Gluteal tendons

Function

Where the tendons attach

The gluteus medius lies beneath the gluteus maximus, and the gluteus minimus lies beneath the medius⁹. Both end in tendons on the greater trochanter, the bony bump at the outer hip^1,2,3. A study of cadavers (donated bodies) and MRI scans described its surface as four facets, or small flat areas¹. These were the front, outer, back and upper back facets¹.

Cadaver studies found the gluteus medius tendon attaching at two of these sites^1,2:

Attachment site	Size in 8 cadaver hips
Outer facet	About 438 mm², 34.8 mm long, set at about 37 degrees to the thigh bone2
Upper back facet	About 197 mm², roughly round and about 17 mm across2

The gluteus minimus tendon attaches to the front facet^1,3. In 16 cadaver hips, the muscle started on the outer surface of the ilium, the wide upper part of the hip bone¹⁰. On its way down, it also attached to the joint capsule of the hip, the sleeve of tough tissue that encloses the joint^3,10.

In a cadaver and MRI study, three bursae (small fluid-filled sacs that cushion tissues where they rub) sat around these tendons¹. One lay over the back facet and the outer gluteus medius attachment¹. The other two lay beneath the gluteus medius tendon and beneath the gluteus minimus tendon¹.

What the two muscles do

Together, the gluteus medius and minimus act as hip abductors, moving the thigh out to the side, and are important for normal walking⁴. The gluteus minimus acts mainly to steady the hip and move the thigh outward¹¹.

In cadavers and a plastic bone model, the minimus did different jobs depending on thigh position and which part was working¹⁰. It could bend the hip, move the thigh out, or turn it in or out¹⁰. One of its roles was to hold the ball of the thigh bone in the hip socket¹⁰.

The superior gluteal nerve supplies the gluteus medius, the gluteus minimus and the tensor fasciae latae, a small muscle at the upper outer thigh¹². Damage to this nerve paralyses the gluteus medius¹². The result is a typical walking and standing pattern called the Trendelenburg gait¹².

In 18 adult cadavers, the gluteus medius had three distinct parts and the minimus had two¹³. Each part had its own branch of the superior gluteal nerve¹³. From their fibre directions, the parts seemed suited to different jobs¹³:

• The front and middle parts of the medius, and the front part of the minimus, appeared suited to starting the outward lift¹³.
• The back parts of both appeared suited to steadying the ball of the hip in its socket during walking¹³.

How much force the muscles make in walking

One computer model of walking was scaled to one healthy adult man¹⁴. At peak loading early in each step, the ground pushed up with about 120% of body weight¹⁴. The model’s gluteus medius then made about 897 newtons and the minimus about 158 newtons¹⁴.

The same study then changed the shape of the hip in its model¹⁴. A high angle at the femoral neck (the angled part of the thigh bone below the ball) and a narrow pelvis gave the shortest leverage¹⁴. That shape also gave the highest peak gluteus medius force, 1,240 newtons¹⁴. A wide pelvis with a low neck angle gave the longest leverage and the lowest force, 742 newtons¹⁴.

Breakdown

What gluteal tendinopathy is

Gluteal tendinopathy is now seen mainly as a problem of the gluteus medius or minimus tendons where they attach to bone, without inflammation⁶. It is described as the most common tendinopathy of the leg^5,6. Levels of disability and quality of life have been reported as equal to those in end-stage hip osteoarthritis, a long-term disease of a joint⁶.

It brings pain and tenderness over the greater trochanter, which sometimes spreads down the outer thigh⁶. The pain disturbs sleep⁶. Loading one leg at a time brings it on, as in climbing stairs, walking and dressing⁶.

In tendinopathy, the fibres of collagen, the strong, rope-like protein that tendons are mainly built from, become disorganised⁶. More small blood vessels form and new nerves grow in, and the tendon loses its integrity⁶.

From bursitis to a full tear

A systematic review searches for the research on a question in a set, checkable way and sums it up. One such review used four grades of worsening tendon change⁵:

1. Bursitis, a swollen bursa⁵.
2. Tendinopathy⁵.
3. A tear through part of the tendon’s thickness⁵.
4. A tear through its full thickness⁵.

Tears of the medius, minimus or both sit at the more severe end of gluteal tendon problems¹⁵. People whose tears cause symptoms show disability like that of end-stage hip osteoarthritis¹⁵. These tears show up in three ways¹⁶:

• Tears from wear or injury, sometimes called rotator cuff tears of the hip, in older people with outer hip pain, weakness and no hip arthritis¹⁶.
• Tears that may cause few symptoms, found during hip replacement¹⁶.
• Tears or failed repairs after hip replacement through one particular surgical approach¹⁶.

