Gluteal tendinopathy exercises to avoid (and what runners should focus on instead)
Want to know the quickest way to start making a positive difference to your gluteal tendinopathy pain and begin recovering?
Current research says the best way to do this is to start reducing the compressive forces on your tendon and progressively build your tendon strength to cope with the loads that your sport and physical activities demand.
This article will help you understand how you can do this and why it’s necessary to do it this way.
First, let's briefly recap how tendinopathies develop and the likeliest cause of gluteal tendinopathy.
How tendinopathy develops
Tendons are good at coping with normal levels of strain
Every day, when you exercise or do physical activity, your muscles and tendons develop tiny injuries and repair themselves. This normal and healthy process helps make your body stronger over time.
Too much strain, too little recovery
If you load your tendons with more than they can handle or don’t allow enough recovery time, the small injuries that develop in your tendon accumulate, affecting your tendon’s structure and eventually causing tendinopathy.
Too much compression
The glute medius and minimus tendons are the most commonly affected tendons in gluteal tendinopathy, likely because of their location.
They lie between the outer hip structures (glute max, tensor fascia latae, IT band) and your hip bones. So, when your leg moves inward or across your midline, it pulls all these structures into a stretch and compresses the glute medius and minimus tendons against the bones.
Tendinopathy can develop when this compression is sustained for long periods or happens repetitively with high loads.
How does tendinopathy affect your tendons?
Tendinopathy changes the structure of your tendon, causing it to lose strength, meaning its capacity to cope with load is lower, and it's more likely to get injured again.
If you keep training through the pain with gluteal tendinopathy, you won’t break the cycle of "too much strain and not enough recovery.” Your tendon will become progressively more irritated, and eventually, very little activity will bring on your pain.
Now let's look at what to avoid and focus on to help you recover.
Gluteal tendinopathy exercises to avoid
Evidence indicates that managing loads to reduce compressive and tensile (pulling) forces on your gluteal tendons can help manage tendinopathy.
Runners are often advised to do stretches for gluteal tendinopathy to improve their hip flexibility and reduce stiffness. But, the research doesn't support this advice, and these stretches often increase pain.
Although you may feel tightness in your hip and buttock area when you have gluteal tendinopathy, this sensation is likely from the irritation in your tendon and not the tightness in your muscle. The stiffness feeling usually improves as your tendon recovers.
Remember, excessive gluteal compression is what likely led to your gluteal tendinopathy. So, stretching the area doesn't usually help and can worsen your pain because it compresses the irritated tendons (a bit like pressing on a bruise).
What to avoid
- Any movement or stretches that involve bringing your knee across your body, for example, glutes, piriformis, buttock, lower back rotation stretches
- Any stretches that push your hip outward, like IT band stretches
What to do instead
- Strengthening exercises to restore the strength and endurance of your tendon - this will allow the pain to calm down and your muscles to be less irritated.
Clams and side-lying exercises (initially)
The clam and side leg lift exercises are commonly prescribed for gluteal tendinopathy rehab. But they can often aggravate your pain in the early stages because they stretch and compress the tendons.
What to avoid:
- Hip exercises that take your leg past the midline or rotate it far backward - these can be added later in your rehab plan
What to do instead:
- Strengthening exercises where the hip is in a neutral position, e.g., isometric hip abduction with pillows for guidance
The Exakt Health app is designed to help solve this problem. It provides tailored, evidence-based exercises that progressively load your tendons, building up your strength over time and helping to reduce pain in the long run.
The best exercises for gluteal tendinopathy
Strengthening exercises are best for recovering from gluteal tendinopathy.
Before we move on to the exercises, here are a few guidelines to follow to help you get the best results.
Guidelines for gluteal tendinopathy exercises
Use pain to guide your rehab
Unfortunately, there is no specific dosage (e.g., repetitions and sets) for gluteal tendinopathy exercises. How much you do will depend on your tolerance during the exercise and 24 hours after, as with all tendinopathies.
Tip: A good way to correct your dosage is to:
- Start with short holds and a few repetitions
- Check how your pain reacts in the 24 hours after doing the exercises
- Progress or adapt the exercise dosage accordingly: If your pain flared up significantly, reduce the amount you do; if your hip tolerated it well, continue with that dosage or even increase it slightly
How to start
For extremely sensitive gluteal tendons:
- Start with low-load exercises
- Keep your gluteals out of stretched positions
Isometric exercises are great for sensitive tendons because they allow you to activate your muscles without movement, making them unlikely to irritate your injury and worsen your pain.
