Gluteal Tendinopathy Exercises: What Helps & What Makes It Worse

By Emma Glynn - The Hip & Knee Physio

When you have gluteal tendinopathy, exercise feels like a minefield. Do the wrong movement and your lateral hip pain flares for days. Do nothing, and your glutes stay weak and the tendon stays irritable. The truth sits in the middle and it matters a great deal which side of it you are on.

I see this pattern regularly in clinic. Someone has been doing glute bridges and side-lying leg raises for weeks - movements that feel productive, only to find their pain has not shifted. Or they have avoided exercise entirely because they are afraid of making things worse. Both approaches stall recovery. Gluteal tendinopathy responds to specific loading, applied at the right time - not to blanket rest or random exercise.

If you are not sure whether your current approach is working or whether what you have is actually gluteal tendinopathy rather than bursitis, this post will help you understand the difference.

Why Exercise Matters in Gluteal Tendinopathy

The gluteus medius and gluteus minimus tendons attach your hip abductor muscles to the greater trochanter - the bony prominence on the outside of your hip. These tendons handle repeated stress from walking, stair climbing, running, and single-leg activities. When they develop load-related changes, pain and functional limitation follow.

Rest does not fix this. Tendons adapt to load, and without appropriate exercise they stay weak, irritable, and prone to re-irritation (Cook & Purdam, 2009). The goal of a gluteal tendinopathy exercise program is not to work through pain - it is to progressively load the tendon in a way that builds strength, improves movement patterns, and gradually restores tolerance for daily life and activity.

A 2024 systematic review and meta-analysis confirmed that exercise is superior to minimal intervention for improving function in both the short and long term in people with gluteal tendinopathy (Patricio Cordeiro et al., 2024). The evidence supports exercise as the core treatment but it has to be the right exercise, done in the right sequence.

Exercises That Help: Starting Where the Tendon Is

Stage 1: Isometric holds (weeks 1 to 3)

If you are in acute pain or early recovery, start here. Isometric exercises - where you contract the muscle without moving the joint - are well tolerated by irritable tendons and have been shown to provide pain relief while beginning to build baseline strength (Clifford et al., 2019).

The movement: lie on your side with hips stacked. Bend the bottom knee slightly for stability. Keep the top leg straight and lift it 10 to 15 centimetres, then hold for 30 seconds without moving. No bouncing, no range of motion. Just sustained contraction.

Aim for three sets of 30-second holds per side, up to three times daily. This phase feels underwhelming - that is normal. The tendon is adapting before the pain reliably changes.

Stage 2: Side-lying hip abduction (weeks 2 to 5)

Once isometric holds are well tolerated, introduce controlled movement through a limited range. Lift the top leg slowly to approximately 45 degrees - no higher - then lower with control. Two seconds up, one second hold, two seconds down. No momentum.

This exercise begins to replicate the gluteus medius's primary function: stabilising the pelvis during single-leg loading. Allison et al. (2016) found that people with gluteal tendinopathy have significantly weaker hip abductors than pain-free controls - bilateral weakness, not just on the painful side - which means this phase of loading is building capacity that was already deficient before symptoms started.

Aim for three sets of ten repetitions, three times per week with at least one rest day between sessions.

Stage 3: Standing hip abduction (weeks 3 to 6)

Stand sideways to a wall with fingertips resting on it for balance. Lift the far leg 15 to 20 centimetres out to the side, leading with the heel, and lower with control. Keep the torso upright - no leaning through the trunk to compensate. This is the first weight-bearing stage and it more closely mirrors how the gluteus medius is used during walking.

Stage 4: Single-leg stance (ongoing from week 3)

Stand on one leg for 30 to 45 seconds. Hold a counter lightly if needed for balance. Progress to eyes closed or a cushion under the foot as tolerance improves. This exercise directly translates to walking, stair climbing, and any activity that involves single-leg loading - which is most of daily life.

Stage 5: Side Lying Hip Abduction (weeks 4 onwards)

Lie on your side with the bottom knee bent at 45 degrees and the top leg straight. Lift the top leg toward the ceiling, then close and repeat.

Three sets of 12 to 15 repetitions, three times per week.

