Gluteal Tendinopathy: The Condition Misdiagnosed as Hip Bursitis

Lateral hip pain - pain over the outer hip and thigh - is common, particularly in middle-aged women and runners. For years it was labelled as trochanteric bursitis and treated with cortisone injections. We now know that in the vast majority of cases it's actually gluteal tendinopathy, and the management is fundamentally different.

Why the diagnosis matters

Bursitis treatment focuses on reducing inflammation in the bursa - typically with rest, anti-inflammatories, and cortisone injections. These can provide short-term relief. But if the underlying problem is a degenerated gluteal tendon, the pain returns because the tendon hasn't been rehabilitated. Cortisone injected directly into a degenerative tendon can also weaken it further.

What makes gluteal tendinopathy worse

The gluteal tendons are compressive-load sensitive. Activities that adduct the hip (bring the leg across the midline) compress the tendon against the greater trochanter, aggravating it. Common provocative positions include:

• Sitting with legs crossed
• Lying on the painful side
• Standing with weight shifted onto one hip
• Walking upstairs or uphill
• Hip-width narrow gait (many women naturally walk this way)

Load management comes first

Before loading the tendon, the compressive positions need to be addressed. Sleep with a pillow between the knees. Stand with weight evenly distributed. Avoid crossing the legs. These changes alone often reduce pain significantly within two to three weeks.

Progressive loading

Once pain is more manageable, gluteal strengthening is introduced carefully - avoiding hip adduction range initially. Isometric gluteal squeezes, clam shells, side-lying abduction, and eventually lateral band walks and single-leg squats (with the trunk upright and the knee tracking straight) progressively load the tendon and drive adaptation.