Tip: Always work within comfortable ranges of hip movement with any exercise so you don't irritate your injury.
Now we will look at the most frequently prescribed exercises for early-stage gluteal tendinopathy and how to progress.
Gluteal tendinopathy exercises and how to progress
Isometric abduction: Side leg lifts
- Lie on your uninjured side with your head supported.
- Bend your bottom leg.
- Straighten your top leg, supporting it on a small step (or pillows).
- The step or pillows should be high enough for your top leg to remain at hip level or slightly higher when you lower it down.
- Place your top arm's hand on the floor in front of you to stabilize yourself.
- Tighten your core and slowly lift your top leg just above hip height.
- Ensure your leg does not drift forward during the exercise - you should only be able to see the tips of your toes when you look down toward your foot. Also, don't let your hips roll back - keep them stacked.
- Hold the position for the suggested time, then lower your leg down slowly to rest.
- Hold the position for 10 seconds.
- Rest for 20 seconds.
- Start by doing 6 repetitions. Then, add a few repetitions as you get stronger. Aim to build up to doing 10 repetitions, but don't force it.
Tip: It is crucial not to lower your foot all the way down to the floor when you rest (rest it on pillows or a step) because this will cause your tendons to stretch and likely increase your pain in the early stages.
- Lean your back against a wall and place your legs hip-width apart.
- Position your feet far enough away from the wall that your knees can stay behind your toes when you slide down.
- Then, slide your body down, stopping before your knees reach a 20-degree angle.
- Ensure that your knees remain in line with the middle of your feet and do not turn in.
- Hold the position for 10 seconds.
- Rest for 10 seconds.
- Start by doing 6 repetitions or fewer. Then, add a few repetitions as you get stronger. Aim to build up to doing 10 repetitions, but don't force it.
Tip: If this exercise causes pain, check that you're not going too low. The lower you squat, the harder your gluteal tendons have to work. So it's best to first restore your hip's strength in high positions.
Isometric glute bridges
- Lie on your back with your knees bent to 90 degrees and your feet flat on the floor.
- Lift your bottom off the floor to a level that is comfortable for you. Your goal is to get your hips and body to form a straight line, but this may not be possible to start.
- Avoid over-arching your back.
- Start by holding the position for 10 seconds or fewer. Then, add a few seconds as you get stronger. Aim to build up to holding for 20 seconds, but don't force it.
- Lower your hips back down to the starting position.
- Rest for 20 seconds.
- Repeat 5 times.
Tip: Common mistakes that can increase your pain are squeezing your glutes too hard or lifting your hips too high. Only lift as high as you can without discomfort. If your hamstrings cramp, move your feet closer to your bottom.
How to progress
With your isometrics, aim to progress to longer holds with fewer repetitions as your symptoms allow. When you can hold them for a reasonable amount of time (e.g., 30 to 60 seconds), it's time to move on to more challenging exercises so you continue building strength in your tendon.
Once you've mastered isometrics
How often should you do your exercises?
With low-load isometrics
- Currently, there’s no frequency guide for low-load gluteal tendinopathy exercises
- It depends on your body's response to exercise and your unique situation and needs
- Best practice recommendations are to test and see what frequency works for you (i.e., what can you do without aggravating your pain and build from there)
With higher-load isotonics (added weight)
- No more than 3 strength sessions per week
- Ensure at least 1 rest day in between (sometimes 2, depending on your body's general recovery response)
Heavy strength training (8-10 repetition max per exercise)
- Aim for a maximum of 2 strength sessions per week
- Incorporate more rest days
With load management, the total daily load on your tendons counts.
If you do running and jumping sports, these are high-impact activities. So, you will need to be strategic about when you do your strength training.
Tip: Keep your heavy strength sessions away from high-load sports in your training diary to help prevent tendon overload.
How much strength do you need?
Hopefully, this article has shown that you can find relief from gluteal tendinopathy.
The main takeaways are:
- Start by reducing the load on your gluteal tendons - avoid hip and buttock stretches (while you're healing) and exercises that stretch and compress your gluteal tendons, such as “the clam”, or other side-lying exercises (initially).
- Follow a comprehensive, progressive gluteal strengthening program - complete recovery only happens when your tendon is strong enough to cope with your sports and activities, and this strength transfers to your sport.