Gluteus maximus tendonitis is an uncommon but often overlooked cause of buttock pain, particularly in active people. The gluteus maximus is the largest muscle in the body, and it powers movements such as running, sprinting, and climbing. When its tendon becomes irritated, it causes deep buttock pain during activity. So what is tendonitis of the gluteus maximus, and how do we treat it? 

location of pain in lower buttock from gleus maximus tendoniti

What is gluteus maximus tendonitis? 

The gluteus maximus is the large, powerful muscle of the buttock. It extends the hip — driving you forwards when you run, sprint, climb, or stand up from a chair. Its tendon attaches to the back of the thigh bone and the nearby connective tissue. Tendonitis (more accurately tendinopathy) develops at this attachment from repetitive overload, causing deep buttock pain.

It’s worth being clear about what this isn’t: it’s a different problem from gluteal tendinopathy of the greater trochanter, which affects the gluteus medius and minimus tendons on the outer hip. Gluteus maximus tendonitis affects the lower buttock.

Symptoms of gluteus maximus tendinopathy

Symptoms are usually felt in the lower, outer buttock, near the buttock fold. Common features include:

  • A deeper pain in the lower buttock, often worse with walking, running, and climbing
  • Discomfort when lying directly on the affected side
  • Pain that eases with rest and returns with activity

These symptoms can mimic other conditions — such as trochanteric bursitis and hamstring-origin tendonitis — which is why a precise diagnosis is essential.

How is gluteus maximus tendonitis diagnosed?

Diagnosis begins with a clinical assessment. Your sports doctor asks about the location of the pain and what aggravates or relieves it, then examines the buttock and hip. In gluteus maximus tendonitis, there’s tenderness over the swollen tendon, and the pain is often reproduced by resisted hip extension (pushing the leg backwards against resistance). Tenderness is generally below the trochanteric bursa and lateral to the hamstring origin tendon. Your doctor also examines the hip, buttock, and lower back to rule out other causes.

Imaging usually confirms it:

  • X-ray — to look for calcification, or to exclude hip arthritis
  • Ultrasound — a practical, dynamic tool for showing thickening, inflammation, or calcification of the gluteus maximus tendon, and for guiding an injection
  • MRI — gives a clear view of the gluteal tendons and surrounding structures, detecting tendon swelling or tears and any co-existing problem

How is gluteus maximus tendonitis treated?

As with other tendon problems, rehabilitation leads the way.

First-line treatment

  • Activity modification — reducing the explosive activities that strain the tendon, such as running and sprinting
  • Isometric and progressive strengthening — a structured programme for the hip and gluteal muscles, which is the mainstay of recovery
  • Addressing the cause — training load, technique, and surrounding muscle strength

If the tendon doesn’t settle

  • Shockwave therapy — useful for a stubborn gluteal tendinopathy, especially with calcification

Cortisone is generally avoided for gluteal tendon problems — it doesn’t heal the tendon and may weaken it — so treatment centres on rehabilitation, shockwave, and, where appropriate, PRP. Surgery is rarely needed.

Frequently asked questions about gluteus maximus tendinopathy

How is gluteus maximus tendonitis different from trochanteric bursitis?

They cause pain in similar areas but at different sites. Gluteus maximus tendonitis affects the lower outside buttock and is reproduced by resisted hip extension. Trochanteric bursitis — and the related gluteal tendinopathy of the greater trochanter — affects the outer hip and involves the gluteus medius and minimus. Examination and imaging tell them apart, which matters because the rehabilitation differs.

What makes gluteus maximus tendonitis worse?

Activities that load the hip extensors — walking uphill, running, sprinting, and climbing stairs — along with lying directly on the affected side. The pain typically eases with rest and returns with activity, which is characteristic of a tendon problem.

Should I have a cortisone injection for it?

Usually not. Cortisone doesn’t heal a tendon and may weaken it, so it isn’t the treatment of choice for gluteus maximus tendonitis. Rehabilitation leads, with shockwave therapy or PRP considered if the tendon is slow to settle. An accurate diagnosis comes first.

How long does it take to recover?

Tendon problems generally take time — often a few months of progressive strengthening. The timeline depends on how long it’s been present and how well the aggravating load is managed. Most people recover well without surgery, provided the tendon is loaded progressively.

Final word from Sport Doctor London about gluteus maximus tendinopathy

Gluteus maximus tendonitis is an overlooked cause of lower buttock pain in active people, often mistaken for trochanteric bursitis or hamstring-origin tendonitis. A precise diagnosis — with examination and imaging — is the key to the right treatment. Rehabilitation leads the way, with shockwave and PRP reserved for stubborn cases, and surgery rarely needed.

If you have persistent buttock pain, Dr Masci can assess you in London, including in-clinic ultrasound. Contact the team here or call +44 (0) 203 488 0350.

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