Part of Greater trochanteric pain syndrome
Gluteal tendinopathy exercises to avoid, and what to turn down instead
Warning signs, and when to get help
What exercises should you avoid with gluteal tendinopathy?
A list of forbidden exercises is the wrong tool, because the same exercise can be fine at one setting and the cause of your flare at another. One rule covers nearly all of it.
One group needs a different answer before anything else. If you have had an operation on that hip, a replacement, a resurfacing, a fixed fracture, an arthroscopy or a repair of these tendons, the list that governs you is your surgeon's and not this one, so read what if you have had a hip operation before you change or start anything here. If you have not had surgery on that hip, the rest of this page is written for you.
Tendons are thought to cope worst with two things happening together: being squeezed against bone, and being pulled hard. For the tendons at the side of the hip the squeeze happens when the thigh travels across the midline of the body, which presses them into the bony point they attach to (Grimaldi and colleagues, 2015). So the exercises to leave out are the ones that put the thigh across the midline and then ask the hip to work there.
There are a handful of things it rules out altogether.
- Stretches for the outer hip and buttock. The piriformis stretch, the lying figure 4 stretch, the seated figure 4 stretch, the side lying IT band stretch and the standing IT band stretch all pull the leg across the body by design.
- Working directly over the bony point. IT band foam rolling over the hip, deep massage there, or anything that presses on it.
- The hip adduction machine in a gym, which trains the exact movement that compresses the tendon, under load.
- Lunges or step patterns where the moving foot lands across the line of the standing one, and any exercise that finishes with the knees together under load.
- Standing hung on one hip, which is not an exercise but happens inside plenty of them.
- Sitting cross-legged on the floor through a class, which both NHS leaflets behind this page ask you not to do. The reason is not the one above: tailor sitting opens the thighs rather than carrying them across the body. It holds the hip flexed, turned out and open, which is close to the FABER position the trials use as a provocation test, because it loads the front of the gluteal tendons in tension and usually reproduces pain at the side of the hip (Mellor and colleagues, 2016). Sit on a cushion with your legs out in front instead, or take a chair. If you have had a hip operation, take the chair: getting down to the floor and back up again is itself one of the things many surgeons limit for the first months.
Everything else is a setting. The rest of this page works through the exercises people actually ask about, and the greater trochanteric pain syndrome program is the staged version of what to do instead.
Why does compression matter more than the exercise's name?
The name tells you what the exercise is called, not what the hip is doing in it. Take the side leg raise. Done with the top leg lifting straight up from a level start, it is a hard pull through the tendon and nothing more.
Let the top leg start dropped below or behind the bottom one, the way it does on a soft mattress when the leg sags, and the same movement becomes a hard pull delivered from the compressed position. Same exercise, same name, two different loads on the tendon. Side lying hip abduction is left out of our own program's stages for exactly that reason.
The same logic sorts a squat. Knees apart and tracking over the toes, the thighs stay where they should be. Let the knees fall inward toward each other at the bottom, the commonest fault in a tired or weak hip, and the squat has become a loaded compression exercise. The squat did not change; the hip did.
So the question to ask of any exercise is not whether it is on a list. It is where the thigh goes, and how hard the hip is working while it is there. Why crossing your legs makes it worse applies the same test to seats, which matters more over a day than any exercise does.
Are clamshells and side lying leg raises bad for it?
Leave them out while this is the problem you have. Nobody has tested either one in a trial, so that is not a finding of harm, and here is what the sources that do exist say.
The Cambridge University Hospitals leaflet is the most direct: people doing floor-based Pilates are told to leave clamshells and side-lying leg lifts out, because they increase compression and friction at the bony point.
The two randomized trials conducted in this condition did not use either exercise. The LEAP program was built from static abduction in lying and standing, bridging progressions, squatting progressions, sidestepping and band side slides (Mellor and colleagues, 2016). The hormone therapy trial's exercise program used standing abductor work, squats, sit to stand, step ups and calf raises (Ganderton and colleagues, 2016). Neither protocol contains a clamshell, and the LEAP team wrote afterwards that their participants had been advised to avoid or minimize side lying clam type exercises along with the hip adducted stretches (Grimaldi and colleagues, 2025). That is not the same as evidence of harm, because nobody has tested it, but it is more than an absence: the one program with trial results behind it deliberately left it out.
