Gluteal tendinopathy: the tendon on the scan may not be the thing that hurts.

Outer hip pain that will not quit despite rest, rehab and injections often has a nervous-system story underneath.

This page is about understanding the condition and the role the brain and nervous system can play in it. It is not a diagnosis. Your own clinicians know your case.

What gluteal tendinopathy is

The gluteal muscles in the buttock connect the thigh bone (femur) to the pelvis. Gluteal tendinopathy describes pain where the gluteus medius and minimus tendons attach to the bony bump on the outer hip (the greater trochanter). It is common in women over 40 and in runners, and it typically hurts when lying on that side, climbing stairs, standing on one leg or sitting with crossed legs.

The word tendinopathy means 'something wrong with the tendon'. It replaced 'tendinitis' once researchers found little inflammation in most chronic tendon pain. Standard care is education, avoiding positions that compress the tendon, and a graded strengthening program. Injections sometimes give short-term relief.

The neuroplastic contribution

The ATNS Index of Neuroplastic Symptoms takes a clear position. It notes that tendinopathy is a term for pain at the junction between a muscle and its tendon's attachment to bone, and that it has not been shown to be a separate disease entity. On that basis the index says neuroplastic symptoms should be strongly considered whenever a diagnosis of tendinopathy is made.

Neuroplastic symptoms are real, physical pain produced by learned patterns in the brain and nervous system, a sensitized alarm, rather than by ongoing damage to tissue. They are not imaginary, and because the brain can change, they can be unlearned.

Why would the hip be a target? Tendon changes on scans are common in people with no pain at all. Once pain starts, the brain can learn to guard the hip, which changes how you walk, sleep and sit, which feeds more pain. Fear of 'tearing the tendon' keeps the guarding going. The tendon may have started the conversation, but the nervous system is often the one keeping it up. Our pages on central sensitization and the fear-avoidance cycle explain the loop.

What the research shows

Gluteal tendinopathy has not been studied directly for central sensitization, so the evidence is indirect but pointed.

• A 2025 secondary analysis of a randomised trial of 204 people with clinically diagnosed gluteal tendinopathy examined their MRI scans. Tendon pathology was common (tears in 42 percent), but pain, function and disability were not associated with how severe the MRI changes were. In plain terms: what the scan showed did not predict how much people hurt.
• A narrative review of chronic non-specific low back pain asked whether central sensitization there is a structural phenomenon or a psychological reaction, and concluded that features such as heightened pain perception, excessive pain sensation and depression may contribute to the development of central sensitization. The same mechanisms apply to any persistent musculoskeletal pain, including the hip.
• A cross-sectional study in shoulder surgery patients found that long pain duration and severe pain were associated with higher central sensitization scores, showing that the longer a 'tendon' problem persists, the more the nervous system tends to be involved.

The gap between imaging and pain is the key finding. It does not mean the tendon is irrelevant. It means the pain is not a readout of tendon damage, which is exactly the opening the ATNS index asks you to explore.

Signs the brain may be part of the picture

• Pain has lasted many months despite rest, rehab and injections.
• Pain is out of proportion to what imaging shows, or imaging is nearly normal.
• It has spread to the thigh, buttock, groin or the other hip.
• Pain varies with stress, sleep and mood more than with activity.
• Light touch or lying on the hip hurts far more than the pressure should.
• You have other persistent pain conditions, such as back pain, neck pain or headaches.
• You avoid walking, stairs or exercise because you fear damaging the tendon.

A solution that addresses it

For a sensitized hip, there is an approach called pain and symptom reprocessing. It pairs education about neuroplastic symptoms with somatic tracking (attending to hip sensations with curiosity, not dread), reducing fear and threat, a graded return to walking, stairs and exercise, emotional awareness and expression, and acceptance and commitment skills. Trained clinicians deliver it, often alongside physiotherapy, and digital programs increasingly do too. Pacing and hurt versus harm are two ideas at the heart of it.

Cindra is a daily AI companion built around these approaches, with daily check-ins, short practices and plain-language lessons, for people whose symptoms have a neuroplastic component. Join the waitlist if your hip has outlasted the usual answers.

What to do next

1. Have a clinician examine the hip to exclude a stress fracture, hip joint arthritis, a full tendon rupture, referred pain from the spine, or (rarely) infection or tumour.
2. Ask whether your pain pattern fits a neuroplastic picture, especially if it has lasted months and the scan does not match the pain.
3. Keep moving. A graded strengthening program remains helpful, and pairing it with neuroplastic skills makes it less frightening and more sustainable.
4. Start learning and practising daily.

Seek prompt medical attention for hip pain after a fall, inability to bear weight, fever, night pain that wakes you, or unexplained weight loss.

This article is for general education and is not medical advice, and it does not diagnose or treat any condition. Persistent symptoms deserve a proper medical assessment to rule out disease or injury before a neuroplastic explanation is considered. If your symptoms are new, changing, or come with red-flag signs such as fever, unexplained weight loss, numbness or weakness, chest pain, or loss of bladder or bowel control, see a clinician promptly.