Exercises for gluteal tendinopathy

To choose the right exercises for your specific case of gluteal tendinopathy, you first have to understand what causes it, what happens to the tendons, and what type of exercises are best suited to correct it. So we'll kick this article off with a quick overview of the causes and injury process before we discuss what exercises to do. Remember, if you need more help with an injury, you're welcome to consult our team of sports physios online via video call.

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In this article (click or tap to skip straight to a specific section):

1. What causes gluteal tendinopathy and how does it affect the tendons?

2. Gluteal tendinopathy exercises to avoid

3. What are the best exercises gluteal tendinopathy?

4. How we can help via video call

5. What our patients say

6. Research references

What causes gluteal tendinopathy and how does it affect the tendons?

What it is

Gluteal tendinopathy is one of the most common causes of pain that you feel in your buttock or over the outside (lateral) hip. It's an overuse injury that mostly affects the glute med tendon but can also involve the glute minimus and glute max tendons.

Picture credit: Wikimedia

It's quite common to have gluteal tendinopathy and hip bursitis at the same time, which is why researchers have started to refer to it as greater trochanteric pain syndrome. Now, that is quite a mouthful, so in this article we'll just call it gluteal tendinopathy or lateral hip pain.

What causes gluteal tendinopathy?

Gluteal tendinopathy is an overuse injury which develops when you overload your gluteal tendons. In other words, the volume or intensity of the activity you did was too much for the tendons (they weren't strong enough).

Whenever we exercise or do physical activity such as gardening or walking, our bodies sustain micro-damage. This is normal. The body then repairs this micro-damage to a better level than before the exercise or activity and that is how we grow stronger. However, if you don't give your body enough time to repair this damage between training sessions or activities, or the activity is a lot more than what your body is used to, the micro-damage can accumulate and cause an overuse injury like gluteal tendinopathy.

Other factors, like the menopause, can predispose you to developing gluteal tendinopathy because it influences how well or quickly your body can repair itself after exercise. The person in charge of your rehab plan should take this into consideration.

Alison explains how the menopause affects your gluteal tendons in the video below. She also shares some useful tips on how to adapt your training and rehab to minimise this effect.

What happens in the gluteal tendons and how can you fix it?

Once injured, the tendons lose some of their strength. This causes a vicious cycle because it now takes even less activity or exercise to overload them. So, people often find that as time goes on, they can do less and less activity before the pain kicks in.

How do you fix this? Through a combination of relative rest and a carefully graded strength training programme.

Relative rest means that you limit all your activities to a level that doesn't cause your pain to increase. This allows the injury to settle down.

The strength training programme will help to restore your gluteal tendons' strength to their previous level and beyond, so that they are strong enough to cope with all the activities that you want to do. We'll explore what this strength training should look like in the next sections.

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Gluteal tendinopathy exercises to avoid

Stretches - any and all gluteal stretches, iliotibial band stretches, and tensor fascia latae stretches should be avoided (see the video below for examples). These stretches used to be (and unfortunately still often are) commonly prescribed as part of the treatment of gluteal tendinopathy because practitioners used to think that the cause of this injury was overly tight gluteal muscles.

However, in recent years the research has shown that this is not the case and that stretching the gluteal muscles and their injured tendons usually just further irritate them. Alison explains this in the video below.

The tightness that you feel in your buttock or hip muscles when you have a gluteal tendinopathy is caused by the injured tendons that also irritate the muscles, causing them to tighten up. It is not a tightness that can be stretched out. The tightness will reduce as your injured tendons heal.

Stretching the glutes can often feel good while you're doing it, but then cause increased pain later in the day or the next day. So, if you're struggling with a case of gluteal tendinopathy that doesn't want to get better and you've been doing glute stretches, stop doing them for a week or two and see whether there's any improvement.

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What are the best exercises for gluteal tendinopathy?

Strength training exercises are the best exercises to do, but the success of your rehab plan also depends on choosing the correct type/intensity of strength exercise for your specific case. I'll explain this in more detail in this video and below it.

Isometric exercises

These exercises are usually most appropriate during the early stage, when the tendons are still very sensitive and easy to irritate. When you do an isometric contraction, you tense the gluteal muscles but without actually moving the leg.

The most common exercise used is an isometric side leg lift. Here, it is also important to avoid any positions that cause a stretch in the tendons. To achieve this, we like to use a pile of cushions or pillows to keep the leg in a more neutral position. Maryke demonstrates it in the video above.

Isometric exercises should start with short holds and low loads (e.g. 10-second holds with just the weight of your leg) and be progressed to longer holds and heavier loads (e.g. 30 seconds with a weight or heavy shoe on your foot).

What we prescribe very much depends on what we find when we assess our patients. Gluteal tendinopathy often only causes pain several hours after you do an exercise, so it's best to ease into strength training and carefully test the tendons' tolerance. Not everyone will find lying on their side comfortable, but fortunately you can do isometrics while standing, sitting, and even lying on your back. If your exercises are making your pain worse, tell your physio so that they can adapt them.

How often to do isometrics: You may be able to do them daily, but this will depend on your tendons' tolerance. Some of our patients require several recovery days in between and will typically do them every other day or just three times a week.

Isotonic exercises (concentric/eccentric exercises)

Once you've built a good base with your isometric exercises, you should migrate to doing isotonic exercises. If we think of the side leg lift exercise again, an example of doing that as an isotonic exercise is when you lift your leg up and down to the side.

We tend to start with these exercises in positions that still avoid stretching the tendons (so keep using that pile of pillows), as it is often still easy to irritate them. Once you've built a good base level of strength in this protected range, then you can usually safely transition into positions that cause a bit of a stretch on the tendon by removing some of the pillows.

Other examples of isotonic exercises that work the glutes include squats, bridges, and the leg press. What exercises are most appropriate for you and how you should progress them will depend on your current level of strength and also what goals you have. Runners, for instance, will have to build a much higher level of strength and endurance than someone who just wants to walk their dog for 30 minutes.

That's why we don't have a one-size-fits-all programme that we dish out to our patients. We test their strength (easily done via a video call) and do a thorough review of all their current activities and how these affect their symptoms, discuss their goals, and then design and adapt their programme with these factors in mind.

How often to do isotonic exercises: These exercises usually require a bit more recovery time than isometric exercises and should NOT be done daily. You usually need at least one recovery day between sessions if you're doing light to moderate strength training (max three sessions a week). If you're doing heavy strength training or doing other exercise that also load the glutes (e.g. running), it's best to leave at least two recovery days between sessions and only do two strength training sessions per week.

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How we can help via video call

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

What our patients say

References:

1. Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. (5th ed.) Vol 1: Injuries. (2017) McGraw-Hill Education.

2. Grimaldi, A. and A. Fearon (2015). "Gluteal tendinopathy: integrating pathomechanics and clinical features in its management." Journal of Orthopaedic & Sports Physical Therapy 45(11): 910-922.

3. Grimaldi, A., et al. (2015). "Gluteal tendinopathy: a review of mechanisms, assessment and management." Sports Medicine 45(8): 1107-1119.

4. Mellor, R., et al. (2018). "Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial." British Journal of Sports Medicine 52(22): 1464-1472.