So our own program leaves the clamshell out of all three of its stages. A pillow between the knees is the version people ask about, and it answers half of what the sources object to. It keeps the thigh out of the squeezed position. What it does not touch is the bony point rotating under the band of tissue that crosses it, and that friction is the other thing those same sources name. Two documents say leave it out and nothing says put it in, so it is out.
Nothing is lost by dropping it. The isometric clamshell gives you the same muscles with the leg going nowhere, and standing hip abduction, side stepping and the band versions of both are what the trial programs actually used. If a physio who has examined your hip puts a clamshell back in later, once the hip is settled, follow them rather than this page. If you have had surgery on that hip, do not start any of those alternatives on the strength of this page either: active hip abduction is the movement most published protocols rule out after a repair of these tendons (Anwunah and colleagues, 2026), so the go-ahead comes from your own team, and what if you have had a hip operation sets out the rest.
Should you stretch, foam roll or massage the outside of the hip?
On stretching, every source on this page points the same way, which does not happen often.
The Cambridge University Hospitals leaflet advises against gluteal stretches, strong lumbar rotation stretches and iliotibial band stretches, and states that stretching increases compression over the bony point. The LEAP trial program deliberately contained no hip stretches, and the trial team explained that the commonly prescribed techniques may place high compressive load on the tendons (Mellor and colleagues, 2016). The instinct to loosen off a tight-feeling outer hip is understandable, and it works against you.
Foam rolling and deep massage over the bony point are the same problem by a different route: they add external pressure to tissue that is already being compressed from inside. The Cambridge leaflet asks people to leave the area alone while symptoms are settling. No trial has tested whether one session does damage, but the mechanism runs the wrong way and the minutes are better spent on strength.
There are two exceptions. If your sore spot is the outside of the knee and not the hip, IT band syndrome is the condition and the advice differs. And if your physio has a specific reason to use a stretch on you, they have seen your hip and this page has not.
What about squats, lunges, running and the gym?
Turn them down rather than drop them, and be suspicious of anyone who bans them without showing their reasoning.
Lists of forbidden exercises for this condition circulate, and running, jumping and loaded squats are the items usually on them. Nothing we have read in this condition, trial or guideline, says to stop any of them, and the better-evidenced material says the opposite. The 2022 ISHA physiotherapy agreement has strengthening progressed from submaximal isometrics through to heavy load and eccentric exercise, based on what the patient tolerates (Disantis and colleagues, 2023), and the 2025 gluteal tendinopathy masterclass argues directly against the protect-and-settle model in favor of education, load management and progressive exercise (Grimaldi, Ganderton and Nasser, 2025). Heavy work is part of the plan, not the enemy of it.
The bigger risk on this page is the opposite one. Plenty of people arrive here having stopped everything, because every exercise they tried hurt and nobody told them which setting to change. Stopping removes the one treatment with trial evidence behind it, and it leaves the tendon less able to cope with an ordinary week. Gym and lifting covers the wider training picture.
Three groups have a check to make first, and it comes before anything in the list below.
If you have had a hip or knee replacement, or other hip surgery
If you have had a hip replacement, get the go-ahead from your surgeon or physio before you try these exercises. Some operations limit this kind of work for the first months, so the timing depends on your surgery. After a hip operation the movements you have to keep away from are often different ones from the list at the top of this page, and they come from your surgeon rather than from the tendon, so read what if you have had a hip operation before you use anything here. If you have had a knee replacement, get the go-ahead from your surgeon or physio before the squats, step ups and step downs.
If you have had a hip or knee replacement, get the go-ahead from your surgeon or physio before you try jumping or hopping. Many surgeons advise against jumping and hopping after a joint replacement for good, not just for the first months, because each landing sends high impact through the new joint. The same applies to running: if you have had a hip or knee replacement, get the go-ahead from your surgeon or physio before you try running. Many surgeons advise against running and jogging after a joint replacement for good, not just for the first months, because each step sends impact through the new joint.
If you are pregnant
If you are pregnant, check with your midwife or physio before you start, and once you are past the first three months check with your physio before the bridges, which are done lying flat on your back.
