Dead Butt Syndrome: What It Is, and Which Exercises to Avoid
Quick answer: “Dead butt syndrome” is a popular label rather than a medical diagnosis, and it gets used for two quite different situations. One is simple deconditioning — glutes that are weak because they have not been asked to do much. The other is gluteal tendinopathy, the most common lower limb tendinopathy, which affects about one in four women over 50. The two need opposite handling in one important respect: tendinopathy is aggravated by compression, and several of the stretches most often recommended for “dead butt” push the hip into exactly the position that compresses the sore tendon. The clue that separates them is simple — pain when you lie on that side at night. Our therapists talk through the whole-body side of it in the video below.
What the therapists cover
In this discussion our therapists work through what people mean by dead butt syndrome or gluteal amnesia, and why the glutes often are not the place to start. The glutes can certainly become weak and under-used — long periods of sitting, and habitual positions that give them little to do, both contribute. What follows is usually compensation: the lower back, hamstrings and even the upper body take on work the hips are not contributing.
One clarification worth making, because the popular phrasing invites it. Muscles do not switch off or forget how to work. They can be weak, deconditioned, poorly coordinated, or inhibited by pain — all real and all addressable — but “amnesia” is a metaphor rather than a mechanism, and it matters because it changes what you go looking for.
Our posture experts explain that while glute-focused exercises like bridges can help, they may not reach the root of the problem if the pelvis, spine, hips or even the upper back are not doing their share. Where the pelvis sits is a large part of it: a pelvis tucked under or held in anterior tilt changes the length the glutes have to work at before any exercise begins.
The practical emphasis in the video is on movement, position and frequency rather than any single exercise — getting out of sustained sitting, varying how you stand, and giving the hips something to do across a day. That is not a substitute for strengthening, but strengthening a muscle you then spend fourteen hours sitting on is an uphill arrangement.
The bridge test they demonstrate: lie on your back, bend your knees, and lift your hips while trying to drive the movement from the glutes. If you mostly feel your lower back or hamstrings doing the work, that is worth noticing. Read it as information about how you are organizing the movement rather than as a diagnosis — and if the outside of your hip is painful, see the compression section below before you start adding exercises.
Telling the Two Apart
This is the question to settle before adding any exercise, because the answer changes what helps.
| Feature | Deconditioned glutes | Gluteal tendinopathy |
|---|---|---|
| What it is | Muscles that are weak and under-used | A tendon problem where the gluteal tendons attach at the point of the hip |
| Main complaint | Weakness, poor endurance, things feel hard. Often no real pain | Pain over the bony point at the side of the hip, which can refer down the outer thigh toward the knee |
| The giveaway | Nothing hurts to lie on | Pain lying on that side at night — described as the hallmark sign |
| Who gets it | Anyone who sits a great deal | About one in four women over 50; women outnumber men between 2.4 and 4 to 1 |
| Response to loading | Progressive strengthening, straightforwardly | Loading helps — but in positions of minimal hip adduction, and compressive positions have to come out first |
| Stretching it | Harmless | Can make it worse. See below |
Gluteal tendinopathy is the most common lower limb tendinopathy, and the figures above come from the clinical summary of it (Physiopedia). It is worth knowing that what used to be called trochanteric bursitis is mostly this: only around 20% of cases involve true bursitis, with the rest being gluteal tendon problems, usually on a background of hip abductor weakness (Pain Medicine). Which is also why an injection is not the obvious first move — see the trial results further down.
The Compression Problem, and the Stretches to Stop
Here is the mechanism that makes this page worth reading if the outside of your hip hurts. The gluteal tendons run under the iliotibial band on their way to the bony point of the hip. When the hip moves across the body — into adduction — the band presses them against the bone, and the force is not trivial: compression rises from about 4N to 106N as the hip goes from neutral to 40 degrees of adduction. That is roughly a twenty-six-fold increase.
Which means a sore gluteal tendon is loaded, hard, by positions that feel like rest. The ones named in the load-management guidance:
- Sitting with the knees together or crossed.
- Standing hanging on one hip, with the pelvis dropped to one side.
