Gluteal Tendinopathy &
Hip Flexor Tendinopathy Treatment

Gluteal tendinopathy is irritation of the gluteus medius and gluteus minimus tendons where they attach to the bony point on the outside of the hip (the greater trochanter). It causes aching on the outer hip that is tender to press, hurts when lying on that side, and flares with stairs, hills, standing on one leg or sitting with the legs crossed. It is the most common cause of what used to be called hip bursitis, and it is now often called greater trochanteric pain syndrome.

At Solas Physical Therapy in west El Paso, Dr. Andrew Cisneros, PT, DPT, MS treats gluteal tendinopathy and hip flexor tendinopathy one-on-one, for a full hour every visit, at 300 N Resler Dr, Ste F. No referral is needed to start, evening and weekend appointments are available, and the evaluation is $150 with follow-up visits at $120, paid per visit.

Mostly, yes. Pain on the outside of the hip was long blamed on an inflamed bursa, but imaging shows the gluteal tendons are usually the main source, with the bursa irritated alongside them. The difference matters because tendons need the right load to recover, while rest and stretching across the body tend to keep them sore.

Lying on the painful side presses the tendon against the bone. Lying on the other side lets the top knee drop across the body, which stretches and squeezes the same tendon. A pillow between the knees, or a soft topper, keeps the top leg level and usually helps within days, while treatment works on the cause.

Usually not early on. Stretches that pull the leg across the body, like the classic IT band stretch or a figure-four, compress the irritated gluteal tendons and often make the pain worse. Treatment starts with avoiding those compressed positions and loading the tendon with strength work instead.

It can calm the pain for a few weeks, but the pain often returns. In a large randomized trial (Mellor and colleagues, BMJ 2018), education plus a progressive exercise program did better than a cortisone injection at eight weeks, and better than waiting it out at one year. Many people try physical therapy first and keep the injection as an option with their physician.

They can contribute. The gluteus medius holds the pelvis level each time you stand on one leg. When it cannot, the pelvis drops, the thigh drifts inward and the knee and foot collapse with it, which adds load to the kneecap, the low back, the plantar fascia and the Achilles. Not every leg problem is a glute problem, but at Solas PT glute med strength and control are tested and trained with every hip, knee, back, foot and ankle patient.

Most people notice easier nights within the first two weeks once compressed positions are managed, and a clear improvement in walking, stairs and sleep over six to twelve weeks of progressive loading. Tendons adapt slowly, so the strength program keeps building after the pain settles to keep it from coming back.

Hip flexor tendinopathy is irritation of the iliopsoas or rectus femoris tendon at the front of the hip. It hurts when lifting the knee, getting in and out of a car, sprinting, kicking or doing sit-ups, and is common in runners, soccer players and lifters. Because pain at the front of the hip can also come from the hip joint itself, such as a labral tear, the evaluation sorts out which one it is first.