If you have fallen in the past year, or have osteoporosis
If you have osteoporosis or have had a fall in the past year, ask your physio before you do any jumping or hopping.
If you have fallen in the past year, feel unsteady on your feet, or take medicines that make you dizzy, keep a hand on a kitchen counter or the back of a sturdy chair for the whole of the standing exercises, practice only when someone else is at home, and ask your doctor or physio about a falls check. If you live alone, that rule still stands, so plan around it rather than ignoring it. Do the exercises that ask for someone to be at home at your physio appointments or in a class instead, keep to the seated and supported work when you are on your own, and ask your physio which of the standing exercises you may do alone. Keep your phone in a pocket rather than in another room, so you can reach it from the floor, and ask about an alarm you wear.
If you do fall and cannot get up, or you think you may have hurt your head, neck, back or hip, stay where you are, keep warm and call emergency services, or get someone to call for you. Do not let anyone haul you up first.
What to change, by exercise
- Squats. Keep the knees apart and tracking over the toes, and go only as deep as you can hold that. The squat is in the program for this condition, not excluded from it.
- Lunges. Shorten the step and keep the moving foot in its own lane. A lunge that crosses the midline has turned into a compression exercise.
- Running. No trial and no guideline in this condition tells runners to stop. What to change is the camber, the same direction round a track, and a sudden jump in distance or hills. If the hip is clearly worse the morning after a run, the run was too long rather than forbidden.
- Jumping and hopping. These are high, fast loads and few people need them for daily life, so they sit late in a program if they come in at all.
- Cycling. A saddle set too high makes the pelvis rock from side to side with every pedal stroke, which takes each hip toward the compressed position in turn. That is reasoning from the mechanism, not a tested finding, and it is a cheap thing to check.
- Yoga and Pilates. The poses that take one leg across the body, and the floor clamshells and side leg lifts, are the ones to sit out. Tell the teacher instead of improvising.
- The side plank, which comes up in the hip literature and is a heavier piece of work than it looks. Holding your hips up also works the muscles at the side of the bottom hip, much like a side leg lift. Getting into it means lying on the sore side first, which is the position this hip dislikes most, so if it objects before you have lifted anything, that is the exercise telling you it is too early. If you have had a hip replacement or other hip surgery, get the go-ahead from your surgeon or physio before you try the side plank. Some operations limit this kind of work for the first months, so the timing depends on your surgery. The technique belongs on its own page rather than here.
What if you have had a hip operation?
If you have not had an operation on that hip, none of this section is for you, and the page picks up again at how do you know an exercise was too much.
Two different sets of instructions can land on the same hip, and they are not the same kind of rule.
Everything above this point is a tendon rule. It comes from what compression does to a sore tendon, and when you get one wrong the hip is sorer the next morning. If you have had an operation on that hip you also have surgeon's rules, and those come from what the operation did to the bone, the joint capsule or a repaired tendon.
Getting one of those wrong can mean a dislocation, a break in the bone around the metal, or a repair that pulls away. The two lists are not interchangeable and they do not carry the same price. Your surgical team's instructions come first, and where they differ from anything here, follow them.
The staged greater trochanteric pain syndrome program this page points to is written for outer hip pain that is being managed without surgery, and it says so on the page. If you have had an operation on your hip, follow the program your surgical team and physio gave you instead of that one. The alternatives named further up, the isometric clamshell, standing hip abduction, side stepping, the squat and the side plank, each carry their own check-with-your-surgeon line on their exercise page, and that go-ahead has to come from your team rather than from here.
After a hip replacement or a hip resurfacing
The movements you have to keep away from are set by your surgeon and by the way the hip was opened, not by the tendon. Precautions after a replacement put in through the back of the hip have traditionally limited bending the hip past a right angle, taking the leg across the midline of the body, and turning the leg inward. An approach from the front is often restricted the other way, away from taking the leg backward with the foot turned out.
Units differ now on whether they give precautions at all, because one systematic review of 6,900 patients found no difference in dislocation rates between people given them and people not, and a later review of 8,835 patients found no effect on early recovery either (Crompton and colleagues, 2020; Korfitsen and colleagues, 2023). That is the reason no web page can give you your own limits. Ask your team which movements, how far, and until when.
