The Hidden Cause of Gluteal Tendonitis and How to Self-Treat
Key insights: 60-second read
- The hidden cause of gluteal tendonitis is often the lower back – Stiffness and restriction at the thoracolumbar junction (base of the rib cage) can short-circuit hip function and set your glutes up to fail.
- Test-retest is your best friend – Find a movement that triggers your hip pain, do the mobilisation work, then re-test. If it feels better, you have identified the connection.
- Release your spine first, then your glutes – Use a foam roller or ball to find hidden restrictions in your lower back, then use a ball to release tight glute tissue while respecting painful spots.
- Progress strength gradually – Start with clams and side-lying hip abduction, then progress to banded crab walks, penguin walks, and finally banded squats.
In this article, I will walk you through a hidden cause of gluteal tendonitis, how to test if your back is involved, and a complete self-treatment protocol that includes spinal mobilisation, glute release work, and a progressive strength pathway.
On this page
1. The Hidden Cause: Your Lower Back
One of the most important things to appreciate when trying to resolve your gluteal tendonitis is that it could very well be back-related.
Interestingly, this doesn't mean you have to have a sore back. Simple lower back dysfunction - stiff joints, overloaded tissue, tight muscles at specific segments of your spine that relate to controlling or supplying your gluteal function - can fundamentally set your glutes up to fail.
If you've been struggling with gluteal tendonitis (tendinopathy) for a long time, and you have tried all the hip mobility drills, strength exercises, and injections you can handle - without much luck, you might be missing some very basic lower back dysfunction.
"The base of your rib cage and the top of your lower back has the potential to short-circuit hip function. Hidden lower back dysfunction can potentially inhibit the function of your hip, theoretically opening the door for dysfunction to occur at that hip."
This follows a very distinct anatomical pattern highlighted by something called "dermatomes". The thoracolumbar junction - where your mid-back meets your lower back - has a dermatomal referral pattern that can refer dysfunction down into the hip area. This can be a huge reason why treating the hip alone doesn't fix hip pain - because we could be missing the bigger picture.
2. The Test-Retest Approach
You shouldn't have to trust me or take a leap of faith with this. The best way to figure out whether this is genuinely relevant for you is to establish an initial baseline of how your symptoms feel. From here, once you've worked on improving your back funciton, you can immediately re-test the exact same thing to see if anything meaningful has changed.
How to Test
- Find a specific movement or activity that genuinely highlights your glute dysfunction - walking, squatting, bending over, or lying on that side.
- Notice how your symptoms feel and rate them.
- Do the mobilisation work described below.
- Re-test the same movement immediately and see if anything meaningful has changed.
3. Spinal Mobilisation: Finding Hidden Restrictions
How to Do It
- Use a foam roller, lacrosse ball, or tennis ball. You can do this lying on the floor or standing against a wall.
- Place the tool at the base of your rib cage and gently recline over it.
- Move the roller up and down until you find a part of your back that feels stiff, tight, harder, or more restricted than the other side.
- It may or may not be tender. If it is tender, respect that and go gently.
- Do not roll back and forth like an exercise. Instead, recline back to a comfortable level and gently roll to the left and right, noting which side feels hardest and stiffest.
- Leave the roller on the restricted spot for 30 seconds to a minute. Take a couple of slow, controlled deep breaths to help your nervous system relax.
- Systematically work your way up and down, finding any hidden restrictions you may not have realised were there.
- Spend 10-15 minutes doing this while watching TV.
- Immediately re-test your baseline activity again to look for any meaningful change.
"If I've treated someone's spine and successfully freed up any restricted spots, I would expect something about the hip to then feel better - whether it feels stronger, looser, or just less painful than it did before."
4. Glute Release Work
How to Do It
- Use a tennis ball or lacrosse ball lying down or against a wall.
- Place the ball into your glutes and lie down on it.
- Do not go directly onto the painful spot - go looking for anything that feels tight, thick, restricted, and potentially tender.
- If a spot is tender but not restricted, do not press into it. Work around it.
- If a spot is tender AND restricted, gently let the ball press in there while breathing.
- To enhance the release, tense the muscle underneath the ball for 5-10 seconds, then relax. This creates a reflex where the muscle should relax more deeply.
