Gluteus medius

The gluteus medius is a fan-shaped muscle on the outer side of the hip. It lies between the gluteus maximus on the surface and the smaller gluteus minimus underneath, running from the outer surface of the pelvis (the ilium) to the outer side of the greater trochanter, a bony point at the top of the thigh bone (TeachMeAnatomy).

What does the gluteus medius do?

It moves the thigh out to the side (abduction) and rotates it inwards. Its most important job is less visible: when you stand on one leg, which happens with every step, the gluteus medius and minimus on the standing side contract to stop the pelvis dropping on the other side. Both are supplied by the superior gluteal nerve (TeachMeAnatomy). Together they are the main hip abductors and are vital to normal walking (Shah & Bordoni, 2023).

When they are weak, the pelvis dips on the side of the lifted leg as you stand on one foot. Clinicians call this a positive Trendelenburg sign and check it by watching the level of the hip bones (TeachMeAnatomy).

Its larger neighbour, which straightens the hip, is the gluteus maximus. Deeper still lie small rotator muscles such as the piriformis.

Gluteus medius and pain on the side of the hip

The tendons of the gluteus medius and minimus, where they attach to the greater trochanter, are now recognised as a main local source of pain on the outside of the hip. This gluteal tendinopathy mostly appears in mid-life, in people who exercise and people who don’t, and affects women more than men. It can disturb sleep when lying on that side and make weight-bearing tasks painful (Grimaldi et al., 2015).

The review’s authors point to a combination of compression and tension on the tendon, with the hip drawn in across the body’s midline (adduction) as a key position (Grimaldi et al., 2015). The NHS also advises people with hip pain not to sit in low chairs, which can put extra pressure on the hips (NHS). Seat height is covered in how to set up your office chair.

What helps gluteal tendinopathy?

The LEAP trial randomised 204 people aged 35 to 70 with side-of-hip pain for more than three months, confirmed on MRI. One group had 14 physiotherapy sessions of education about managing load plus exercise over eight weeks, one had a single steroid injection, and one waited and saw (Mellor et al., 2018):

• At eight weeks, 51 of 66 people in the education and exercise group reported success, against 38 of 65 after the injection and 20 of 68 who waited.
• At one year, education and exercise still led on overall improvement compared with the injection, but pain levels in those two groups were similar. Both did better than waiting.

Gluteus medius and lower back pain

In 150 people with chronic non-specific low back pain and 75 matched people without, the gluteus medius was weaker in the back pain group, the Trendelenburg sign was more common, and the buttock and side of the hip were more tender to touch (Cooper et al., 2016). Strength was tested by hand rather than measured with a device, and the authors called for studies that check these findings with quantitative measures and test whether strengthening the muscle helps. Like the hip flexors, it is a plausible part of the picture rather than a proven cause. For the bigger picture, see lower back pain from sitting.

When to see a doctor

See a GP if hip pain is stopping you doing normal activities or affecting your sleep, is getting worse or keeps coming back, hasn’t improved after two weeks of treating it at home, or your hip is stiff for more than 30 minutes after waking. Ask for an urgent appointment or contact NHS 111 if severe hip pain started suddenly without a fall, your hip is swollen and feels hot, or you feel unwell with a high temperature. Call 999 or go to A&E if you have severe hip pain after a fall or injury or can’t put weight on your leg (NHS).