If you do not know which approach was used, the leaflet you came home with, your discharge letter and the ward that looked after you can all tell you, and the scar on its own cannot, because a scar on the side of the hip can belong to more than one approach. Until somebody tells you, use the stricter version: nothing that takes the leg across the midline, no bending that hip past a right angle, no turning the leg inward, no twisting on that leg, and none of the jumping, hopping, running or side plank work on this page. None of those is a problem after a front approach either, so it is the safe default while you are waiting to be told, and it is not a substitute for being told.
Notice what the rule on this page does not cover. The thigh crossing the body is on both lists, so following this page keeps you on the right side of that one. The deep bend is not on this page at all, so following this page tells you nothing about how low you may sit, how far down you may squat, or how much weight you may put through that leg. Nor does the stricter set above cover the other direction, the leg taken back behind you with the foot turned out, which is the one a front or a side approach may restrict. The lunge on this page is that movement for the trailing leg, so leave lunges out until your team has said the leg may travel back, whichever approach you had. A side approach also lifts the front of the abductors off the bone at the top of the thigh and stitches them back onto it, so the loaded work for the side of the hip waits for the same go-ahead.
After a fixed hip fracture
How much weight you may put through the leg, and the date that changes, comes from your surgeon and from the kind of fixation used. Nothing on this page sets it. The exercises that stand you on one leg, including the side plank, wait for your team to say so.
The same goes for a fall after that operation. If your hip, groin or thigh is newly painful, bruised or swollen after a fall or a knock, even a small one, and even if you can still walk, stop the exercises, go back to your crutches or frame, keep your full weight off that leg and contact your surgical team the same day. A break in the bone around metalwork or around a new joint usually follows a low-energy knock rather than a heavy one, and it is easy to miss while you are still getting about on it (Williams and colleagues, 2024). At the top of the thigh bone, which is the bony point this page is about, that kind of crack is sometimes treated without another operation, so it is worth catching early.
After a hip arthroscopy
The limits usually sit on range of movement and on resisted work, and they move on the dates in your surgeon's protocol rather than on how the hip feels that week. So your protocol decides when anything on this page starts, including the holds, and if you were not given one in writing, ask for it before you add load.
After a repair of the gluteal tendons
This is the operation sometimes offered for this condition when nothing else has worked, and it turns the advice on this page around. The alternatives we suggest instead of the clamshell are the exercises most likely to be out of bounds, because standing hip abduction, side stepping and the side plank are all active hip abduction. A 2026 review of 54 published American rehabilitation protocols for this operation found 91 percent advised against active abduction and 78 percent against taking the leg passively across the midline, 77 percent asked for toe-touch or similar protected weight bearing, and the median length of that weight bearing restriction was 6 weeks, with protocols ranging from 2 to 8 weeks (Anwunah and colleagues, 2026).
The same review found wide variation between surgeons in nearly everything else, including bracing and the return to sport, so the dates come from your own protocol and not from an average. One published protocol does set out a full staged version for this operation, and it was written because the rehabilitation detail in the surgical papers was thin (Ebert and colleagues, 2022). Until your own protocol reaches them, the holds are the work.
Did the outer hip pain start after the operation?
Then this page is probably not your answer, and the route is a review rather than a program. Outer hip pain that begins after a hip operation, rather than carrying on from before it, has causes that loading does not fix: the approach used to reach the hip can damage the muscles at the side of the hip, their tendons or the nerve that drives them, the bony point itself can be broken or pulled off, and a leg or an offset rebuilt longer or shorter than it was changes how the side of the hip is loaded (Krüger and Heller, 2023). Pain over the bony point after a hip replacement is a recognized problem in its own right, and the old explanation that it is simply an inflamed bursa has not held up (Abdulkarim and colleagues, 2018). Loosening and infection also begin as pain. So ask your surgical team for a review, and tell them when the pain started in relation to the operation, because that is the most useful single thing you can give them.
Weakness is the part not to work around. A hip that gives way, a limp that is new, or a pelvis you cannot hold level when you stand on that leg can mean the muscles at the side of the hip are not attached or not firing, and abductors that are not working are one of the reasons a replaced hip dislocates more than once (Elbuluk and colleagues, 2020). Strengthening is still the basis of treatment for this, but only once somebody has established why the muscle is not working, which takes an examination and usually a scan.