One prospective study (a study that follows people forward in time) took in 176 people having hip replacement for osteoarthritis¹⁷. Of these, 34 (20%) had wear-related tears of the hip abductor mechanism¹⁷. These tears were more common in elderly women¹⁷.

What scans show at the outer hip

Bursa changes alone are uncommon in pain at the greater trochanter, and inflammatory cells are rarely found⁶. Bursa changes may still occur alongside tendon changes⁶. One retrospective study looked back at ultrasound scans of 877 people with pain at the greater trochanter¹⁸. One finding involved the iliotibial band, a long band of tough tissue running down the outer thigh¹⁸:

Finding on ultrasound	Share of the 877 people
Gluteal tendon change (tendinosis)	49.9%18
Thickened iliotibial band	28.5%18
Trochanteric bursitis	20.2%18
Gluteal tendon tear	0.5%18

In an MRI study of 40 people with pain in one outer hip, the pain-free hips also showed changes, especially bursitis¹⁹.

Who is affected

One cross-sectional study, looking at a group once, took in 3,026 community adults aged 50 to 79⁷. It counted greater trochanteric pain syndrome (pain and tenderness at the outer hip, over the greater trochanter)⁷:

Group	One side	Both sides
Women	15.0%7	8.5%7
Men	6.6%7	1.9%7

In that study, women had about 3.4 times the odds of the condition, while age and race were not significantly linked⁷. After adjustment, tenderness of the iliotibial band, knee osteoarthritis and low back pain were linked to it⁷. Body mass index, a measure of weight for height, was not⁷.

Age, sex and hormonal status are described as risk factors for hip tendinopathy⁶. It is common in postmenopausal women, those after menopause⁶. In one review of 27 studies testing approaches to gluteal tendinopathy, the people studied had a mean age of 53.7 years⁵. Women outnumbered men 7 to 1⁵.

Counts from family doctors’ records differ^20,21:

• In one Dutch general practice in 2012, the figure for prevalence (how many people have a condition at one time) was 4.22²⁰. New cases were 3.29 per 1,000 person-years, a count of people times the years each was followed²⁰.
• That was the highest of the five leg tendinopathies counted there²⁰.
• In records from 39 family doctors, there were 1.8 new cases of pain at the greater trochanter per 1,000 patients a year²¹.

Load patterns and body shape linked to it

In tendinopathy, high tensile load, a pulling force that stretches a tissue, combined with compressive load is considered most harmful⁶. That is especially so when repeated⁶. Low tensile load with compression can also lower how much load a tendon can take⁶.

Hip adduction, moving the thigh toward the midline, can raise the pressure of the iliotibial band on tissues over the greater trochanter⁶. Sitting with the legs crossed is one example⁶. In 18 unfixed corpses and 12 patients during hip replacement, force under the band there rose with adduction and fell with abduction²². It rose by up to 106 newtons at 40 degrees of adduction²².

Studies of standing and walking found these differences^6,23:

• Standing on one leg, 20 people with gluteal tendinopathy moved the hip more toward the midline than 20 pain-free people of the same age²³.
• In that study, the opposite side of the pelvis also rose less²³.
• Biomechanical studies show changed walking in people with the condition, leading to much higher loads on these tendons⁶.

A more acute angle between the femoral neck and the shaft of the thigh bone may add to squeezing forces on the tendons⁶. People with the condition show bigger differences between the width of the pelvis at the ilium and the width across the greater trochanters⁶. A systematic review of 13 studies compared 229 people with greater trochanteric pain syndrome and 193 without it²⁴. On very low quality evidence, the first group had wider greater trochanters, higher body mass index and weaker hip abductors²⁴. They also showed changed loading on one leg and changed walking²⁴.

Weaker, smaller muscles

One study compared 50 people with gluteal tendinopathy on one side with 50 people without it²⁵. Hip abductor strength was 32% lower on the painful side²⁵. In the same study, the pain-free side was also weaker than in the comparison group²⁵. Its strength was 23% lower²⁵. It was not clear whether the weakness came before the condition or resulted from it²⁵.

It was not clear whether the weakness came before the condition or resulted from it.

In gluteal tendinopathy, the weakness comes with wasting of the gluteal muscles and fat building up within them⁶.

Recovery

How long the pain can last

Hip tendinopathies are described as common, with a real impact, and as not settling on their own⁶. One retrospective study followed 164 family-doctor patients with pain at the greater trochanter²¹. Their mean age was 55, and 80% were women²¹. At least 36% still had pain after one year, and 29% after five years²¹. In this group, those with osteoarthritis in the leg had a 4.8-fold risk of pain lasting a year²¹.

