seating

• Pain on walking, particularly uphill, on stairs, or after prolonged walking

• Pain when rising from sitting or standing on one leg

• Tenderness on pressing directly over the greater trochanter

Symptoms are often aggravated by positions that increase compression of the tendons, such as crossing the legs, standing with the hip shifted to one side, or sleeping on the affected side without a pillow between the knees.

 Gluteal tendinopathy has a strong association with certain demographics, though it can occur in a wide range of individuals:

• Women in their 40s to 60s (it is significantly more common in women than men)

• Runners, walkers, and those who regularly climb stairs or hills

• People with altered hip biomechanics or reduced gluteal strength

• Those who sit for prolonged periods with the hip in a crossed or adducted position

• Individuals who have recently increased activity levels or changed training surface

Management focuses on reducing compressive load on the tendons while progressively rebuilding strength and capacity. Key elements include:

• Posture and position modification - avoiding leg crossing, hip adduction, and compressive positions

• Progressive gluteal and hip strengthening exercises

• Gait retraining where abnormal walking patterns are contributing

• Activity modification during the early phase of treatment

• Manual therapy to address hip, lumbar, and pelvic stiffness where relevant

For cases that have not responded to exercise-based management, focused shockwave therapy is a well-evidenced and commonly used treatment. It is more accurate and comfortable than radial shockwave therapy and typically produces results from fewer sessions

We take a structured, evidence-based approach to outer hip pain that begins with accurate diagnosis. Diagnostic ultrasound imaging allows us to visualise the gluteal tendons and associated bursae, confirming the diagnosis and guiding treatment decisions. Many patients are referred or self-refer having been given a non-specific diagnosis of 'bursitis', and imaging often reveals a more complex picture.

Treatment at Tenby Health & West Wales Ultrasound is tailored to each individual and typically includes:

• Clinical and ultrasound assessment to confirm the diagnosis

• Focused shockwave therapy for suitable tendon pathology

• Supervised rehabilitation targeting the gluteal muscles and hip mechanics

• Education on load management and position modification

Related Pages: Focused Shockwave Therapy | Tendon Pain & Injuries 

 New to the clinic? Here's what to expect:

•  If you've not seen us before, you will start with a short new patient consultation (£65) so we can understand your symptoms and confirm a scan is the right next step. In most cases, the scan can be carried out in the same appointment for the additional scan fee above.  When booking, please select 'New Patient Consultation.'
• Existing patients and anyone referred by a GP, physiotherapist, osteopath, podiatrist or chiropractor can book the scan directly - no consultation needed and the prices above apply. Please contact us if you are being referred, prior to booking.
• You will speak directly to the clinician who performs your scan - before, during, and after.