Understanding Gluteal Tendinopathy and Its Impact on Hip Pain for Runners

Hip pain can be a frustrating and limiting problem for runners. One common cause that often goes unrecognized is gluteal tendinopathy. This condition affects the tendons around the lateral hip and can significantly disrupt running performance and daily activities. Understanding what gluteal tendinopathy is, how it develops, and the best ways to treat it can help runners manage pain and return to their sport stronger.

Anatomy of the lateral hip highlighting gluteal tendons

What Is Gluteal Tendinopathy?

Gluteal tendinopathy is a condition where the tendons of the gluteal muscles, especially the gluteus medius and minimus, become irritated and painful. It is the most common cause of pain on the outside of the hip, particularly in women over 50 and in runners or endurance athletes. The pain usually appears on the lateral hip and can be mistaken for trochanteric bursitis, a different but related condition.

Runners often notice the pain worsening during activities such as:

• Walking or running, especially uphill or on uneven surfaces

• Climbing stairs

• Lying on the affected side

• Sitting with legs crossed

  
  

This pain can limit training and reduce overall mobility.

Why Does Gluteal Tendinopathy Occur?

Recent research has changed how we understand this condition. It is not just about tendon overload from repetitive running but also about compressive loading of the tendon. This happens when the hip moves into adduction (moving the leg toward the midline), which compresses the tendon against the bone.

Common activities that increase compressive load include:

• Crossing legs while sitting

• Hip drop during running gait (when the pelvis tilts down on the opposite side)

• Certain hip stretches that push the tendon into a compressed position

  
  

This explains why some traditional hip stretches, often recommended for lateral hip pain, can actually worsen gluteal tendinopathy.

How to Treat Gluteal Tendinopathy

The best treatment approach focuses on progressive tendon loading rather than rest or anti-inflammatory injections alone. The LEAP trial, a large clinical study, showed that a structured physiotherapy program combining education and gradual tendon loading exercises leads to better outcomes than corticosteroid injections or simply waiting for the pain to improve.

Key Components of Treatment

• Load Management Education

Patients learn which positions and activities to avoid during recovery, such as crossing legs or prolonged sitting on the painful side. This helps reduce compressive forces on the tendon.

• Progressive Loading Exercises

Exercises start gently and increase in intensity to strengthen the gluteal tendons without causing irritation. This helps the tendon adapt and heal over time.

• Running Gait Retraining

For runners, correcting running form is essential. Reducing contralateral pelvic drop and limiting excessive hip adduction can lower tendon compression during running.

• Manual Therapy and Pain Relief

Techniques like soft tissue massage, acupuncture, and manual therapy can reduce pain and improve mobility, making it easier to engage in loading exercises.

Practical Tips for Runners with Hip Pain

If you are a runner experiencing lateral hip pain, consider these steps:

• Avoid sitting with legs crossed and lying on the painful side.

• Focus on strengthening exercises for the gluteal muscles that avoid excessive hip adduction.

• Work with a physiotherapist to assess your running gait and make necessary adjustments.

• Use manual therapy or acupuncture to manage pain during the early stages of treatment.

• Be patient and consistent with your rehabilitation program, as tendon healing can take several months.

  
  

When to Seek Professional Help

Persistent lateral hip pain that worsens with activity should be evaluated by a healthcare professional. Physiotherapy can provide a tailored program that addresses your specific needs and running style. For runners in South Kensington, Ali Momeni Pour at Physiome Kensington offers expert physiotherapy care focused on gluteal tendinopathy and hip pain.