Address safety, settle excessive irritability and maintain useful movement.
What to do
Reduce compressive positions and excessive adduction
Modify running/stair load
Begin tolerable isometric abductor loading
Exercise dosage
Abduction isometric: 4–5 x 20–30 seconds
Avoid prolonged hip-crossed sitting if it provokes symptoms
Progress when
Daily function is stable or improving.
No new red flags or progressive neurological deficit.
Exercise response returns to baseline by the following day.
Phase 2 — Mobility, Strength & Capacity
Restore the specific strength, mobility and control required by the condition.
What to do
Progress isotonic hip abductor strengthening
Add pelvic control and single-leg functional work
Increase walking and stair tolerance
Exercise dosage
Side-step or standing abduction: 3 x 8–15
Single-leg control: 2–3 x 6–10
Progress when
Target movement and resistance are tolerated with good quality.
Functional capacity is improving without sustained symptom flare.
Progression is based on objective performance and patient goals.
Phase 3 — Functional Restoration & Return to Activity
Rebuild real-world, occupational or sporting capacity.
What to do
Progress heavier, faster and multiplanar loading
Graded return to running/hills/sport
Maintain strength two or more times weekly
Exercise dosage
Heavy resistance: 3–4 x 6–10, 2–3 days/week
Running progression with planned recovery days
Progress when
Condition-specific return criteria are met.
Full task exposure is completed progressively.
No clinically meaningful deterioration during the following 24 hours.
Manual Therapy — Role & Application
Manual therapy only for relevant coexisting impairments; avoid painful direct compression.
Education and progressive loading have stronger rationale than passive tissue techniques.
Modalities — Use / Avoid
Positioning and temporary load modification are useful.
Injection decisions belong to medical shared decision-making; repeated injections may not support long-term tendon capacity.
Return / Discharge Criteria
Single-leg loading without marked pain
Walking, stairs and side-lying manageable
Strength and running tolerance restored progressively
Common Clinical Mistakes
Aggressive adduction stretching
Treating only the bursa
No progressive strength plan
Using pain-free palpation as the only discharge measure
Clinical Pearls
The LEAP trial supports education plus exercise for gluteal tendinopathy.
Manage tendon compression as well as tensile load.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
