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The VerdictHIGH CONVICTIONVerdict Score 79

Your hip tendons are being crushed by your own habits — and stretching makes it worse.

Tonight, try this: stand near a wall for balance, then stand on one leg for 30 seconds. If it reproduces your outer hip pain, that's your diagnostic clue. Then stop crossing your legs — starting right now.

  1. Here's what's really happening: it's not bursitis — the tendons on the outside of your hip are wearing down from being compressed against the bone, especially in women over 40 where hormonal changes slow tendon repair.
  2. The myth that won't die: stretching your IT band or glutes makes this worse, not better — it crushes the damaged tendon harder against the bone, which is the exact problem.
  3. Start here: wall pushes — stand sideways to a wall, push your knee outward into it, hold 45 seconds, repeat 5 times, 2-3 times a day. 79% of people recover fully with this approach.

Picture a rope draped over a sharp fence post. Every time you pull the rope sideways, it grinds against the post and frays a little more. That's what's happening to your hip tendons every time you cross your legs, stretch your IT band, or sleep on that side without a pillow between your knees. The fix isn't to rest the rope — it's to stop pulling it sideways and gradually make it thicker and stronger so the grinding can't damage it.

SH
Dr. Seth Holbrook, DPT — Doctor of Physical Therapy • Coach to 300+ clients
I built The Verdict to cut through recycled health advice and show what the evidence actually supports.

Gluteal Tendinopathy in Women

Hip — Evidence-Based Protocol

Conviction: HIGH

Tonight, try this: stand on one leg for 30 seconds. If it reproduces your outer hip pain, that's your answer. Then stop crossing your legs — starting now.

The 30-second single-leg stance test has up to 100% specificity for this condition — if it reproduces your lateral hip pain, the diagnosis is near-certain.

Takes 30 seconds. No equipment needed.

The Verdict

Your hip tendons are being crushed by your own habits — and stretching makes it worse.

Picture a rope draped over a sharp fence post. Every time you pull the rope sideways, it grinds against the post and frays a little more. That's what's happening to your hip tendons every time you cross your legs, stretch your IT band, or sleep on that side without a pillow. The fix isn't to rest the rope — it's to stop pulling it sideways and gradually make it thicker so the grinding can't damage it.

  1. Here's what's really happening: it's not bursitis — the tendons on the outside of your hip are wearing down from being compressed against the bone, especially in women over 40 where hormonal changes slow tendon repair.
  2. The myth that won't die: stretching your IT band or glutes makes this worse, not better — it crushes the damaged tendon harder against the bone, which is the exact problem.
  3. Start here: wall pushes — stand sideways to a wall, push your knee outward into it, hold 45 seconds, repeat 5 times, 2-3 times a day. 79% of people recover fully with this approach.

Want the full evidence? Keep scrolling

What Works

Progressive loading rehabilitation for gluteal tendinopathy

Tier 1 — Strong Evidence

Education + Progressive Exercise (EDX) STRONG

Progressive loading in non-compressed positions + education about what to avoid. 78.6% success rate at 1 year (LEAP RCT, n=204). Beats cortisone at every time point beyond 8 weeks.

Timeline: Pain reduction in 2-4 weeks, functional improvement 6-12 weeks, full recovery 3-12 months.

See full treatment hierarchy

Tier 2 — Moderate Evidence

Focused Shockwave Therapy (f-ESWT) MODERATE

Adjunct to exercise for stubborn cases. Long-term pain relief superior to cortisone. 3-6 sessions over 3-6 weeks.

Cortisone Injection (CSI) MODERATE (short-term only)

Short-term pain relief. 58.3% success at 1 year — statistically identical to doing nothing (51.9%). Weakens collagen matrix. Use only if pain prevents any exercise.

Tier 3 — Emerging

PRP Injections EMERGING

Short-term functional improvement over cortisone, but long-term data is mixed.

HRT (postmenopausal women) EMERGING

Estrogen supports collagen synthesis — mechanistic rationale is strong but no RCT specifically for gluteal tendinopathy + HRT yet.

What Doesn't Work

  • Complete rest — triggers tendon breakdown. Your tendons need load to heal.
  • IT band / gluteal stretching — compresses the tendon harder against the bone. The most common mistake.
  • Cortisone as a standalone treatment — no better than doing nothing at 1 year. Short-term chemical pain relief, no structural healing.
  • Plyometrics in early rehab — high-impact loading before the tendon can handle it causes setbacks.