- The goal is to "feed slack" back into the irritated spot by freeing up surrounding tightness.
5. Strength Exercises: Clams to Squats
Once you have used strategic mobility to feed some slack back into that hip, we want to go through a progressive strength pathway.
Exercise 1: Clam
- Lie on your side with the hip you want to strengthen on top.
- Bend your hips and knees to about 45-90 degrees with your heels together.
- Place your hand on the side of your hip, back towards your back pocket, to feel for the deep hip stabilisers working.
- Keep your heels together and lift your top knee up as far as you can before you feel yourself rolling backwards.
- Do 10-15 reps, 3 sets, aiming for a good fatigue.
Exercise 2: Side-Lying Hip Abduction
- Lie on your side with your legs out straight, rolling forward of vertical just slightly.
- Lead with your heel (toes pointing down) and lift your leg straight up and down.
- Come up as high as you can before you feel yourself rolling backwards or hiking your hip.
- Do 10-15 reps, 3 sets, within a range that feels safe for your symptoms.
Exercise 3: Banded Crab Walk
- Place a band just above your knees.
- Stand up tall, draw your belly in, and get into a slight squat.
- Walk side to side as smoothly as possible, resisting the band pulling your knees in.
- This closely resembles the clam exercise in standing.
Exercise 4: Banded Squats
- Place a band around your knees.
- Perform a squat, keeping your knees pushing out against the band the entire time.
- This is a fantastic functional exercise that gets all your glute muscles working together.
6. Why Posture Matters
This one may feel left-of-centre if you haven't gone through the process of connecting the dots to your lower back. If you've found that mobilising those hidden restrictions has improved your glute function, we also need to understand why that exact part of your spine became dysfunctional in the first place.
The shapes and positions you put your back into the most throughout the day - sitting in the car, at your computer, on the couch - may directly overlap with which part of your spine you are unknowingly slouching or hinging through.
If we do not also pair better postural shapes with the mobilisation and strength work, you may never reasonably expect this to go away permanently.
Key Takeaway: If you can create the most optimal environment possible for that dysfunction to exist within, you give it the best chance to successfully get better.
I genuinely hope this article offers a fresh perspective - or at least one useful takeaway. The hidden cause of gluteal tendonitis is often your lower back, and by addressing that first, you can create the optimal environment for your hip to heal.
If you have a different issue, or simply want to learn more about how your body moves, head over to the Your Wellness Nerd YouTube channel. Subscribe if you feel inclined, and let me know in the comments what you would like me to cover next.
- Grant
Frequently Asked Questions
Why does my gluteal tendonitis keep coming back?
If your gluteal tendonitis keeps returning, there is likely a hidden underlying cause that is not being addressed. In my clinical experience, the most common hidden cause is lower back dysfunction - specifically stiffness and restriction at the thoracolumbar junction that can short-circuit hip function and set your glutes up to fail. If you treat the hip but not the back, the dysfunction may return.
What is the best exercise for gluteal tendonitis?
There is no single "best" exercise. The key is to progress gradually through a pathway: start with clams and side-lying hip abduction (isolation exercises), then progress to banded crab walks and penguin walks (standing with resistance), and finally to banded squats (functional, weight-bearing). The right exercise depends on where you are in your recovery journey.
Can lower back stiffness cause hip pain?
Yes. The thoracolumbar junction - where your mid-back meets your lower back - has a dermatomal referral pattern that can refer dysfunction down into the hip area. Hidden lower back dysfunction can inhibit gluteal function and create the environment for hip pain and tendonitis to develop.
How do I know if my back is causing my glute pain?
Use the test-retest approach. Find a movement that triggers your hip pain, rate your symptoms, do the spinal mobilisation work (foam roller or ball at the base of your rib cage), then re-test the same movement. If your symptoms improve immediately, your back is likely a significant contributor.
One key insight from this video
"The hidden cause of gluteal tendonitis is often your lower back. Stiffness at the thoracolumbar junction can short-circuit hip function and set your glutes up to fail. If you treat the hip but not the back, the dysfunction may never fully resolve."
Living With Hip Pain?
If your hip pain has lasted longer than expected or has not responded to standard treatment, you may benefit from a broader approach. Learn more about our hip pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via telehealth.
