Understanding Gluteal Tendinopathy in the Active Ageing Population

Gluteal tendinopathy is one of the most common sources of lateral hip pain, particularly in postmenopausal women and active adults over 50. It involves irritation or degenerative changes in the gluteus medius and gluteus minimus tendons where they attach to the greater trochanter of the femur.

For Pilates teachers working with mature clients, understanding this condition — and how to modify programming appropriately — is essential for safe, progressive results and for collaborating effectively with allied health professionals.

What Causes Gluteal Tendinopathy?

Common contributing factors include:

• Overuse or repetitive load (walking long distances, running, stair climbing).

• Reduced gluteal strength or poor recruitment of stabilising muscles.

• Hormonal influences — particularly oestrogen decline affecting tendon integrity.

• Biomechanical factors such as contralateral pelvic drop or hip adduction during gait.

• Compression from side-lying sleeping positions or excessive stretching of the lateral hip.

These clients often describe pain lying on their side, climbing stairs, or standing on one leg.

The Role of Pilates in Rehabilitation and Active Ageing

As Pilates teachers, our role is to apply appropriate loading strategies to support tendon healing, maintain function, and build confidence in movement — always in collaboration with a physiotherapist or referring health professional.

When programming for gluteal tendinopathy, consider three key stages of load progression:

Stage 1: Isometric Loading – Early Tendon Conditioning

When pain is acute, isometric exercises provide safe activation and can reduce pain sensitivity.
Focus on gentle, controlled contraction without joint movement.

Examples:

• Supine Hip Abduction Holds:

  • Client lies supine with a resistance band around the thighs.

  • Cue neutral pelvis and controlled abduction, holding for 20–30 seconds.

  • Repeat 4–5 times, progressing hold time as tolerated.

Teaching Tips:

• Avoid pushing into pain — mild discomfort is acceptable, sharp pain is not.

• Emphasise even pelvic alignment and relaxed breathing.

Stage 2: Isometric Strength and Pelvic Control – Standing Reformer Work

Once clients tolerate early load, transition to closed-chain positions for improved functional stability.

Reformer Standing Side Split Holds:

• Begin with one heavy spring resistance to encourage control - not too heavy, not too light.

• Cue upright posture, neutral pelvis, and equal weight distribution.

• Hold the side split position for 10–15 seconds, avoiding pelvic drop.

This exercise promotes pelvic control, gluteal co-contraction, and dynamic alignment — essential for walking and stair climbing.

Clinical Collaboration:
This stage is an ideal time to liaise with a physiotherapist to assess load tolerance, range of motion, and progress toward isotonic strengthening.

Stage 3: Functional Strength and Endurance – Wunda Chair Footwork

As pain subsides and tolerance improves, progress toward functional, concentric-eccentric loading. You may need a small box for your client to sit on to prevent loss of spinal alignment and too much flexion at the hip.

Wunda Chair Footwork:

• Emphasise equal loading through both hips.

• Avoid hip adduction or pelvic tilt compensations.

• Use a controlled tempo — slow down the eccentric phase to build tendon resilience.

This phase develops the strength, control, and endurance required for everyday function in active ageing clients.

Working in Partnership with Physiotherapists

Successful rehabilitation of gluteal tendinopathy depends on timing and load management.

Pilates teachers should:

• Communicate regularly with the referring physiotherapist regarding pain levels, load progression, and any setbacks.

• Ensure clients have had an assessment and diagnosis before commencing targeted gluteal work.

• Align progressions (from isometric → isotonic → functional) with the physiotherapist’s recommended timeframe.

• Use subjective feedback and pain monitoring (0–10 scale) to guide intensity and volume.

This integrated approach ensures consistency across care providers and supports best-practice tendon rehabilitation.

Key Teaching Considerations

• Avoid stretching the lateral hip or crossing the legs, as this increases tendon compression.

• Encourage postural awareness during daily tasks — cue “hips level” during standing and walking. You can teach hips level when doing standing arm work with either springs, hand weights or stretch bands.

• Reinforce load management — gradual increases in resistance and frequency.

• Use mirror or video feedback for pelvic control and alignment cues.

• Prioritise client education about tendon healing timeframes (often 6–12 weeks).

Summary

Gluteal tendinopathy is common in the active ageing population, particularly among postmenopausal women. Pilates, when applied with precision and in collaboration with physiotherapists, offers a safe and effective way to:

• Build gluteal strength,

• Improve pelvic stability,

• Support long-term hip function, and

• Empower clients to stay active and pain-free.

As instructors, our role is to guide clients through progressive, evidence-informed movement, ensuring each stage of loading supports tendon recovery — not aggravation.

Continue Learning: Deepen Your Expertise in Active Ageing & Menopause

Supporting clients through the transitions of midlife and beyond is one of the most rewarding aspects of our work as Pilates professionals.

If you’d like to enhance your knowledge in this area, explore my specialised online teacher training courses:

🌿 Pilates for Active Ageing – learn evidence-based strategies to improve bone density, balance, and postural control in mature clients.
🔥 Harnessing Hormonal Harmony – Pilates for Perimenopause & Menopause – understand how hormonal shifts affect strength, flexibility, and recovery, and how to adapt programming with confidence.

Each course offers certification, lifetime access, and practical tools to elevate your teaching and client outcomes.
👉 Discover courses at Taube Pilates