Glute Tendinopathy Symptoms: What They Feel Like, Where They Sit, and When to Take Action

Outer hip pain that gets worse when you cross your legs, flares after a long walk, and makes lying on your side at night feel impossible - these are classic signs of glute tendinopathy. If you have been living with this pattern for weeks or months, and perhaps been told it is bursitis or given generic advice that has not helped, this post will give you a clearer picture of what is going on.

Glute tendinopathy - also referred to as gluteal tendinopathy is a condition affecting the gluteal tendons where they attach to the bony prominence on the outside of your hip, called the greater trochanter. It is one of the most commonly misdiagnosed causes of lateral hip pain in active adults, largely because it gets confused with hip bursitis and treated accordingly - which often makes it worse, not better (Grimaldi & Fearon, 2015).

I am Emma, an APA Titled Musculoskeletal Physiotherapist who works exclusively with hip and knee conditions. Here is what glute tendinopathy feels like, where it is located, and what to look for.

Where the Pain of Glute Tendinopathy Sits

The pain sits on the outside of the hip, specifically at or just below the greater trochanter, the bony point you can feel when you press into the side of your hip. It does not usually radiate down the leg the way sciatica does, though some people describe a dull ache extending toward the outer thigh.

The location is important because it helps distinguish glute tendinopathy from other causes of hip and buttock pain that require a different approach entirely.

If your pain is deep in the groin, it is more likely a hip joint issue. If it radiates down the back of the leg, the sciatic nerve may be involved. Outer hip pain sitting right on that bony prominence, that is the tendon.

The Classic Glute Tendinopathy Symptoms

Glute tendinopathy has a fairly recognisable pattern. Most people I see in clinic describe some combination of the following:

• Pain when crossing your legs. Crossing the legs compresses the gluteal tendon against the bone, which provokes pain in a sensitised tendon. If you have quietly stopped crossing your legs because it hurts, that is clinically significant.

• Pain on single-leg loading. Going up stairs, standing on one leg to put a shoe on, or walking uphill. These activities load the gluteal tendons heavily and will provoke pain when the tendon is irritated.

• Stiffness after prolonged sitting. Many people with glute tendinopathy notice they are stiff and sore when they stand up after sitting, particularly after long periods in low chairs or car seats. The hip loosens within a few steps, but the initial getting-up is consistently uncomfortable.

• Pain lying on the affected side at night. Lying directly on the affected hip hurts. If you roll your top leg forward during sleep, the tendon gets compressed and the pain can wake you. More detail on managing this is in the sleeping positions post.

• Difficulty with sustained or uphill walking. Flat ground walking is often manageable at first, but longer distances or inclines provoke symptoms. Many people notice the pain arrives after the walk rather than during, a delayed-onset pattern that is characteristic of tendon conditions.

• Flares after higher-than-usual activity. Pain the day after a longer walk, a busy day on your feet, or a weekend of more movement than usual is common. The tendon reacts to load increases with a lag.

Fearon et al. (2014) documented in a case-control study that greater trochanteric pain syndrome, the broader clinical term that includes glute tendinopathy, significantly affects work, physical activity, and quality of life in those it affects. This is not a minor inconvenience for most people; it is a condition that progressively limits what they can do.

What Does Not Usually Hurt and Why That Matters

People with glute tendinopathy often notice there are certain things that do not provoke their pain, which can be confusing. Lying on your back with your legs straight is usually comfortable. Flat walking at a moderate pace is often fine until a certain duration or gradient is reached.

The most important thing to know about what does not hurt: deep hip stretches into adduction - like pigeon pose or a figure-four stretch, may feel temporarily satisfying but tend to flare symptoms the following day.

This is a red flag I specifically ask about in clinic. If stretching the outer hip feels good in the moment but reliably makes you worse the next day, that is a strong indicator the tendon is involved. These stretches place the gluteal tendon in exactly the compressive position that drives the condition, they feel like relief but they are adding to the problem (Grimaldi & Fearon, 2015).

Who Typically Gets Glute Tendinopathy

Glute tendinopathy is most common in peri- and post-menopausal women, though it occurs in men and in active adults of all ages. Hormonal changes are thought to affect tendon tissue integrity, which is why incidence spikes in women in their 40s and 50s. A change in activity — whether a sudden increase such as a new walking routine or exercise program, or a period of rest followed by returning to normal activity, is often what triggers onset.

Runners are particularly susceptible. The repetitive single-leg loading of running, combined with a hip crossover gait pattern that many runners have, creates a compressive environment for the tendon that can tip a manageable presentation into a painful one.

The common thread across almost all presentations is compressive load — not a single traumatic event, but accumulated load through positions and activities the tendon cannot currently tolerate.

How Glute Tendinopathy Is Diagnosed

Glute tendinopathy is primarily a clinical diagnosis - made on the basis of your history and a physical assessment, not just a scan. A thorough assessment will include questions about your symptom pattern, what provokes and eases the pain, and your activity history, followed by hands-on testing including single-leg loading tests and assessment of hip abductor strength and control.

Imaging - ultrasound or MRI, can be helpful but is not always necessary. Scans can show tendon changes in people with no pain at all, and can appear relatively normal in people with significant symptoms. The scan is not the whole picture, and a clinical assessment is needed to interpret it in context.

If your pain has been labelled "hip bursitis" without a thorough clinical assessment, it is worth getting a reassessment. The two conditions overlap in presentation, but the treatment approach is meaningfully different and treating glute tendinopathy as bursitis tends to reinforce the behaviours that keep it going.

What to Do If This Sounds Like You

The most important thing to know is that glute tendinopathy responds well to evidence-based rehabilitation — but it needs the right approach. Rest alone does not fix it. Stretching into hip adduction makes it worse. Anti-inflammatory medications may take the edge off in the short term but do not address the underlying tendon load capacity problem that causes the condition to persist (Mellor et al., 2018).

What the evidence supports is a graded loading program — starting with isometric exercises and progressing through isotonic and heavier resistance work — that builds the tendon's capacity to handle load gradually and consistently. The glute tendinopathy exercises post covers this in detail, including what to do at each stage and what to avoid.

Getting the diagnosis right is step one. Everything else follows from there, and a clear assessment makes the path forward significantly more direct than continued trial and error.

If you are in Melbourne, I offer in-person assessments in Camberwell. If you are not local, I also work with people through telehealth appointments. Either way, the starting point is the same: a thorough assessment that gives you a clear picture of what is driving your pain and what needs to change.

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Emma

APA Titled Musculoskeletal Physiotherapist

The Hip & Knee Physio

Medical Disclaimer: The information in this post is for general educational purposes only and does not constitute medical advice. It is not a substitute for assessment, diagnosis, or treatment by a qualified health professional. If you are experiencing hip pain, please seek assessment from a registered physiotherapist or your GP.

References

Fearon, A. M., Cook, J. L., Scarvell, J. M., Neeman, T., Cormick, W., & Smith, P. N. (2014). Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: A case control study. Journal of Arthroplasty, 29(2), 383–386. https://doi.org/10.1016/j.arth.2012.10.016

Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: Integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 910–922. https://doi.org/10.2519/jospt.2015.5829

Grimaldi, A., Mellor, R., Hodges, P., Wajswelner, H., Littlewood, C., & Bennell, K. (2015). Gluteal tendinopathy: A review of mechanisms, assessment and management. Sports Medicine, 45(8), 1107–1119. https://doi.org/10.1007/s40279-015-0336-5

Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H., & Vicenzino, B. (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. BMJ, 361, k1662. https://doi.org/10.1136/bmj.k1662