How do you know an exercise was too much?
Tomorrow morning, not this afternoon.
A tired, working ache through the buttock and thigh muscles while you exercise, gone by breakfast, is what you are aiming for. Sharper pain over the bony point during the set is the signal to make that exercise smaller or easier straight away. A hip that is clearly sorer the next day, or that woke you in the night, means the total was too much for where you are now.
The trial program used the same test. No increase in pain over the bony point was accepted during the functional exercises, and the heavier strengthening tolerated some discomfort only if it eased afterwards and was no worse that night or the next morning (Mellor and colleagues, 2016). The parent program carries the effort guidance and the staging. The numbers on each exercise page are general starting points for any condition and several are higher than this program uses, so take the lower figure and build the repetitions before you add a second set. Your physio will adjust this.
When it has been too much, the answer is one step back rather than a stop. Outer hip pain flare ups sets out how to scale the program down for a few days without losing the thread, and the same next-morning check is how physios judge load across every condition on this site, as the knee arthritis version of this page does for the knee.
When to see a physio or doctor
Book a routine appointment with a doctor or physio if outer hip pain is stopping you sleeping or doing what you normally do, if it keeps coming back, or if it has not improved after 2 weeks of looking after it at home (NHS). Go sooner if every exercise you try hurts, because that usually means the starting level is wrong, not that the exercise is wrong for you.
A physio can watch you squat, stand on one leg and walk. That is where the compression shows up, and they can then set the load so the hip is no worse the following morning. If you have been doing a program properly for 6 to 8 weeks with no change, ask for the diagnosis and the plan to be reviewed, and whether a scan would change anything explains what imaging does and does not settle. Outer hip pain covers the wider list of causes if you are not certain this is what you have.
Some signs need help faster, from an emergency visit to a doctor within a few days. They are listed under the warning signs below, each with its own timing. Several of them apply only to a hip that has been operated on, and each of those says so in its first words.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
- Emergency: you have had a hip replacement and have sudden severe pain in your hip or groin, sometimes with a clunk or pop, and you cannot move the leg or put weight on it, or the leg suddenly looks shorter or turned in or out. Do not try to walk on it or push it back into place. Keep still and call emergency services or go to an emergency department, and do not drive yourself. Your new hip may have come out of its socket (dislocated), and a medical team needs to put it back.
- Emergency: your operated leg looks shorter than it did, or its foot turns in or out more than before, or the hip moves in an unusual way, even if the pain is not severe. Keep your weight off it and go to an emergency department straight away, and do not drive yourself. If you are in severe pain or cannot move the leg, call emergency services.
- Emergency: since your operation, you suddenly become short of breath, you get chest pain or pain in your upper back that may be worse when you breathe in, you cough up blood, your heart is beating very fast, or you faint. Call emergency services straight away, even if your leg looks normal. These can be signs of a blood clot in the lungs (pulmonary embolism).
Get help today
- Same day: the hip is hot and swollen, the skin around it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- Same day: a child or teenager has sudden pain in the hip, thigh or knee, is limping, or cannot put weight on one leg. Get an urgent appointment with a doctor the same day. If they have a high temperature or seem very unwell, go to an emergency department. This page is for adults, and hip pain in children has different causes.
- Same day: at any time after your operation, even years later, new pain in your new hip along with a high temperature or feeling hot, cold or shivery, or a hip that becomes hot, red or swollen, which counts on its own, with or without pain and with or without a temperature. Contact your surgical team or get medical advice the same day. A new joint can become infected long after the operation, and that needs treating quickly. A normal temperature is not an all clear: OrthoInfo says fever is no longer considered a sign of an infection after a joint replacement, that the signs can be as little as mild redness and swelling and sometimes there are none at all, and that increased pain or stiffness in a joint that had been working well is one of them. So do not wait for a temperature before you report new or increasing pain in your new hip to your surgical team.