- Lying on the affected side — which is why night pain is the hallmark.
- Running on a cambered road, where one foot lands across the midline.
- Adduction stretching — and the guidance is blunt about this one: stop adduction stretching.
That last point deserves spelling out, because it contradicts most of what you will find searching for dead butt syndrome exercises. The classic glute stretches — lying on your back and pulling one knee across the body, the figure-four, the pigeon position — all take the hip into adduction. If your problem is deconditioning, they are harmless. If it is gluteal tendinopathy, they compress the tendon you are trying to settle. People often report that the stretch feels like it is reaching exactly the right spot, and then that the hip is worse later that day or that night.
The practical substitutions in the guidance are undramatic: do not cross your legs, avoid knees-together sitting, put a pillow between your knees if you sleep on your side, and stop stretching into that position. None of it is exercise. All of it reduces what the tendon has to tolerate between sessions.
What the Evidence Says Works
Gluteal tendinopathy has unusually good trial evidence, and it points firmly at exercise. The LEAP trial (Mellor et al., BMJ, 2018) randomized 204 people — mean age 54.8, 81.9% women, all with lateral hip pain for more than three months — to one of three things: an education and exercise program, a single ultrasound-guided corticosteroid injection, or a wait-and-see approach.
| Global improvement | Education + exercise | Corticosteroid injection | Wait and see |
|---|---|---|---|
| At 8 weeks | 77.3% | 58.5% | 29.4% |
| At 52 weeks | 78.6% | 57.9% | 51.7% |
| Pain at 8 weeks (0–10) | 1.5 | 2.7 | 3.8 |
| Pain at 52 weeks | 2.1 | 2.3 | 3.2 |
Read the two rows together, because the story is in the comparison. At eight weeks the injection looks reasonable — better than doing nothing by a wide margin. By a year, the exercise group has held its ground at 78.6% while the injection group has fallen to 57.9%, which is barely ahead of the people who were told to wait and see. The injection bought short-term relief and then the advantage evaporated.
This is also the answer to the question underneath most searches for dead butt syndrome exercises. Yes, exercise is the thing — and the trial that shows it is one of the cleaner pieces of evidence in musculoskeletal care.
What the Program in That Trial Actually Involved
Worth knowing, because “do some glute exercises” undersells it considerably. The education and exercise arm was 14 individual sessions with a physiotherapist over eight weeks, plus a home program of four to six exercises performed daily, targeting the hip abductors, alongside education on load management — which is where the compression advice above comes from.
Two features of the published approach are worth noting. Isometric holds are used early for pain relief, and the analgesic effect reportedly lasts four to eight hours — five repetitions of around 45 seconds, with a couple of minutes between them. Then progressive strengthening follows, in positions of minimal hip adduction, before anything faster or more elastic is added.
We have set that out as what the research tested rather than as a prescription. Which exercises suit you, at what dose, depends on which of the two problems you have, how irritable the tendon currently is, and what you are trying to get back to — and a web page cannot settle any of those. If you take one thing from it, take the sequence: settle the compression, then load, then progress.
When It Is Neither of These
Pain around the outside of the hip and buttock has several other causes, and a few of them need a different route entirely (Pain Medicine):
- Pain that travels below the knee, with numbness, tingling or weakness — that pattern points at the lumbar spine rather than the hip. Weakness with pain needs medical assessment rather than exercise.
- Pain that eases when you bend forward and builds when you walk upright — also a spine pattern.
- Numbness or tingling in a patch you can trace precisely on the outer thigh, with no weakness — that suggests a nerve rather than a muscle, and no amount of glute work will touch it.
- Deep buttock pain with pins and needles into the leg, worse with prolonged sitting — worth having assessed properly rather than self-treating.
- Groin pain, or pain when someone moves your hip for you while you lie down — more suggestive of the hip joint itself.
- Sudden severe pain after a fall, or inability to bear weight.
For the wider version of that differential, including the figures behind it, see the section on lateral thigh pain in our page on the vastus lateralis.