Exercise Prescription

Phase 1: Weeks 1-4 (Pain Control + Early Loading)

Wall Isometric Hip Push

5 x 45-60s holds | 2-3x daily

Stand sideways to wall, push knee outward into wall. Hold steady. Should feel effort but no sharp pain. Pain up to 3/10 is fine.

Supine Band Abduction

5 x 45-60s holds | 2-3x daily

Lie on back, knees bent, band around knees. Push both knees outward against the band and hold.

Phase 2: Weeks 4-8 (Strengthening)

Glute Bridge

3 x 12 | 3x per week

Progress from double-leg to single-leg when pain-free. RPE 7-8 on hard days, lighter on alternate days. Pain up to 5/10 acceptable.

Side-Lying Hip Abduction

3 x 10 | 3x per week

Lie on unaffected side. Lift top leg ~30cm with 3-second lower. Don't let hip roll forward. Add ankle weight when ready.

Phase 3: Weeks 8+ (Functional)

Step-Downs

3 x 10 | 2-3x per week

Stand on step, affected leg. Slowly lower other foot over 3-4 seconds. Keep pelvis level — stop if it drops. No pain increase allowed.

Critical Habit Changes (All Phases)

  • Sleep with a pillow between your knees
  • Stop crossing your legs when sitting
  • Stop all IT band and hip adduction stretches
  • Avoid standing with your hip popped out to one side

Return to Training

Red Flags — When to Get Checked Urgently

  • Unexplained weight loss, night sweats, or fevers — could indicate something more serious than a tendon problem
  • Constant deep pain that doesn't change with position — typical tendon pain eases when you change position; constant pain needs investigation
  • Can't put weight on the leg after a fall or injury — possible fracture, needs imaging urgently
  • Numbness, tingling, or weakness getting worse in the leg — nerve involvement needs assessment

If any of these apply, see your doctor this week. Don't wait.

What's Actually Going On

Gluteal tendon compression mechanism at the greater trochanter

The gluteus medius and minimus tendons wrap around the greater trochanter — the bony bump on the outside of your hip. The deep fibers of these tendons get sandwiched between the bone and the iliotibial band during any movement that brings your leg inward.

Over time, this repeated compression triggers a breakdown of the collagen fibers — the structural protein that gives tendons their strength. New blood vessels and nerve endings grow into the damaged area (which is why it hurts), and the tendon progressively loses its ability to handle load.

Why Women Are Hit Harder

Women are 3.3 times more likely to develop this condition. Three factors drive this:

This is tendon degeneration, not inflammation — which explains why anti-inflammatory approaches (cortisone, NSAIDs) provide only short-term relief while the tendon continues to deteriorate underneath.

How to Identify It

Clinical assessment of gluteal tendinopathy

What Patients Report

Key Diagnostic Tests

30-Second Single Leg Stance Sn: 38-100% | Sp: 97-100%

Stand on the affected leg for 30 seconds. Positive if it reproduces lateral hip pain. Very high specificity — a positive result is near-diagnostic.

Trochanteric Palpation Sn: 80% | Sp: 47%

Firm pressure over the posterosuperior facet of the greater trochanter. Good at catching it, less good at ruling other things out.

FADER-R (Resisted Internal Rotation) Sn: 44% | Sp: 93%

Hip flexed, adducted, externally rotated, then resist internal rotation. High specificity — if positive, it's very likely gluteal tendinopathy.

The Winning Combination (Kinsella 2024, n=272)

Positive palpation + positive resisted hip abduction = 96% post-test probability. Both negative = drops to 14%. This is the most efficient diagnostic pathway.

What to Rule Out

Hip Osteoarthritis — Deep groin pain (not lateral), restricted internal rotation, morning stiffness over 30 minutes

Lumbar Referred Pain — Follows nerve distribution patterns, positive Slump or Straight Leg Raise test, possible numbness/tingling

Proximal Hamstring Tendinopathy — Pain at the sitting bone (not the side of the hip), worse with deep squatting and prolonged sitting

The Debate

The most relevant clinical guideline (JOSPT 2015) is over 10 years old. Here's where modern research contradicts older practice.