- Same day: you have had a hip replacement and your hip clunks and feels as if it partly slipped out of place and went back, even if it settles straight away and your leg looks normal. Stop the exercises, avoid the movement that brought it on, go back to your crutches or frame, and keep away from deep bending, crossing your legs and twisting on that leg until you have been seen. Contact your surgical team or get medical advice the same day. If the leg then looks shorter or turned, or you cannot move it or put weight on it, call emergency services.
- Same day: you have had a hip replacement and, after a fall or a knock, even a small one, your hip, groin or thigh is newly painful, bruised or swollen, even if you can still walk and your leg looks normal. Stop the exercises, go back to your crutches or frame and keep your full weight off that leg, and contact your surgical team or get medical advice the same day. A break in the bone around a new hip is not always obvious at first, and walking normally on one can move the broken ends apart.
- Same day: you have a hip resurfacing, a fixed hip fracture, metalwork in the hip or a repair of these tendons and, after a fall or a knock, even a small one, your hip, groin or thigh is newly painful, bruised or swollen, even if you can still walk and even if nobody has told you that you have thin bones. Stop the exercises, go back to your crutches or frame, keep your full weight off that leg, and contact your surgical team or get medical advice the same day, and ask whether an X-ray is needed. A break in the bone around metalwork usually follows a low-energy knock rather than a heavy one (Williams and colleagues, 2024), and a crack at the bony point you can feel on the side of the hip is easy to miss while you are still getting about on it.
- Same day: since an operation, the wound is red, hot, swollen, leaking fluid or opening up, you have a fever or feel hot and shivery, or the pain in that area is new or getting worse quickly. Contact your surgical team or the ward you went home from the same day rather than waiting for your physio appointment, and if you cannot reach them, go to an emergency department the same day. This can be an infection in the wound or deeper, around a repair or a new joint.
- Same day: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. See your doctor within a few days.
- Within a few days: new pain in the groin or buttock, and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
- Within 2 weeks: pain that spreads down the leg below the knee, especially with numbness or tingling in the leg or foot. The pain may be coming from your lower back rather than the hip tendons. Book an appointment with a doctor or physio.
- Within 2 weeks: the pain is mostly in the groin rather than on the outside of the hip, or the hip is stiff and hard to bend, for example when you put on socks. This points more toward the hip joint itself, such as hip osteoarthritis. Book an appointment with a doctor or physio so the cause can be checked.
- Routine: pain in your new hip that had settled and has come back, or pain that is getting worse month by month, for example in the groin or thigh when you first stand up and start to walk. This is not an emergency, but ask your surgical team for a review, as the parts of a new joint can loosen or wear over the years. Get medical advice the same day instead, not a routine appointment, if the hip also becomes hot, red or swollen, or you have a high temperature or feel hot, cold or shivery, or the pain is building week by week rather than month by month. A new joint can become infected years after the operation, and the two can feel similar at first.
Common questions
What exercises should I avoid with gluteal tendinopathy?
Start with the rule rather than a list. Anything that holds or drags the thigh across the midline of your body while the hip is loaded is the thing to drop or change, because that is the position that compresses the tendons against the bony point, and compression plus hard pulling is thought to be what these tendons tolerate worst (Grimaldi and colleagues, 2015). In practice that rules out the outer hip and buttock stretches, pressing or rolling over the bony point, the hip adduction machine, lunges that cross over your own standing foot, and standing with your weight hung on one hip. The rest is a question of how much, not whether.
Are clamshells bad for gluteal tendinopathy?
Leave them out while this is your problem. That is where the published sources point, and no trial has tested one either way. The Cambridge University Hospitals leaflet tells people doing floor Pilates to leave clamshells and side-lying leg lifts out, on the grounds that they increase compression and friction at the bony point. Neither of the two randomized trial programs run in this condition contained a clamshell: the LEAP program used static abduction, bridging, squatting and sidestepping progressions (Mellor and colleagues, 2016), and the hormone therapy trial's exercise program used standing abductor work, squats, sit to stand, step ups and calf raises (Ganderton and colleagues, 2016). The LEAP team wrote later that their participants had been advised to avoid or minimize side lying clam type exercises (Grimaldi and colleagues, 2025). Our own program leaves the clamshell out of all three stages for those reasons, and uses the isometric clamshell, which holds still, then standing hip abduction and side stepping, which is what the trials used.
Should I stretch my glutes or my IT band?