Why the Therapists Keep Pointing Away from the Glutes
The video spends more time on the pelvis and the rest of the chain than on the glutes themselves, and the evidence supports that instinct even where it does not support the “amnesia” framing. Most gluteal tendinopathy sits on a background of hip abductor weakness, and a review of lateral hip pain reports hip abductor strengthening achieving an 80% success rate against 48% for injection at 15 months. The muscles that stabilize the pelvis in standing and walking are the target, not the ones that look best in a mirror.
Where the pelvis sits changes what those muscles can do. A pelvis that drops to one side puts the hip into exactly the adducted position that compresses the tendon, and holds it there for as long as you stand that way — which is why the standing habit matters as much as the exercise. Anterior and posterior tilt both change the length the glutes work at. Our pelvic tilt tests page walks through how that is assessed.
And the chain runs further down than people expect. Restricted ankle dorsiflexion changes how you load the whole leg, and the same hip control shows up in Achilles problems and in kneecap pain. The broader pattern vocabulary — and the caution about how firm the evidence for it actually is — sits in muscle imbalance.
Frequently Asked Questions
What is dead butt syndrome?
A popular name rather than a medical diagnosis. It is used for two different situations: glutes that are weak and under-used from sitting and inactivity, and gluteal tendinopathy, a tendon problem at the point of the hip that is the most common lower limb tendinopathy. The phrase “gluteal amnesia” is a metaphor — muscles do not switch off or forget. They can be weak, deconditioned, poorly coordinated or inhibited by pain.
What are the symptoms of dead butt syndrome?
If it is deconditioning: weakness, poor endurance, the sense that your lower back or hamstrings take over, and often no real pain. If it is gluteal tendinopathy: pain over the bony point at the side of the hip, sometimes referring down the outer thigh toward the knee, and — the hallmark — pain when you lie on that side at night. That night-pain clue is the most useful single thing to check.
What exercises help dead butt syndrome?
Exercise is genuinely the answer, and there is good trial evidence for it. In the LEAP trial, education plus exercise produced 77.3% global improvement at 8 weeks and 78.6% at 52 weeks, against 58.5% and 57.9% for a corticosteroid injection. The program was 14 physiotherapy sessions over 8 weeks plus four to six home exercises daily targeting the hip abductors, with load-management education. We have described what the research tested rather than prescribing a sequence, because which exercises suit you depends on which of the two problems you have.
Which exercises should I avoid?
Anything that takes the hip across the body — into adduction — if the outside of your hip is painful. That includes the classic glute stretches: lying on your back pulling a knee across the body, the figure-four, and the pigeon position. Compression of the tendon rises from about 4N to 106N as the hip moves from neutral to 40 degrees of adduction, so those stretches load the sore tendon hard. The load-management guidance says to stop adduction stretching. Also avoid sitting with your legs crossed and standing with the pelvis dropped to one side.
Does sitting too much cause it?
Prolonged sitting contributes to glutes being weak and under-used, and it is a reasonable thing to address — the therapists in the video make that point. For gluteal tendinopathy specifically, how you sit may matter more than how long: sitting with the knees together or legs crossed holds the hip in the position that compresses the tendon. Varying position and getting out of sustained sitting is worth doing for both.
How do I know if my glutes are weak or if it is a tendon problem?
Start with night pain. Pain lying on that side points to the tendon; no pain lying on it points to simple deconditioning. Gluteal tendinopathy is also much more common in women over 50 — around one in four — and women outnumber men by between 2.4 and 4 to 1. If you are unsure, assume the tendon and leave the adduction stretches out until someone has assessed it, because that way round the mistake costs nothing.
Should I get an injection for hip pain?
The trial evidence is not encouraging for it as a first move. At eight weeks a corticosteroid injection beat doing nothing, 58.5% to 29.4%. By 52 weeks it had fallen to 57.9% while the exercise group held at 78.6% — barely ahead of the wait-and-see group at 51.7%. Separately, only about 20% of cases at the side of the hip involve true bursitis, so the inflammation an injection targets is often not the main problem. Worth discussing with a clinician rather than ruling out, but exercise is the better-evidenced starting point.
How long does it take to improve?