Hip tendinopathies are described as common, with a real impact, and as not settling on their own.

What trials of exercise and injection found

One randomised trial took in 204 people aged 35 to 70 with gluteal tendinopathy confirmed on MRI⁸. It compared an eight-week education and exercise programme, one corticosteroid injection, and waiting to see⁸. A corticosteroid is a drug that copies a type of hormone the body makes. The table shows how many in each group rated their overall change a success⁸:

Group	Success at 8 weeks	Success at 52 weeks
Education and exercise	51 of 668	51 of 658
Corticosteroid injection	38 of 658	36 of 638
Wait and see	20 of 688	31 of 608

At 52 weeks, pain did not differ between the exercise group and the injection group⁸.

A meta-analysis (a study that pools the results of several earlier studies) combined 3 trials with 383 people with gluteal tendinopathy²⁶. Exercise programmes improved function more than minimal care, in both the short and long term²⁶. The certainty of that evidence was rated low to very low²⁶. In the same review, exercise and corticosteroid injection had similar effects on pain²⁶. More people counted as a success after exercise than after injection²⁶.

A network meta-analysis compares many options at once, including ones never tested against each other directly. One pooled 19 randomised trials of non-surgical approaches, with 1,701 people with greater trochanteric pain syndrome²⁷. Of the approaches it compared, exercise programmes showed the largest gains in pain scores and in a function score for gluteal problems²⁷.

Corticosteroids have been reported to lower tendon cell survival, collagen production and the tendon’s mechanical properties⁶.

What studies of tears report

A systematic review of gluteal tendon tears took in 38 papers with 1,584 people¹⁵. It found no studies of non-surgical approaches¹⁵. Every paper studied surgery, most were case series (reports on a group of patients without a comparison group), and none were randomised trials¹⁵. After surgery, quality of life and pain had improved at 12 months or more¹⁵. The certainty of that evidence was very low¹⁵.

A second review pooled 34 studies of 1,278 people who had surgical repair²⁸. It compared open repair with endoscopic (keyhole) repair²⁸. Both gave similar short-term gains in function and pain²⁸. Complications occurred in 33 of 371 open repairs and in 25 of 433 endoscopic repairs²⁸.

How load shapes tendon tissue

Mechanical load is an important trigger for both breaking down and building up tendon⁶. Both too much and too little load affect how sound a tendon is⁶.

Another meta-analysis, of 27 exercise studies, found that tendons respond to many kinds of loading²⁹. Its data strongly suggested that how heavy the load was mattered more than the type of muscle contraction²⁹. Those studies looked at the Achilles and patellar tendons, so they are not evidence about the gluteal tendons²⁹.

Connections

The muscles around them

The gluteus maximus covers the gluteus medius, which in turn covers the gluteus minimus⁹. The gluteus maximus’s line of pull suits it to help lift the thigh out to the side³⁰. The tensor fasciae latae is a small muscle in the upper outer thigh that pulls the iliotibial band taut⁹. The iliopsoas is a deep hip muscle, made of the psoas and iliacus, that bends the hip. The tensor fasciae latae works with it and the gluteus medius to bend the hip and move the thigh outward⁹.

Exercises that work these muscles

Related exercise pages: side-lying hip abduction and single-leg Romanian deadlift^31,32. The studies below measured muscle activity or estimated muscle force, rather than load on the tendons themselves^31,32.

• In an EMG (muscle activity) review of healthy people, side-lying hip abduction worked the middle gluteus medius at about 40% of maximum, a moderate level³¹.
• In a modelling study of 14 female footballers, the loaded single-leg Romanian deadlift was among the top exercises for estimated gluteus medius force³².
• In that study, it and the body-weight side plank were the top exercises for estimated gluteus minimus force³².
• There, a 12-repetition maximum load (liftable 12 times) raised peak gluteal muscle forces by 28 to 150 newtons over body weight³².

Sources

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28. Ramadanov N, Voss M, Lott A, Hable R, Prill R, Becker R, Ostojic M, Penchev P, Banke IJ (2026). Endoscopic gluteal tendon repair reduces complication rates while achieving outcomes comparable to open repair: A multilevel meta-analysis.. Knee Surgery, Sports Traumatology, Arthroscopy. doi:10.1002/ksa.70309 PMID 41618800
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Every source the library cites

Changes

• September 29, 2026 Tidy pass: minor review findings fixed, glosses aligned with the reviewed glossary.
• September 29, 2026 First published.