Not while the hip is irritable, and this is the one point every source agrees on. Those stretches pull the thigh across the body and hold the tendon in the compressed position. The Cambridge University Hospitals leaflet advises against gluteal stretches, strong lumbar rotation stretches and iliotibial band stretches, and says plainly that stretching increases compression over the bony point. The LEAP trial team left hip stretches out of their program for the same reason, stating that the commonly prescribed techniques may place high compressive load on the tendons (Mellor and colleagues, 2016). A stretch that feels good at the time and leaves the hip sorer that night is not helping.
Is foam rolling the side of my hip bad?
Rolling or digging directly over the bony point presses on tissue that is already compressed, so it is not the place to work. The Cambridge leaflet asks people to leave the area alone while symptoms settle. No trial tells you that one session of rolling causes harm, but the mechanism runs the wrong way and the time is better spent on loading. If your sore spot is the outer knee and not the hip, that is a different condition with different advice.
Can I still run, or do squats and lunges?
Probably, and the lists that say otherwise do not show their working. No trial or guideline in this condition tells people to stop running, squatting or lunging, and the better evidenced sources go the other way: the 2022 ISHA physiotherapy agreement has strengthening progressed from submaximal isometrics through to heavy load and eccentric exercises based on what the patient tolerates (Disantis and colleagues, 2023), and the 2025 masterclass argues for progressive exercise, not protection (Grimaldi, Ganderton and Nasser, 2025). The question is not whether but how much, how deep, how often, and what the hip is like the next morning. Running on a camber or always round the same way on a track is worth changing, because it tips the pelvis the same way every stride.
Can I exercise at all with gluteal tendinopathy?
Yes, and you need to. Loading is the treatment with the best evidence behind it: in the LEAP trial, education plus exercise beat a steroid injection and beat waiting at 8 weeks, and still had better overall improvement than the injection a year later (Mellor and colleagues, 2018), and a 2024 review of 6 trials in 733 people recommends exercise as the first treatment for this condition (Kjeldsen and colleagues, 2024). If you have already stopped exercising because everything hurt, you are a bigger risk to yourself than the person still doing clamshells. Start with the holds and build from there.
I have had a hip replacement. Do these exercises to avoid apply to me?
Not as your main list, no. After a hip operation you have two sets of rules on one hip, and the surgeon's set comes first. The movements restricted after a replacement are set by your surgeon and by the way the hip was opened: after an approach through the back of the hip they have traditionally been bending the hip past a right angle, taking the leg across the midline and turning the leg inward, and after an approach from the front they often run the other way. Units differ on whether precautions are given at all, because systematic reviews found no difference in dislocation rates or early recovery with or without them (Crompton and colleagues, 2020; Korfitsen and colleagues, 2023), which is exactly why your own limits have to come from your team. The compression rule on this page does not mention the deep bend or how much weight you may put through the leg, so following it tells you nothing about either. If your outer hip pain started after the operation rather than before it, ask your surgical team for a review instead of starting a program.
How do I know an exercise was too much for my hip?
The next morning tells you. A tired, working ache in the buttock and thigh muscles that has gone by breakfast is normal. Sharper pain over the bony point during the exercise means make it smaller or easier now. A hip that is clearly sorer the next day, or that woke you that night, means the amount was too much for today, so do less tomorrow rather than nothing. In the LEAP program no increase in pain over the bony point was accepted during the functional exercises, and the heavier strengthening tolerated some discomfort only if it settled afterwards and was no worse that night or the next morning (Mellor and colleagues, 2016). The parent program carries the full effort and pain guidance.
