Etiology — what causes it

Load-related changes in the gluteus medius and minimus tendons at the greater trochanter, driven by compressive loading from hip adduction (crossed-leg sitting, hanging on one hip), training error, and reduced gluteal capacity.

Epidemiology — who gets it

Most common cause of lateral hip pain in middle-aged women — peak prevalence 40–60 years. Affects up to 1 in 4 women in this age range (Albers et al., BMJ Open).

Clinical signs

Point tenderness over the greater trochanter, positive single-leg stance test (pain at 30 seconds), pain with resisted hip abduction. Trendelenburg sign in some cases. Restricted hip extension and internal rotation often present.

Symptoms

Lateral hip pain at the greater trochanter, worse with side-lying on the affected side, prolonged standing, walking, and stairs. May refer down the lateral thigh. Night pain common.

Best evidence for chiropractic treatment

The LEAP trial (Mellor et al., BMJ 2018) showed that education plus progressive loading outperformed corticosteroid injection and 'wait-and-see' at 8 weeks, with effects sustained at 1 year. Modern management emphasizes load management (avoiding hip adduction, crossed-leg sitting), progressive gluteal loading, and pain education. Shockwave is a supported adjunct in selected refractory cases.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Gluteal tendinopathy responds well to education and progressive loading — better than injection at 8+ weeks. Side-lying habits and crossed-leg sitting often need adjusting.