Exercises for gluteal tendinopathy – What works, how to progress, and what to avoid
- Maryke Louw
- Apr 10
- 9 min read
Updated: 6 days ago
To choose the right exercises for your specific case of gluteal tendinopathy, you first have to understand what happens to the tendons when they are injured, what type of exercises are best suited to correct it, and how to choose the correct level of difficulty for you.
Remember, if you need help with an injury, you're welcome to consult our team of sports physios online via video call.
In this article:
What happens to the gluteal tendons when they're injured?
Gluteal tendinopathy is an overuse injury that mostly affects the gluteus medius tendon (the main muscle on the side of your hip) but can also involve the gluteus minimus and gluteus maximus tendons.
We've explained in detail what causes the tendons to become overloaded and how factors like the menopause can play a role in our other articles.
Once injured, the tendons lose some of their strength and become sensitive and painful. This creates a bit of a vicious cycle – because the tendons are now not as strong, it takes even less activity to overload them. So, many people find that as time goes on, they can do less and less before the pain kicks in.
The good news? This cycle can absolutely be reversed.
💡 How do you fix it? Through a combination of relative rest and a carefully graded strength training programme.
Relative rest means limiting your activities to a level that doesn't cause your pain to increase significantly. This gives the injury a chance to settle down.
The strength training programme helps your gluteal tendons in two ways:
It restores your tendons' strength to their previous level (and beyond), so they can cope with all the activities you want to do.
It can help decrease pain and desensitise the pain system.
You have to get the balance right
👉 It's important to understand that recovering from gluteal tendinopathy is not 100% dependent on or guaranteed by strength training exercises alone. Loss of strength is not the only factor that plays a role in the pain and symptoms you feel.
Sometimes, the tendons are strong but just extremely sensitive and cause pain that is disproportionate to any injury seen on scans. Also, doing strength training exercises that are too much for what your pain system is currently happy to tolerate can actually amplify the pain even if the tendons are physically strong enough to do them.
💡 This is why it's important to not only consider your strength but also your pain levels and how it responds to activity when choosing what exercises you do.
If you try to ignore your symptoms and just get on with things, it usually just makes the pain worse until it eventually forces you to stop.
Like with most things in rehab, it's about getting the balance right ⚖️
How to use pain to guide your rehab
Your body uses pain to get you to pay attention and change your behaviour. When you have an injury, this pain alarm system becomes a bit overprotective – it sounds the alarm long before any actual tissue damage occurs.
So, yes, some of the pain you feel when injured can be safely worked through. However, if you push too far into pain, the alarm system becomes even more sensitive – and instead of calming down as the tissue recovers, it starts sounding louder and gets triggered more easily.
Research has shown that what works well for gluteal tendinopathy rehab is to keep within these guidelines:
It's OK (and expected) to be aware of your injured area while doing an exercise, but the discomfort should not really go above a 1 to 2 out of 10.
You should not experience a significant increase in discomfort in the hours after completing the exercises – up to a 3 out of 10 increase can be OK as long as it settles back down to your normal day-to-day pain levels within 24 hours.
⚠️ Tendons often have a delayed pain response – An exercise or activity might feel absolutely fine while you're doing it, but then your pain flares up significantly afterwards. So, always keep an eye out for this and, if you do experience a flare-up, also think about what you did the previous day.
Gluteal tendinopathy exercises to avoid
Now that you understand how to gauge your pain levels, let's cover the exercises that tend to make things worse before we get into the ones that help.
Gluteal stretches, iliotibial band (ITB) stretches, and tensor fascia latae (TFL) stretches should be avoided.
These stretches used to be (and unfortunately still often are) commonly prescribed for gluteal tendinopathy, because practitioners used to think the problem was overly tight gluteal muscles.
👉 However, the research has shown that this isn't the case – stretching the gluteal muscles and their injured tendons usually just further irritates them. Alison explains this in the video below.
The tightness in your buttock or hip muscles when you have gluteal tendinopathy is caused by the injured tendons irritating the surrounding muscles, causing them to tighten up. It's not a tightness that can be stretched out. The good news is that this tightness will decrease as your injured tendons become less sensitive and grow stronger.
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.
💡 If you've been struggling with a case of gluteal tendinopathy that doesn't want to get better and you've been doing glute stretches, try stopping them for a week or two and see whether there's any improvement.
What are the best exercises for gluteal tendinopathy?
Strength training exercises are the most effective exercises for gluteal tendinopathy. But the success of your rehab plan also depends on choosing the right type and intensity for your specific case.