References
- Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine. 2015;45(8):1107-1119. https://doi.org/10.1007/s40279-015-0336-5
- Grimaldi A, Nasser A, Mellor R, Vicenzino B. An examination of imaging findings in patients with clinically diagnosed gluteal tendinopathy: a secondary analysis of a randomised clinical trial. Archives of Orthopaedic and Trauma Surgery. 2025;145(1):347. https://doi.org/10.1007/s00402-025-05964-z
- Mellor R, Grimaldi A, Wajswelner H, Hodges P, Abbott JH, Bennell K, Vicenzino B. Exercise and load modification versus corticosteroid injection versus 'wait and see' for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskeletal Disorders. 2016;17:196. https://doi.org/10.1186/s12891-016-1043-6
- Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. https://doi.org/10.1136/bmj.k1662
- Ganderton C, Semciw A, Cook J, Pizzari T. Does menopausal hormone therapy (MHT), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial. BMC Women's Health. 2016;16:32. https://doi.org/10.1186/s12905-016-0311-9
- Disantis A, Andrade AJ, Baillou A, et al. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. Journal of Hip Preservation Surgery. 2023;10(1):48-56. https://doi.org/10.1093/jhps/hnac050
- Grimaldi A, Ganderton C, Nasser A. Gluteal tendinopathy masterclass: Refuting the myths and engaging with the evidence. Musculoskeletal Science and Practice. 2025;76:103253. https://doi.org/10.1016/j.msksp.2025.103253
- Kjeldsen T, Hvidt KJ, Bohn MB, Mygind-Klavsen B, Lind M, Semciw AI, Mechlenburg I. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy. 2024;123:69-80. https://doi.org/10.1016/j.physio.2024.01.001
- Anwunah C, Rosenberg S, Hartwell M. Variability in United States online rehabilitation protocols after open and endoscopic hip abductor repair. Archives of Orthopaedic and Trauma Surgery. 2026;146(1):278. https://doi.org/10.1007/s00402-026-06451-9
- Ebert JR, Fearon AM, Smith PN, Janes GC. Recommendations in the rehabilitation of patients undergoing hip abductor tendon repair: a systematic literature search and evidence based rehabilitation protocol. Archives of Orthopaedic and Trauma Surgery. 2022;142(11):3165-3182. https://doi.org/10.1007/s00402-021-03952-7
- Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthopaedica. 2020;91(6):687-692. https://doi.org/10.1080/17453674.2020.1795598
- Korfitsen CB, Mikkelsen LR, Mikkelsen ML, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthopaedica. 2023;94:141-151. https://doi.org/10.2340/17453674.2023.11958
- Krüger DR, Heller KD. Hip abductor deficiency after total hip arthroplasty: diagnostic and therapeutic methods. Zeitschrift für Orthopädie und Unfallchirurgie. 2023;161(1):65-73. https://doi.org/10.1055/a-1488-7005
- Elbuluk AM, Coxe FR, Schimizzi GV, Ranawat AS, Bostrom MP, Sierra RJ, Sculco PK. Abductor deficiency-induced recurrent instability after total hip arthroplasty. JBJS Reviews. 2020;8(1):e0164. https://doi.org/10.2106/JBJS.RVW.18.00164
- Abdulkarim A, Keegan C, Bajwa R, Sheehan E. Lateral trochanteric pain following total hip arthroplasty: radiographic assessment of altered biomechanics as a potential aetiology. Irish Journal of Medical Science. 2018;187(3):663-668. https://doi.org/10.1007/s11845-017-1701-1
- Williams JA, Khawar H, Middleton R. Periprosthetic femoral fractures. British Journal of Hospital Medicine. 2024;85(2):1-9. https://doi.org/10.12968/hmed.2023.0378
- NHS. Complications of a hip replacement. Page last reviewed 6 March 2024. https://www.nhs.uk/tests-and-treatments/hip-replacement/complications-of-a-hip-replacement/
- Cambridge University Hospitals NHS Foundation Trust. Gluteal tendinopathy. Patient information. Approved 14 January 2025. https://www.cuh.nhs.uk/patient-information/gluteal-tendinopathy/
- Kingston and Richmond NHS Foundation Trust. Greater trochanteric pain syndrome. Patient leaflet. Last updated 9 December 2024. https://www.kingstonandrichmond.nhs.uk/patients-and-families/patient-leaflets/greater-trochanteric-pain-syndrome
- NHS. Hip pain in adults. Page last reviewed 20 November 2025. https://www.nhs.uk/symptoms/hip-pain/
- Agarwala S, Jagani N. Osteotendinous suturing for anchorage of hip abductor mechanism in total hip arthroplasty through a lateral approach: a technical note. Journal of Orthopaedic Case Reports. 2018;8(2):26-29. https://pubmed.ncbi.nlm.nih.gov/30167407/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-17.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.