Historical standard of care

Cortisone injection as first-line treatment

vs

LEAP Trial, BMJ 2018 (n=204)

Exercise program beats injections at every time point beyond 8 weeks. Cortisone success rate at 1 year (58%) is no different from doing nothing (52%).

Follow the LEAP protocol: exercise first. Reserve cortisone only if pain is so severe you can't exercise at all.

General practice, anecdotal

Stretch the IT band and glutes to relieve lateral hip pain

vs

OSU Guidelines 2020; JOSPT 2015

Stretching in hip adduction increases compressive load on the damaged tendons against the bone. It's the exact mechanism causing the problem.

Stop all IT band and crossed-leg stretches. This is the most common clinical error for this condition.

Historical standard

Rest the hip until pain subsides

vs

LEAP 2018; Physio Network 2025

Tendons need mechanical loading to heal. Complete rest triggers rapid breakdown of the tendon's collagen structure.

Load it to heal it. Start with isometric exercises from day one. Pain up to 5/10 during exercise is acceptable and safe.

Honest Limitations

The Dose Problem

The research: The LEAP trial used 14 supervised physical therapy sessions over 8 weeks to achieve 79% success.

The reality: Most insurance plans or NHS referrals cover 5-6 sessions. Home exercise compliance drops dramatically without supervision.

The adjustment: Front-load education. Use an exercise tracking app. Simplify to 2-3 key exercises. A hybrid digital model is being tested in Ireland.

Expectations vs Biology

The research: Full recovery takes 3-12 months as tendon collagen remodels.

The reality: Patients expect a quick fix because they've been told it's "bursitis." Postmenopausal women face slower collagen repair.

The adjustment: Set expectations at session one: "3-month minimum commitment. Improvement is gradual — first sleep, then stairs, then prolonged walking."

Form Breaks Down at Home

The research: Maintaining a level pelvis during single-leg exercises is critical to avoiding re-compression of the tendon.

The reality: Without a therapist's hands and eyes, most people compensate with trunk lean or hip drop — reintroducing the exact forces the exercises are meant to avoid.

The adjustment: Video self-monitoring with a phone propped at hip height. Mirror feedback. Regress to bilateral exercises if single-leg form breaks down.

The Nuance

Here's what the simple answer misses: over 50% of people with gluteal tendinopathy improve at 1 year with no treatment at all. The natural history of this condition is surprisingly favorable. What exercise buys you is faster recovery, fewer pain days along the way, and a structurally stronger tendon at the end.

Surgery is genuinely rare for this condition. It's reserved for confirmed full-thickness tendon tears (visible on MRI) that have failed 6+ months of supervised progressive loading with documented adherence. The vast majority of women recover without surgery.

The biggest real-world problem isn't the exercises — it's the compression habits. Crossed legs, side-sleeping without a pillow, standing with a hip pop, IT band stretches. Many patients do their exercises diligently but sabotage their recovery by compressing the tendon for 8 hours every night. The habits matter as much as the exercises.

One emerging angle: for postmenopausal women, HRT may support tendon recovery through its effect on collagen synthesis. There's no RCT specifically studying this, but the mechanistic case is strong. It's worth discussing with your doctor if you're postmenopausal and struggling with tendon issues.

What would change this protocol: a large trial (N over 300) comparing the 14-session supervised LEAP protocol against a 4-session hybrid model with digital exercise tracking, in women aged 40-65. If the hybrid model matches outcomes at 1 year, it would transform how this condition is managed in real-world healthcare.

Sources

Conviction: HIGH

Based on the LEAP RCT (BMJ 2018), 2024 JOSPT diagnostic review, and 2025 network meta-analysis.

DM me on Instagram for guidance.

Verdict Score

How strong is the evidence for the claims in this review? Higher = more confidence the claims are supported. This does not measure how large the effect is or how important it is compared with other levers.

79 Mixed evidence
80–100Strong evidence
60–79Mixed but supportive ◀
40–59Uncertain
0–39Weak support

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The Verdict is built by the same team behind Precision Metrics — a physique and health coaching practice with 300+ clients coached. Dr. Seth Holbrook, DPT and Luke Holbrook lead the coaching.

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