Exercises That Make Gluteal Tendinopathy Worse

Wide-stance squats. A wide base increases hip abductor demand through a large range of motion and places the gluteal tendons in a compressive position. If you want to squat, use a narrow stance, limit depth to a quarter squat, and avoid the bottom range where gluteal load spikes.

Deep or wide lunges in early recovery. Lunges load the tendon unevenly through the trailing leg and are too aggressive in the first four weeks. A controlled, narrow lunge may be appropriate from week five onwards. Deep or loaded lunges should wait until base strength is solid.

Returning to running too soon. This is the most common mistake I see. Two weeks of reduced pain feels like permission to run. It is not. Impact loading and sustained hip abduction during running will re-irritate a tendon that has not yet built sufficient capacity. A graduated return-to-run protocol starting from week six at the earliest, with walk-jog intervals, is the appropriate approach.

Bilateral leg raises. Two-leg raises generate significant hip extension force through the gluteal tendons and frequently aggravate symptoms. Single-leg raises on the non-painful side are generally fine.

Heavy barbell loading in the first six weeks. Deadlifts, Bulgarian split squats, and hip thrusts are useful tools later in rehabilitation but they impose high compressive and tensile loads that exceed what an irritable tendon can currently tolerate. These belong in month three onwards, once base strength is established.

Aggressive static glute stretching. Pigeon pose, figure-four stretch, and pulling the knee across the body feel like they should help because the hip feels tight. They tend to make gluteal tendinopathy worse. These stretches place the tendon in exactly the compressive position that drives irritation.

If your hip feels tight, that is more likely a protective response from the tendon than a flexibility problem that needs stretching.

The walking modification post covers relevant movement pattern changes in more detail.

The Progression Principle: Load Tolerance, Not No Load

The practical rule for judging whether an exercise is appropriate: if it increases your pain that day or the following morning, it is too much. Back off. If it causes mild discomfort during the exercise but does not increase pain afterwards, it is likely appropriate.

The patients who recover fastest are the ones who find this threshold and stay just below it - consistently - over weeks and months.

Those who do too much too soon repeatedly set themselves back. Those who do too little never build the capacity the tendon needs. Neither extreme shortens the timeline.

Recovery from gluteal tendinopathy is discussed in more detail in the How Long Does Gluteal Tendinopathy Take to Heal? post, including what the research shows for mild, moderate, and chronic presentations.

When to Get Help

If you have been working through a self-directed program for six to eight weeks without meaningful improvement, the program likely needs adjustment - not more of the same.

An APA Titled Musculoskeletal Physiotherapist who focuses entirely on hip and knee conditions can assess where your tendon currently is, identify what is not working, and recalibrate the program around your specific presentation and goals.

If you are in Melbourne, I see patients in Camberwell. You can find out more about what to expect from an initial assessment.

If you are not local or prefer to work through a structured program at your own pace, the Glute KickStarter online rehabilitation program is built around exactly this progression - isometric loading through to functional strength, with guidance on load management, compressive positions, and return to activity. It is designed for active adults over 40 who want a structured, evidence-informed approach they can follow at home.

If you have already tried the standard advice and it has not shifted your pain, the 5 Mistakes People Make When Rehabbing Gluteal Tendinopathy post may be worth reading before you decide on your next step.

Start the Glute KickStarter Program |

Book an in-clinic assessment

Emma

References

Allison, K., Vicenzino, B., Wrigley, T. V., Grimaldi, A., Hodges, P. W., & Bennell, K. L. (2016). Hip abductor muscle weakness in individuals with gluteal tendinopathy. Medicine & Science in Sports & Exercise, 48(3), 346–352. https://doi.org/10.1249/MSS.0000000000000781

Clifford, C., Paul, L., Syme, G., & Millar, N. L. (2019). Isometric versus isotonic exercise for greater trochanteric pain syndrome: A randomised controlled pilot study. BMJ Open Sport & Exercise Medicine, 5(1), e000558. https://doi.org/10.1136/bmjsem-2019-000558

Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409–416. https://doi.org/10.1136/bjsm.2008.051193

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

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

Patricio Cordeiro, T. T., Rocha, E. A. B., & Scattone Silva, R. (2024). Effects of exercise-based interventions on gluteal tendinopathy: Systematic review with meta-analysis. Scientific Reports, 14, 3343. https://doi.org/10.1038/s41598-024-53283-x

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.