The trial measured outcomes at 8 weeks and again at a year, and the exercise group was still improving at 52 weeks. Think in months rather than weeks, and expect the first gains to come from removing the compressive positions rather than from the exercises themselves.
Full transcript
So, hey, guys. The other day, I got a text from one of my clients, and it was a link to The New York Times article on dead butt syndrome. And she got really excited, and she said, is this what I have? And then that same week, a few other clients asked about it. So I thought it might be nice to talk about dead butt syndrome, what it is, if you have it, and why that might matter.
And my short answer to her was, like, yes. That you could call it that if you want, and that’s not the only problem. Because everything we do, our whole body is involved. And once when your butt does go dead, and I think it says gluteal atrophy. I think that’s a term it mentions in there.
A lot of times it’s because your shoulders get really hunched over and you’re pulling your erector muscles tight and then you’re pulling your glutes really, really long. So in the article, there are a lot of glute exercises you can do, and all of them are good. They’re good exercises. And truth be told, most people do need a lot more glute work and should be doing most of those exercises, but there’s probably some setup that you need elsewhere in your body first before you go into those exercises. Do you guys have thoughts on that?
Yeah. What comes to mind. So gluteal amnesia is another term for that too. So just the sort of disappearance and it’s kind of interesting to have a real term for it now because we used to joke about it and call it NBD or no butt disease because we saw a lot of clients who who had literally no butt, and we joke about like where it went and it has a lot to do with well, there’s two things. So there’s the postural position, right?
So if someone is tucked under in posterior pelvic tilt, then that’s going to make their butt disappear in and by itself. And when the pelvis goes, the lumbar spine goes into flexion and then the whole C curve of the spine can start, and head forward position that can go with that. And then, whether with the legs doing underneath that as well. So we’ve gotta gotta consider all those things. And then there’s the actual muscle activation aspect of it.
So if you’re in a posterior pelvic tilt, chances are your glutes are short and not able to get much leverage. And then if you’re in an anterior pelvic tilt, sometimes it works in the sense that the sacrum is pushing out. So it makes it look like you have a little shelf there for a butt. But really, there’s no real glute activation there. So even people in an anterior tilt, like Carrie Ann mentioned about how the muscles get long, a lot of those people have hyperactive hamstrings, and the glutes don’t actually do the job.
So we wanna make sure those muscles are active and kind of sounds like what the article was going after, was trying to wake up the glutes. But if they don’t look at the position of the body, then sometimes that can be interfering.
Yeah. I think a lot of, and it has to be individually tested to see what is activating and what isn’t, but sometimes, in a lot of people, just because their upper back is in, I guess, such a stuck position, you have to do some thoracic work just to even gain some length before you even wanna worry about the glutes. Like, it isn’t always the first thing you go to. You can, but it’s not always the best thing. And so before everybody gets really excited about this new diagnosis and just is like, oh, that’s what I have. I just can focus on bridging and squeezing my butt and then and then I’m gonna be better.
I just want people to know that there are other things and other parts of your body that go into it. So, and putting a name on something can be really reassuring, but it doesn’t make it go away.
Yeah. Is there a pill for that now? Is there a shot for that now? Is there some surgery that I can do to get my glutes back?
It’ll look like it. Well You know? Surgery will make it look like you have glutes, but that surgery doesn’t make them any more functional.
Yeah. You can get implants anywhere. But, anyways yeah. No. It’s funny. I have a couple clients say the same thing. I feel like I lost my butt once I started working, once I got out of college, and I have a desk job. They’re like, I sit there 5 days a week, you know, 40 hours a week.
And I go, well, yes. They’re inactive, but, again, what else is going on with your body? Because you can do as many glute contractions, like bridges. But is that actually what’s turning on when you’re actually trying to contract, or is it your lower back? Or is it your hamstring? Something above or below that’s making it look like it’s doing the work because you’re doing the motion of a bridge, but my lower back is what’s actually hurting while doing a bridge instead of my glutes actually squeezing and contracting.
So it’s I feel like I’m saying this every time, but I tell people to take breaks. Best thing to do is I use my little Apple Watch that tells me, hey. You’ve been sitting on your butt for an hour. It’s time to get up. So I will get up, and I’ll walk. I’ll get a drink of water. I’ll move around for a few minutes, do a couple exercises, and then I’ll sit back down. I know it’s hard, especially if you’re kind of in the thick of something to do it. But at least then if you get a second notification saying, hey.
