By Dr. Zach Greenwade, DC, MS | Published: June 15th, 2026
In our clinic, one of the most common things we hear is, “I’ve been doing clamshells for weeks, but my hip still hurts.”
For patients with gluteal tendinopathy, greater trochanteric pain syndrome, or other forms of lateral hip pain, clamshells can sometimes aggravate symptoms by placing already irritated tendons in a compressed position. While they do activate the gluteus medius, they are often not the most comfortable or effective option.
Instead, we typically focus on exercises that strengthen the hip while minimizing tendon compression, helping patients build strength and stability without increasing pain. Interested in the myths surrounding gluteal tendinopathy and bursitis? Check out our blog.
Watch the Video Breakdown
Before diving into the science below, check out this quick breakdown of how this common movement can work against your recovery:
📺 Watch: Why Clamshells May Aggravate Hip Pain
What Is a Clamshell, Anyway?
The exercise is simple: you lie on your side with your knees bent and feet together, then lift your top knee open like a opening clam.
The goal is to isolate the gluteus medius. When this muscle is weak, it causes the pelvis to drop or tilt, placing extra stress on your lower back, knees, and hips. While the intention behind the clamshell is great, the physics of the movement can create a perfect storm for certain types of hip pain.
3 Reasons Clamshells Can Make Hip Pain Worse
1. They Compress Irritated Tendons
The most common culprit behind outer hip pain is gluteal tendinopathy (often lumped under the umbrella term Greater Trochanteric Pain Syndrome). This is an injury to the tendons that attach your glute muscles to the bony bump on the side of your hip (the greater trochanter).
When a tendon is healthy, it tolerates compression well. But when it is injured and highly sensitive, compressing it makes it worse. When you bend your hips and rotate your leg open during a clamshell, you are repeatedly squeezing and rubbing that sensitive tendon right against the bone. It’s the mechanical equivalent of rubbing a shoe against an active blister.
2. The Position Provokes Sensitive Structures
Many painful hip conditions are highly aggravated by a specific combination of movements: hip flexion (bending), internal rotation, and joint compression.
The starting position of a clamshell puts your hip into these exact angles. If you find yourself tossing and turning with side-hip pain at night, or if walking and climbing stairs feels more painful a few hours after your workout, the clamshell is likely overloading a highly reactive joint or tendon.
3. They Aren’t Actually That Efficient
From a purely biographical standpoint, the clamshell is a relatively low-yield exercise. Electromyography (EMG) studies—which measure how hard a muscle is actually working—show that clamshells produce significantly lower gluteus medius activation compared to several simpler, non-compressing alternatives. If your goal is to build real-world strength and pelvic stability, there are much faster ways to get there.
The most common culprit behind outer hip pain is gluteal tendinopathy (often lumped under the umbrella term Greater Trochanteric Pain Syndrome).
👉 If you’re unsure whether your pain is from a bursitis vs tendinopathy, read this guide.
Ready to Get to the Root of Your Hip Pain?
If your outer hip pain isn’t improving—or clamshell exercises seem to make it worse—a personalized assessment can help identify the underlying cause and create a treatment plan tailored to your goals.
👉 Book Your Hip Evaluation Online
A Pain-Free Progression: Better Alternatives to the Clamshell
To get your hip moving in the right direction, you need exercises that recruit the gluteus medius without smashing the tendon against the bone. Here is a progressive roadmap based on your current pain levels.
Lie on your side with your top leg completely straight. Raise your leg toward the ceiling, keeping your toes pointing straight ahead (don’t let them turn up) and your heel slightly back.
Tip: Do this with your back and heel resting lightly against a wall to keep your pelvis perfectly stable.
Using a low step, step up firmly onto the platform. Focus entirely on keeping your hips level—do not let your trailing hip drop or your torso lean excessively to the side. This builds strength in a functional position that directly carries over to walking and climbing stairs.
Once basic weight-bearing is pain-free, progress to lateral step-ups (stepping up sideways onto a box) to heavily challenge your hip stabilizers. Pair this with side planks to integrate your core, obliques, and deep hip stabilizers for long-term protection.
👉 If you’re also wondering how to modify daily positions and activities with gluteal tendinopathy, see this guide on positions and activity modifications.
👉 Read: The Best Exercises for Gluteal Tendinopathy (Easy to Advanced)
Does the Clamshell Ever Have a Place?
This doesn’t mean the clamshell is inherently “bad” or should be banned forever. It can still be a helpful tool in specific scenarios:
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Early-stage motor control: Helping a patient “find” and wake up a dormant glute muscle.
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Low-load activation: For individuals who aren’t dealing with structural tendon sensitivity or bursitis.
However, if you have active, sharp, or aching lateral hip pain, the clamshell is usually the wrong tool for the job.
The Bottom Line
If you have outer hip pain, pain when lying on your side, or discomfort that lingers after doing clamshells, stop forcing it. Shifting to exercises that strengthen the glutes while minimizing tendon compression will yield faster results, less pain, and a much smoother return to your favorite daily activities.
📅 Ready to fix your hip pain and get a full night’s sleep?
Ready to Find the True Cause of Your Hip Pain?
Generic, one-size-fits-all exercise sheets fail because they don’t account for the unique physics of your injury. Outer hip pain can stem from your gluteal tendons, localized bursitis, joint irritation, or even referred pain from your lower back.
Our team specializes in evidence-based, highly individualized physical therapy plans designed to get you moving pain-free without the guesswork.
[👉 Click Here to Book Your Personalized Assessment Online Today]