If your tendon is currently very irritated and easy to flare up, it's best to start with very light exercises and avoid taking the tendons into positions that cause them to stretch – isometric exercises (where you tense the muscle without moving the leg) can be very useful in this phase.
As your pain settles and your injury starts to recover, it's important to gradually progress the exercises to use heavier loads – what you build up to and the types of exercises you should include will depend on your activity goals.
We also need to eventually get the tendons comfortable with being in stretched positions again – but strength training exercises that move your leg through its full range of motion usually work much better than passive stretching for achieving this.
Let's look at two common types of exercise used for gluteal tendinopathy rehab. These are only examples, and they don't work for everyone – your physio might prescribe something quite different based on your specific situation.
Isometric exercises for gluteal tendinopathy
These are usually most appropriate during the early stages, when the tendons are still very sensitive and easy to irritate. When you do an isometric exercise (also called a static hold), you tense the gluteal muscles but without actually moving the leg.
The most common exercise is an isometric side leg lift, but high wall-sits or isometric bridges can also work well. What's important is to avoid any positions that cause a stretch in the tendons during this phase.
Isometric side leg lift
Lie on your side with your bottom leg bent and your top leg straight – on a bed is fine if it hurts to get down to the floor.
Use a pile of cushions or pillows to keep your top leg in a neutral position (it should not drop down into a hip stretch).
Lift your foot a couple of centimetres off the pillows and hold the position for the prescribed time (see below).
👉 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 they can adapt them.
Isometric high wall-sit
Stand with your back against a wall.
Step your feet forward and slide a short distance down the wall – you're looking for a small bend in your knees and hips (about 20 to 30 degrees).
Hold this position for the prescribed time.
👉 If you slide down too low, it causes the gluteal tendons to stretch and compress against the hip bone, which can irritate them – so keep it shallow to start with.
Isometric glute bridge
Lie on your back with your knees bent and feet flat.
Gently squeeze your buttocks to lift your hips towards the ceiling – your aim is to form a straight line with your body, but don't force it. Only lift as high as feels comfortable.
Check that you're not overarching your lower back – if your hip flexors (the muscles at the front of your hips) are tight, lift only to the point where you can feel them stopping you.
Hold this position for the prescribed time.
👉 If you find the bridge exercise irritates your pain, I share some tips on how you can adapt it in this video.
How long to hold for
Start with short holds and low loads – for example, 10-second holds with just the weight of your leg. Over time, you'll progress to longer holds and heavier loads (e.g. 30 seconds with a weight or heavy shoe on your foot).
What we prescribe depends on what we find when we assess our patients. Because gluteal tendinopathy often only causes pain several hours after you do an exercise, it's best to ease into strength training and carefully test the tendons' tolerance.
How often to do isometrics
You might be able to do them daily, but this depends on how your tendons respond. Some of our patients need several recovery days in between and will typically do them every other day or just three times a week.
💡 Our bodies are all different – your physio will use your feedback to adjust and tailor your rehab plan.
Isotonic exercises
Once you've built a good base with your isometric exercises, the next step is to progress to isotonic exercises – these involve actually moving your body through a range of motion against resistance.
But this too has to be done in small, progressive steps.
We tend to start with isotonic exercises in positions that still avoid stretching the tendons, because they can often still be easy to irritate at this stage:
If we think of the side leg lift exercise again – we might keep the stack of pillows in place, but instead of just hovering above the stack, get you to lift your leg up and down several times.
We might replace the wall-sit with high squats, where you have a chair with a stack of pillows behind you to stop you squatting below a certain level.
💡 Once you've built a good base of strength in this protected range, then you can (and should) safely transition into positions that involve a bit more stretch on the tendon – by gradually removing some of the pillows.
Other examples of isotonic exercises that work the glutes include bridges, deadlifts, and the leg press machine.
What exercises are most appropriate for you and how you should progress them will depend on:
your current level of strength,
what positions your gluteal tendons are happy to tolerate,
and your goals.
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 a day.
That's why we don't dish out a one-size-fits-all programme to our patients. We test their strength (easily done via a video call), 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 all of these factors in mind.
How often to do isotonic exercises
These exercises usually require a bit more recovery time than isometrics and should NOT be done daily.
For light to moderate strength training, you usually need at least one recovery day between sessions – a maximum of three sessions a week.
For heavy strength training or if you're also doing other exercise that loads 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.
How we can help
Need 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.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.