Stand up. It’s been an hour. And they go, oh gosh, I didn’t stand up for the last hour. It’s been two hours, and I’ve been here on my butt. And then I’ll actually connect with myself and go, how do I feel? And I go, oh, okay. I do feel very stagnant. I feel like I can’t even straighten up. It’s almost like if you’ve ever been in a long car ride and you’ve been sitting for 6 hours or 8 hours. And once you get out, like, it takes a moment for you to fully straighten up into a standing position because you feel like you’re stuck. But yeah. So I tell people, take breaks, stop working, for 5 minutes, and then jump back in.
Yeah. I have a similar approach, for my clients that are constantly sitting, and maybe they don’t even have the option for a standing desk, which I still think we need to toggle between the two, not just stick to one.
Really, it is just like give yourself a break whether it’s just resetting your sitting posture, sitting up an extension, or taking a walk, or anything like that. Just getting the whole body moving and not just, I don’t know at the end of the day or the beginning of day, doing bridges and just trying to activate that way, just getting everything from head to toe kind of active as you continue working. I feel like that is the most helpful thing because the body is not meant to sit or stand in one position for 8 hours, 9 hours at a time.
Yeah. I like length. Your body will crave feeling taller and longer. So just really just reaching up and making yourself feel taller and longer is a good thing to do when you take a break from work. One good thing to do to sort of feel if your glutes are working or if your spine, even if you’re ready to go into training, is a pelvic tilt or a cat and dog, which, you know, a pelvic tilt is just laying on your back, doing a nice exhale, pulling your belly button down into the floor. And then when you inhale, when you release, you wanna arch up and feel your hip flexors turning on, getting a little arch in your back. If you can’t do that motion, if you don’t feel anything happening down there, then something… you have more work to do before you decide to work your glutes.
Or if when you tuck under, you go right to the glutes and you just feel your glutes activate and you don’t ever feel your abs or your hip flexors, you have more work to do somewhere else. Your spine being able to move in all areas is really important and one of the first things that has to happen before you tack on harder work. So I like pelvic tilts and cats and dogs and very basic just like opening exercises as self tests.
That’s great. And, I think the lengthening is important that you’re talking about in the movement in general because so what we’re talking about here is the glute amnesia. It can be related to a couple things that you have blood flow, because you get you’re sitting basically in a still position, and circulation happens as we move. So our muscles actually work as pumps to help with circulation. So if we’re sitting on top of those muscles, they’re getting compressed. There’s not much blood flow there.
So we want blood flow coming in and out, which has to do with lengthening and shortening of the muscle or contracting and relaxing of the muscle. And then you also have nerve compression that can happen as well because we’re just sitting on top of that. So that’s where that numbness or amnesia can come in. And and and just to recap what we’re talking about too in terms of muscles, and we’re talking about the glute max, which is the one that we I’ll think about, which is the main butt muscle, but they also have the the side butt muscles, which we find with a lot of our clients that those muscles are shut off or inhibited or not doing their job.
And that has a lot to do with not just movement, but then also pelvic position. So if we’re in hip elevation, for instance, and one side is longer, maybe that lateral glute, the glute medius glute minimus are inhibited there or not doing their job. And the other one might be actually short and tight and stuck. So that’s where that postural positioning comes in also. And so that can also speak to the types of movement.
So, it’s great. Get up, walk. Stairs are good. You know, you can put one foot up on top of a chair and kinda stretch and do things that way. The antagonist to your glute also is your hip flexor.
So getting your hips to open up on the front as well, and then lengthen on the front, and that will allow the reciprocation also of the glute to do its job. So moving back and forth in flexion. So going up and downstairs, I think you guys mentioned that also, but going up two steps even getting that long, elongated stride. Every time you hit the ground walking too, your glutes are supposed to fire. So that’s, you know, we’re really not designed to sit.
