A Pilates perspective on gluteal tendinopathy
Many active people know how to push harder. Fewer know how to modulate effort. Sometimes the work is not about doing more, but about learning how to do enough.
Over the years, I have worked with many people who have remained active well into midlife and beyond. Cyclists, singers, hikers, executives, and recreational athletes often decide to start a private Pilates practice because they want to continue doing the things they love.
As we move through different stages of life, however, our bodies occasionally begin asking different questions of us. People are often surprised when sleeping on one side becomes uncomfortable, long walks feel different, or standing on one leg becomes less effortless than it once was. Recovery after physical activity may take longer, and movements that used to feel automatic suddenly require more attention.
Many do not think of themselves as injured, and perhaps even more importantly, they do not think of themselves as old. They are often still capable of doing the things they value. Their bodies are simply asking for new strategies.
People often notice pain on the outside of the hip when sleeping on one side, climbing stairs, walking longer distances, or standing on one leg. This pain is often felt on the outside of the hip when sleeping on one side, climbing stairs, walking longer distances, or standing on one leg.This pain is often felt on the outside of the hip and may become particularly noticeable when lying on the affected side at night. One of the most common causes of this type of lateral hip pain is gluteal tendinopathy, sometimes still referred to as trochanteric bursitis or greater trochanteric pain syndrome.
What is gluteal tendinopathy?
Gluteal tendinopathy refers to changes in the tendons of the gluteus medius and gluteus minimus — two important muscles located on the outside of the hip. These muscles play an essential role in walking, standing on one leg, climbing stairs, and stabilising the pelvis during everyday activities.
Pain is typically felt around the bony prominence on the outside of the hip, called the greater trochanter. Because of its location, this condition has historically often been diagnosed as trochanteric bursitis. However, contemporary research suggests that many cases of persistent lateral hip pain involve the gluteal tendons themselves, sometimes alongside irritation of the surrounding bursa.
This is one of the reasons gluteal tendinopathy is frequently seen in women during midlife and beyond, a period in which tissue capacity, recovery, and movement habits may all be changing simultaneously. Yet it is by no means limited to this population. Active men can experience it as well.
More broadly, it often appears in people who wish to remain engaged with life: people who enjoy walking, hiking, cycling, golfing, singing, travelling, or simply remaining active in everyday life.
One of the reasons this condition can be particularly frustrating is that the symptoms often seem disproportionate to what people are otherwise able to do. Many people can still walk long distances, go to work, and continue exercising, yet sleeping on one side becomes painful, standing for long periods feels different, or recovery takes longer than it once did.
This can be confusing because people often remain highly capable while simultaneously feeling that something has changed.
Fortunately, this is rarely the whole story.
Many people assume that pain on the outside of the hip means that something is damaged, that they should stop exercising, or that this is simply part of getting older. Others continue pushing through, hoping that more stretching or more effort will eventually make the problem disappear.
In reality, gluteal tendinopathy often sits somewhere in between these two extremes.
The tendon is asking for neither complete rest nor relentless effort. More often, it is asking for a different relationship with load, recovery, and movement.
Hip pain at night: why does sleeping on your side hurt?
One of the most common complaints I hear is:
"I can still do most things, but I can no longer sleep comfortably."
Sleeping on the affected side places direct pressure on the tissues around the outside of the hip. In addition, certain positions — such as crossing the legs, standing predominantly on one hip, or allowing the knees to fall together — can increase compression around the gluteal tendons.
Interestingly, many people do not necessarily notice pain during activity itself. Instead, they notice it later: during the night, after long walks, after hiking holidays, or when trying to recover after periods of increased activity.
This delayed response can make the problem feel unpredictable and difficult to understand.
When active bodies start asking different questions
What s I find most interesting about gluteal tendinopathy is that it often affects people who are not inactive at all.
Quite the opposite.
Many of the people I work with are highly engaged with life. They sing in choirs, cycle long distances, hike, travel extensively, or continue participating in sports and activities that are meaningful to them.
Their bodies have often adapted remarkably well over many years, allowing them to continue doing all of these things. Sometimes, however, the strategies that have served them well for years benefit from becoming more varied and adaptable.
Pain is not necessarily a sign that the body has failed. More often, it may be a reminder that the body is asking us to become more attentive, develop additional movement options, and find different ways of distributing load.
Why stretching and rest are not always the answer
One rather surprising aspects of gluteal tendinopathy is that tissues that feel tight are not always asking to be stretched. As physiotherapist Dr Alison Grimaldi often points out, positions people frequently seek for relief - crossing the legs, letting the knees fall together, or aggressively stretching the outside of the hip - may actually increase compression around the irritated tendons and temporarily aggravate symptoms.
This can feel counterintuitive.
When pain appears on the outside of the hip, many people instinctively do one of two things. Some stop moving altogether. Others continue pushing through, assuming that more stretching, more exercise, or simply "working harder" will eventually solve the problem.
Unfortunately, neither approach is always helpful.
