Weak Glutes: The Hidden Cause of Hip, Knee & Back Pain

Have you ever experienced hip, thigh, knee, or lower back pain seemingly out of nowhere? That’s exactly what happened to me. After a period of reduced activity, while writing an online course, I went on a hike and began to feel pain in my left thigh. I brushed it off at first, but when the pain became persistent, I decided to dig deeper.

My physiotherapist explained something that completely changed how I look at pain:

My right glute is weak, so my left side is overcompensating. Over time, this imbalance overloaded my left hip and thigh tendons, eventually leading to pain.

This pattern is common during menopause—hormones drop, tendons weaken, and many women suddenly take up walking, running, or strength training without realising their glute muscles aren’t strong enough to handle the load. The result? Pain, irritation, and tendon overload. The key to avoiding these issues is to gradually build up your workouts.

Let’s break down why this happens and, more importantly, how to fix it without making things worse.

Why Your Glutes Matter More Than You Think

The gluteus medius and gluteus minimus are stabiliser muscles that keep your pelvis and lower body aligned. When they’re strong, everything moves smoothly. When they’re weak, other muscles—like your lower back, quads, or even the opposite leg—try to help out. But they can’t do this forever, and eventually, they get overloaded and painful.

✔ Pelvic Stability – Keeps your hips level and prevents side-to-side sway
✔ Knee Alignment – Stops knees from collapsing inward when you move
✔ Lower Back Support – Reduces strain and compensations that lead to pain

When these muscles aren’t pulling their weight, your movement patterns change, stress builds up, and pain follows.

Common Pain Problems Caused by Weak Glutes

1. Hip & Outer Thigh Pain (Greater Trochanteric Pain Syndrome - GTPS)

✔ Aching pain in the outer hip or thigh
✔ Worse after long walks, standing, or lying on the painful side

Why? Weak glutes tendons can not handle sudden increases in activity (loading), they get irritated and painful. This is why so many women in menopause develop hip pain after increasing activity levels. They may join a walking club or hiking etc.

2. Knee Pain (Runner’s Knee & IT Band Pain)

✔ Knees collapse inward when walking, running, or squatting
✔ Pain around or outside the kneecap

Why? The glutes control knee positioning. When they’re weak, your knee collapses inward, increasing strain on the patella (kneecap) and IT band.

3. Lower Back Pain

✔ Tight, overworked lower back muscles
✔ Pain after standing or walking for long periods

Why? A weak gluteus medius forces your lower back to take over stabilisation duties. Over time, this leads to stiffness, fatigue, and pain.

Best Glute Exercises for Pain Relief

To rebuild glute strength without overloading your tendons, focus on isometric exercises. They activate the glutes gently but effectively, providing stability and pain relief.

1. Isometric Abduction in Lying

• Lie on your back with a pillow under your knees.
• Place a light resistance band on your thighs just above your knees.
• Keep your knees slightly wider than hip-width.
• Gently press outward (just a 1-2 mm) against the resistance and hold for 10 seconds.
• You should feel your larger muscles on the sides are loose and relaxed
• Relax and repeat for 10 rounds.

Why it works: This activates the deep stabiliser muscles, improving hip control without irritating the tendons.

2. Isometric Abduction in Standing

• Stand tall with your feet hip-width apart.
• Try to split outward gently, focusing on the small stabiliser muscles- gluteus minimus and medius, while keeping the larger outer glute muscles relaxed.
• Hold for 10-15 seconds—do 10 rounds. 

Why it works: This exercise gently activates the deep stabiliser muscles, improving hip control without overloading the tendons. It’s excellent for pain relief and preventing compensations.

3. Lateral Walks

• Step sideways, keeping a good balance at the hips.
• Take 10 steps left, then 10 steps right.
• Do 3 sets.

Why it works: Strengthens pelvic stability and reduces knee and hip stress.

4. Double-Leg Glute Bridges

• Lie on your back with both knees bent and heels as close to your buttocks as comfortable for you. 
• Contract your buttocks
• Press through your heel and lift your hips.
• Hold for a few seconds, then lower down.
• Do 2 sets of 10 reps.

Why it works: Strengthens the glutes and core.

Need More Guidance? Check Out Dr. Alison Grimaldi’s ‘Hip Pain Help’ Course

Dr. Alison Grimaldi is an Australian researcher and physiotherapist specializing in hip pain and gluteal dysfunction. Her advice and program helped reduce my pain when dry needling, massage, etc., were not doing much for the pain relief. And now I am on my way to recovery and strengthening - check it out here: https://hippainhelp.com/self-help-courses-for-hip-pain/ 

Key Takeaways from Her Work:
✔ Weak glutes often lead to hip pain & tendon overload
✔ Doing too much, too fast can worsen pain instead of fixing it
✔ Smart, progressive exercises can reduce pain & build strength safely

Here's Some Research on Menopausal Women

This study explored whether menopausal hormone therapy (MHT), exercise, or a combination of both could help postmenopausal women with greater trochanteric pain syndrome (GTPS). All participants showed improvement over time, largely due to education on reducing pressure on the hip tendons and engaging in regular exercise. Interestingly, the study found that MHT was especially helpful for leaner women with a lower BMI (under 25). 

 This is not unexpected because women with leaner physiques tend to have lower levels of estrogen in their bodies compared to those with a higher percentage of body fat. This happens because fat cells are important in the hormone conversion process, as they convert testosterone into estrogen.

You can read the paper here.

I would also like to add that it's not only estrogen and progesterone that are helpful during menopause; other masculine hormones like DHEA (dehydroepiandrosterone) and testosterone also play important roles. These hormones are commonly prescribed in our practice due to their multiple benefits.

Final Thoughts: Small Changes, Big Relief

My own experience has taught me that glute weakness creeps up on you. Your body compensates until it can’t anymore, and then suddenly—boom!—you’re in pain.

✅ Strengthening your glutes can reduce pain & improve movement

✅ Start slow—especially if you’re dealing with hormonal changes

✅ Check out Dr. Grimaldi’s resources or see a physio trained in hip/glute rehab

✅ And optimise your hormones and nutrition. 

I hope this information is helpful. We can assist you in optimizing your nutrients and hormones. You are welcome to book through our wellness plans.