Our human evolution was not based on sitting at a desk or in a chair for hours at a time. So, it’s really based on movement. So our body operates and moves, or works most efficiently with that. So if things are starting to shut down, I guess the people who understand that see that they have glute amnesia and so that’s a good thing.
Listen to the signs and then, yeah, let’s let’s do something about it. And you can do something about it, you know, through movement, through exercise. Because, like, your client, Carrie Ann that you brought in, was there anything specific going back to her? Was there anything specific with her that you?
She actually has frozen shoulder. That’s why she’s coming in, which I you know, with her, I went through the whole thing about her upper back is locking out your back and leading to your glutes not turning on. But, also, it could go back to her glutes not firing for so many years, which is why she’s got a frozen shoulder now.
Exactly. The body working as a unit rather than looking at it as isolated parts.
Yeah. For me, that’s the main thing I want people to hear. That’s the main takeaway that, yes, you might have a dead butt, but that’s probably not the only thing that isn’t working at capacity. And it’s just really important to kinda move and check all the parts. And the one thing that you talked a lot about going up and downstairs and walking, but lateral movement is also important, especially if you wanna get glute med, shuffle sideways. You know? Dance. Dance is good for you. Do silly weird movements too.
I have a client. I wanna say she has dead butt syndrome. So it was interesting as one of the tests I do is just glute contraction. Just stand there and squeeze your buttocks. And when she did it, as soon as she squeezed her buttocks, her toes just did this on both sides. Her toe is just lifted up. So I was like hmmm. , I was like, okay, I’d like you to try that again, but try not to lift your toes.
And she was like, oh, oh, gosh. This is really hard. She couldn’t because then she was trying to grip her toes to the floor, and then her shoulders just did this. So kind of like opposite ends of her body were pulling to get her glutes to actually contract.
And then I was like, oh, your shoulders went up. But she’s like, I felt that. So I was like, try not to have your shoulders or your toes. And then when you look at her toes, on the knuckles of her 2, 3, 4 toes are calluses because her toes are overworking whenever she walks to try to get her glutes to fire that she’s just like, oh, yeah. I’ve always just had these calluses.
I always have to get my shoes half the size larger because the toe box is too small because she keeps hitting her toes. So it was such an interesting thing to see kind of, again, both ends of her body, either her toes or her shoulders. And her shoulders are very forward, very tight, very stiff, and her toes have these calluses. And when I put her lying down in a different position like hooklying and just to do glute squeezes, she can’t. She can’t squeeze her bottom at all. So it’s one of those things of, yeah, you can try bridges, but will that actually get your butt to fire, or will, again, the toes or something else compensate for it? So it’s all working to help each other out.
Yeah. That’s a great point about compensation through the body and how certain areas will compensate. So and it reminds me, yeah, for decades, we’ve been dealing with glute amnesia and dead butt syndrome with people. We just didn’t have the proper name for it.
So now that it has been dubbed as such, then we can use that term, and people will get it as far as what we’re talking about. But, yeah. So that is a good test for people watching this. They can stand up and just try and squeeze your glutes because there are so many people who can’t even do that or they feel one side working and not the other side working. And that’s not just after you’ve been sitting for hours. That’s any time. And then you may watch in the mirror too. Like, yeah, does something else contract? Or do you maybe feel your quads instead of your glutes firing? Or maybe you feel you have to get your abdominals involved and it’s not really your glutes.
The other thing that you should observe, if you have a full length mirror, observe your knees. So put on some shorts or something, and watch your knees. Because when you squeeze your glutes, they’re external rotators. So I’ve worked a lot of people who I’ll ask them to do that, and they’ll go like, yeah. I’m starting… and I can’t see. So they’re facing me. So are you squeezing your glutes? And then they’ll go, yeah. I’m squeezing them.
But there’s no movement. So there’s no leverage there. So that’s usually when they’re stuck in the anterior pelvic tilt or their femurs are stuck in the socket where they’re squeezing them, so they’re actually getting the activation, but there’s no movement. So the glute again the glute max is an external rotator. So if they’re really squeezing it, then we should see some femur movement or some knee, you know, pointing out movement as they’re doing that.
So, a little test. Try it at home.
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