Contemporary understanding of gluteal tendinopathy suggests that tendons generally respond best to what some clinicians call a Goldilocks approach: not too much and not too little, but just the right amount of challenge.
Complete rest can gradually reduce the tendon's capacity. At the same time, continuing to load an already irritated tendon without making any adjustments can keep symptoms going for longer.
What often proves more helpful is learning how to gradually improve the tendon's capacity while finding different ways of organising movement and distributing load. Sometimes the body is not asking us to do less. It is asking us to do things differently.
One of the things I frequently discuss with clients is that the goal is rarely to stop moving. Instead, it is to become more curious about how we are moving and how much load our bodies are currently prepared to tolerate.
For some people, this means temporarily modifying certain positions or activities. For others, it means gradually rebuilding confidence and capacity through carefully chosen movement challenges.
In many ways, rehabilitation becomes less about avoiding movement and more about developing additional movement options and learning new ways of distributing effort throughout the body.
Why private Pilates can help with gluteal tendinopathy and hip pain
One of the reasons I find private Pilates at Pilates Incorporated in Amsterdam West so valuable for people living with gluteal tendinopathy and persistent hip pain is that it allows us to work with much more than the painful area itself.
The exercises, equipment, and individual attention allow us to gradually explore how the whole body organises movement and responds to load.
Rather than focusing only on the tendon, we can look at questions such as:
How do you stand?
How do you shift your weight from one leg to another?
How do you climb stairs?
How do you recover after long walks or periods of sitting?
How do you organise yourself during activities that matter to you, whether that is hiking, cycling, singing, travelling, or simply sleeping comfortably through the night?
Because every person presents differently, the work often becomes highly individual.
Some people need to calm things down first. Others need to gradually rebuild confidence and strength. Some need to learn how to modulate effort rather than push harder, while others benefit from developing additional movement options and greater variability.
Private Pilates provides a particularly useful environment for this kind of work.
Working across the Reformer, Cadillac, Wunda Chair and other classical Pilates apparatus gives us access to spring resistance, different forms of support, and the possibility of gradually increasing or decreasing load. This allows us to move between supported and more demanding positions and challenge the body without overwhelming it.
Just as importantly, it gives us time to pay attention.
Over time, many clients develop a kind of movement vocabulary. A cue, an image, or a particular sensation can quickly help them find a different strategy without having to start from the beginning each time.
Many active people know how to push harder. Fewer know how to modulate effort. Sometimes the work is not about doing more, but about learning how to do enough.
One of my long-term clients, a singer and enthusiastic hiker in his sixties, often notices his symptoms most clearly at night or after periods of increased activity. He gauges how his hip is doing by how easily he can take the stairs in the Rotterdam metro, and he often notices that when his feet, breathing, and posture feel more organised, his singing feels easier as well.
Rather than preventing him from doing the things he enjoys, the pain has gradually become a reminder that his body benefits from preparation, recovery, and greater movement variety.
Over the years, our work has become less about trying to "fix" his hip and more about understanding how his body responds, preparing for the demands he places on it, and developing strategies that allow him to continue doing the things he enjoys.
Like the rest of our bodies, tendons are remarkably adaptable. Improvements often come not from dramatic interventions but from small, consistent changes in movement habits, recovery, and the gradual rebuilding of capacity.
Fortunately, gluteal tendinopathy is also a condition that tends to respond well to thoughtful and consistent rehabilitation. Improvements often come not from dramatic interventions but from small, consistent changes in movement habits, recovery, and the gradual rebuilding of capacity.
This understanding often becomes just as important as the exercises themselves.
We are not simply practising exercises.
We are practising sleeping more comfortably, walking with greater ease, standing for long choir rehearsals, preparing for hiking holidays, recovering after long cycling trips, and continuing to do the activities that make life meaningful.
Tendinopathy itself is not the teacher. Our bodies are.
Our bodies adapt remarkably well, often for many years, until they begin asking different questions of us. Pain can sometimes become an invitation to pay closer attention, develop new skills, and discover additional ways of moving through life.
Looking after our bodies becomes less about discipline and more about habit. Much like brushing our teeth, it simply becomes part of life.
The goal is not to return to a previous version of ourselves.
The goal is to continue trusting our bodies and feel confident that we can keep doing the things that matter to us.
From hip pain back to the things you love
When gluteal tendinopathy or persistent lateral hip pain begins to interfere with sleep, walking, exercise, or the activities you enjoy, individual attention can make an important difference. This is why, at Pilates Incorporated in Amsterdam West, we often recommend beginning with private Pilates rather than relying entirely on small group Pilates classes.
Private sessions give us the time to understand what is provoking your symptoms, what you need and want your body to be able to do, and which strategies help you manage load and continue moving with greater confidence. Using the possibilities of the Pilates method and classical apparatus, we can develop a practice that responds to the individual rather than simply to the diagnosis.
The aim is not to spend your life rehabilitating a hip. It is to develop the skills, strength, and understanding that allow you to return to—and keep doing—the things that matter to you. Ultimately, the purpose of the practice is to improve the life of the person who comes to it.
