Gluteal Tendinopathy: Treatment for Outer Hip Pain and Regenerative Options

What is gluteal tendinopathy?

Gluteal tendinopathy is a painful condition of the tendons of the gluteus medius and gluteus minimus, the muscles that attach to the bony point on the outside of the hip (the greater trochanter). The tendon becomes less able to handle load, and in some people develops partial or full-thickness tears. It is the most common cause of greater trochanteric pain syndrome (GTPS) and is especially common in women over 40.

Reviews in the sports medicine literature describe it as a compression and overload problem of the tendon (Grimaldi et al., Sports Med 2015).

Symptoms

• Pain and tenderness on the outer hip, sometimes spreading down the side of the thigh
• Pain lying on the affected side, and often on the other side too
• Pain climbing stairs, walking uphill or standing on one leg
• Pain sitting with legs crossed or in low chairs
• Morning stiffness or pain after sitting

Gluteal tendinopathy vs hip bursitis

Many people are told they have “trochanteric bursitis”, but imaging studies show that the gluteal tendons are often the main problem. Our hip bursitis page covers the bursa side of GTPS. The difference matters because the best treatment targets the tendon.

	Gluteal tendinopathy	Trochanteric bursitis
Structure	Gluteus medius and minimus tendons	Fluid-filled sac over the trochanter
Main driver	Tendon overload and compression	Irritation of the bursa, often alongside tendon changes
Key treatment	Progressive tendon loading exercise	Load management, sometimes steroid injection
Possible tear	Yes, partial or full thickness	No
Surgery	Repair for selected full-thickness tears	Rarely needed

Causes and risk factors

• Menopause and hormonal changes
• Sudden increases in activity, such as more walking, running or hill work
• Compression positions: standing hanging on one hip, crossing legs, side-lying
• Weak hip abductor muscles
• Excess body weight
• Lower back problems or hip osteoarthritis, which change how the hip is loaded

How is it diagnosed?

A doctor examines the outer hip for tenderness and tests such as standing on one leg for 30 seconds. Ultrasound or MRI can show tendon thickening, tears and bursa fluid, and helps rule out hip osteoarthritis, a hip labral tear or pain referred from the back. You can send your ultrasound or MRI for a doctor review.

Conventional gluteal tendinopathy treatment

Conventional care should come first and works for many people.

1. Education and load management. Avoiding compression positions such as crossing legs, hanging on one hip and lying on the painful side.
2. Progressive exercise. Isometric holds, then strengthening of the hip abductors and functional exercises over several months.
3. Pain relief. Short courses of anti-inflammatory medicines where safe.
4. Corticosteroid injection. Can give short-term relief.
5. Surgery. Repair of a full-thickness gluteal tendon tear in selected cases.

In the LEAP randomised trial, education plus exercise gave better global improvement than a steroid injection or a wait-and-see approach at eight weeks, and better global improvement than steroid injection at 52 weeks (BMJ, 2018). The NHS page on bursitis covers general self-care for outer hip pain.

Regenerative options: what the evidence shows

PRP

PRP therapy has more evidence in gluteal tendinopathy than in many other hip conditions. A double-blind randomised trial in people with chronic gluteal tendinopathy (symptoms longer than 15 months) found a single ultrasound-guided PRP injection into the tendon gave greater improvement in pain and function than a steroid injection, with benefit sustained at two years (Am J Sports Med, 2019). Trials remain few, so PRP is usually reserved for people who have not improved with exercise.

Stem cells

Stem cell therapy for tendon problems uses mesenchymal stromal cells to try to support tendon healing. Human evidence in gluteal tendinopathy is very limited and early-stage, so this is experimental. Our stem cells vs PRP comparison explains the differences.

Regulatory status

PRP is widely used in many countries, but no stem cell product is approved for tendinopathy by the US FDA, the TGA in Australia or the UK MHRA. The FDA warns about unapproved regenerative products. Patients from Australia, the UK and the US sometimes travel to Thailand, where licensed doctors may provide these treatments under Thai regulation.

Who may be a candidate, and who should not

May be a candidate for an injection:

• Gluteal tendinopathy confirmed on examination and ultrasound or MRI
• Pain that persists after at least three months of a structured exercise programme
• Partial tendon changes rather than a large full-thickness tear
• Willingness to continue the exercise programme afterwards

Usually not suitable:

• Large full-thickness tendon tears that need surgical review
• Outer hip pain actually coming from the back or hip joint
• Active infection, active cancer, pregnancy, or bleeding disorders
• Recent steroid injection into the same area (timing needs doctor advice)
• Anyone hoping to skip rehabilitation

Risks and side effects

• Pain flare after injection for several days (common with PRP)
• Bruising at the blood draw or harvest site
• Infection (rare)
• Reactions to donor-derived products
• No improvement

Cells are prepared in ISO 9001:2015-certified partner laboratories.

What a Bangkok program looks like

1. Send your reports via WhatsApp: ultrasound, MRI and physiotherapy history.
2. Doctor review with an honest view of whether an injection makes sense.
3. Assessment in Bangkok, including examination and ultrasound if needed.
4. Treatment, if suitable: ultrasound-guided injection as a day procedure.
5. Rehab plan to continue tendon loading at home.

See how it works for the full journey.

Sources

• Grimaldi A, et al. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Med, 2015.
• Mellor R, et al. Education plus exercise versus corticosteroid injection versus wait and see for gluteal tendinopathy (LEAP). BMJ, 2018.
• Fitzpatrick J, et al. Leucocyte-rich PRP treatment of gluteus medius and minimus tendinopathy: a double-blind RCT with 2-year follow-up. Am J Sports Med, 2019.
• NHS: Bursitis
• U.S. FDA: Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes