Chiropractic Care Methods For Gluteus Medius Tendinopathy

Find effective solutions for gluteus medius tendinopathy with chiropractic care. Improve your health and regain function now.

Abstract

This educational post explores the diagnosis and management of gluteus medius tendinopathy, a common and often misdiagnosed cause of lateral hip pain, frequently referred to as greater trochanteric pain syndrome (GTPS). As a practitioner with a diverse background in chiropractic, nursing, and functional medicine, I will guide you through a typical clinical encounter, mirroring a case we recently managed at our clinic. We will discuss the hip’s anatomy, the pathophysiology of tendon injuries, and the rationale behind our diagnostic process. We will focus on the ultrasound-guided injection procedure, explaining the technique, the medications used, and the immediate patient feedback that confirms our diagnostic accuracy. This post also highlights our integrative care model at Injury Medical Clinic PA, where I, Dr. Alex Jimenez, work closely with our Medical Director, Dr. Maria Guadalupe Cardenas, a seasoned Internist. This multidisciplinary framework allows us to blend advanced diagnostic and interventional procedures with the foundational principles of chiropractic care, functional medicine, rehabilitation, and personal injury management. We aim to provide a comprehensive, evidence-based journey into why this integrated approach offers a superior pathway to healing and long-term resolution for complex musculoskeletal conditions like gluteus medius tendinopathy.

Our Collaborative Care Model: Bridging Medicine and Chiropractic

Before we delve into the specifics of hip pain, I believe iit’sessential to set the stage by explaining the unique clinical environment we’ve cultivated here in El Paso, Texas. At Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic), our philosophy is rooted in integrative medicine. This isn’t just a buzzword for us; it is the structural and philosophical foundation of our practice.

I am Dr. Alex Jimenez, and my journey in healthcare has been intentionally diverse. My credentials—DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST—reflect a commitment to understanding the human body from multiple perspectives. As a Doctor of Chiropractic (DC), my focus is on biomechanics, spinal health, and the nervous system’s role in governing bodily function. As an Advanced Practice Registered Nurse (APRN) and board-certified Family Nurse Practitioner (FNP-BC), I am trained in conventional medical diagnosis and treatment, including pharmacology and interventional procedures. My certifications in Functional Medicine (CFMP, IFMCP) and as an Autoimmune Trigger Specialist (ATN) drive my passion for uncovering the root causes of chronic disease by examining genetics, lifestyle, and environmental factors.

My collaboration with Dr. Maria Guadalupe Cardenas, MD, powerfully augments this multifaceted expertise. Dr. Cardenas is a highly respected, board-certified physician in Internal Medicine with over 40 years of clinical experience. Her Texas MD License is #J2933, and her NPI is #1164426749. As our clinic’s Medical Director and Collaborative Physician, she provides essential medical oversight to ensure our practices meet the highest standards of care. This MD-DC collaboration is a cornerstone of our multidisciplinary setup, especially in injury and integrative care settings.

Together, Dr. Cardenas and I lead a team that integrates:

• Medical Diagnosis & Oversight (Dr. Cardenas): Ensuring all treatments are medically sound and appropriate, especially for patients with complex comorbidities or those involved in personal injury cases.
• Advanced Interventional Procedures (Dr. Jimenez): Including the ultrasound-guided injections we will discuss shortly.
• Chiropractic Care (Dr. Jimenez): Focusing on spinal alignment, pelvic balance, and nervous system integrity, which are crucial for resolving the biomechanical faults that often lead to conditions like hip tendinopathy.
• Functional Medicine: Investigating and addressing systemic inflammation, nutritional deficiencies, and metabolic imbalances that can impair tendon healing.
• Rehabilitation & Physical Therapy: Prescribing targeted exercises to strengthen weak muscles, stretch tight structures, and restore proper movement patterns.

This model allows us to offer a truly holistic patient journey. We don’t just treat the site of pain; we diagnose and manage the interconnected factors that contribute to it. Now, let’s apply this thinking to a common, frustrating problem: lateral hip pain.

Decoding Hip Pain: A Clinical Encounter with Gluteus Medius Tendinopathy

On the morning of September 15, 2026, a 57-year-old gentleman presented to our clinic with a two-month history of persistent left hip pain. This is a classic scenario we see frequently. Patients often point to the bony prominence on the side of their hip and report an ache that worsens when they lie on that side, walk, or climb stairs. For years, clinicians generically labeled this “trochanteric bursitis,” and treatment often involved blind corticosteroid injections into the bursa.

However, modern research, particularly studies utilizing MRI and ultrasound, has revealed a more complex picture. Leading researchers have shown that in most cases of what is now termed Greater Trochanteric Pain Syndrome (GTPS), the primary pathology is not bursitis but tendinopathy of the gluteus medius and/or minimus muscles (Longo et al., 2021). If present, bursal inflammation is often a secondary reaction to the underlying tendon injury. This distinction is critical, as it fundamentally changes our treatment approach.

The Diagnostic Journey: Finding the Exact Source of Pain

My first step with this patient was to listen carefully to his story and then perform a focused physical examination. The goal is to replicate the patient’s specific pain with precision. This is what we call finding the “concordant pain”—a diagnostic gold standard.

I asked him to point to the exact location of his pain. He indicated an area not directly on the most prominent part of the hip bone (the greater trochanter), but slightly behind and above it. This is a key anatomical clue. The gluteus medius tendon has a broad insertion onto the posterosuperior and lateral facets of the greater trochanter. Pain in this region strongly suggests tendon involvement.

To confirm, I applied firm, targeted pressure. “So, any pain right there?” I asked.

“Some,” he replied.

I adjusted my position slightly. “Further down… Right there. Right in there.”

“And does that exactly replicate the pain that you’re having today?”

“Slowly, yes. Yeah. Yes,” he confirmed.

This was our “aha” moment. We had located the precise spot. I marked it with a surgical pen. This careful palpation is the first, crucial step. It transforms the treatment from a guess into a targeted intervention. Without this confirmation, we risk injecting the wrong structure, leading to failed treatment and continued patient frustration.

Why the Gluteus Medius is So Important

To understand why this small area matters, we need to understand the role of the gluteus medius muscle. Along with the gluteus minimus, it is a primary stabilizer of the pelvis. When you walk, run, or even stand on one leg, these muscles fire to keep your pelvis level. If they are weak or inhibited, the opposite side of the pelvis will drop, a phenomenon known as a Trendelenburg sign.

This weakness leads to a cascade of biomechanical compensations. The tensor fascia lata (TFL) muscle and the iliotibial (IT) band become overworked as they try to assist in hip abduction and stabilization. This chronic overuse and altered loading pattern places immense strain on the gluteus medius tendon right where it anchors to the bone. Over time, this repetitive microtrauma leads to tendinopathy.

Tendinopathy is not simply inflammation (which would be “tendinitis”). It’s a degenerative process. The tendon’s neatly organized collagen fibers become disorganized and frayed. The tendon may show increased ground substance (the gel-like material between the fibers), neovascularization (abnormal ingrowth of new, dysfunctional blood vessels), and nerve ingrowth, which contribute to chronic pain signals (Cook & Purdam, 2009). This degenerative state impairs the tendon’s ability to handle load, perpetuating the cycle of pain and dysfunction.

The Intervention: An Ultrasound-Guided Gluteus Medius Tendon Injection

Having identified the gluteus medius tendon as the likely culprit, the next step was a diagnostic and therapeutic injection. While we could perform this “blind” using landmarks, ultrasound guidance turns the procedure into a science. Ultrasound lets us see the needle in real time as it travels through the tissues, confirming placement directly at the site of pathology—the degenerated tendon or the peritendinous space. This significantly increases the injection’s accuracy, safety, and efficacy (Finnoff et al., 2015).

The Preparation Protocol

Safety and sterility are paramount. My protocol began with meticulous preparation of the injection site.

1. Cleansing: I prepped the marked area first with alcohol wipes to remove surface oils and debris.
2. Antisepsis: I then performed two passes with povidone-iodine. This broad-spectrum antiseptic is highly effective at reducing theskin’ss bacterial load, minimizing the risk of a joint or soft tissue infection, which, although rare, can be a devastating complication.
3. Local Anesthesia: To make the procedure as comfortable as possible, I used a topical vapocoolant spray. I told the patient, “I’m going to give you a free spray of this area.” He felt the intense cold, which temporarily numbed the superficial nerve endings in the skin. This is known as cryoanesthesia. Its effect is brief but very effective at dulling the initial sharp sensation of the needle piercing the skin.

The Injection Technique: A Multi-Sensory Approach

With the patient prepped and the area numbed, I began the injection. Even without ultrasound in this specific demonstration, my technique relies on tactile feedback and a deep understanding of anatomy.

“Now I feel it enter the muscle, the tendon, right there,” I noted.

This subtle but distinct sensation comes with experience. When the needle passes through skin and subcutaneous fat, the resistance is minimal. As it enters the dense, fibrous tissue of a fascia or a tendon, there is a clear increase in resistance—a “gritty” or “leathery” feel. I often teach students, “If you just slide down with your fingers along the sides of the syringe, right when it starts to slip, that’s where you know you’ve got increased resistance.” Your fingers can feel the increased pressure required to advance the plunger.

“So I believe I’m there. Let me give you a little injection there,” I said as I administered a small amount of the solution.

The most important question followed immediately: “Does that actually feel like the pain that you have?”

“Yes,” he replied.

This is the diagnostic confirmation we were seeking. Injecting a small volume of liquid into the pathological tissue distends it, recreating the patient’s familiar pain. This confirms that the needle tip is precisely in the structure responsible for their symptoms.

The “Fanning” Technique and Rationale

The gluteus medius insertion is not a single point; it’s a broad “footprint” on the bone. To ensure the medication covers the entire affected area, I use a “fanning” technique.

“Okay. I’m going to fan it just a little bit,” I explained.

This involves keeping the needle entry point in the skin the same but angling the tip to different locations within the target tissue. I partially withdraw the needle (without exiting the skin) and then redirect it slightly superiorly, then inferiorly, then anteriorly and posteriorly, depositing a small amount of medication with each pass. This ensures the therapeutic solution distributes throughout the degenerated portion of the tendon.

“Okay. Give you a little bit right here… Let me do it one more time, and advance right there.”

After the final medication deposition, the procedure was complete. “Injection is in. Right, I’m out. The needle is out.”

The Contents of the Syringe: What Are We Injecting and Why?

What you inject is as critical as where you inject it. A typical mixture for a diagnostic and therapeutic injection like this includes:

1. Local Anesthetic (e.g., Lidocaine or Bupivacaine): The primary purpose of the anesthetic is diagnostic. If we inject a numbing agent into the suspected pain generator and the patient’s pain is significantly relieved within minutes, we have strong evidence that we’ve found the right spot. Bupivacaine: Anesthetic with a longer duration of action than Lidocaine, providing several hours of anesthesia and giving us a clearer diagnostic window.
2. Corticosteroid (e.g., Kenalog or Dexamethasone): This is the therapeutic option. Corticosteroids are powerful anti-inflammatory medications. While we’ve established that tendinopathy is primarily degenerative, it often has a secondary inflammatory component, especially in the surrounding bursa or peritendinous tissues (Rehman & Finnoff, 2016). Steroids help quell this inflammation, providing significant pain relief. This relief is crucial because it breaks the pain-spasm-pain cycle and opens a “window of opportunity” for the most important part of treatment: rehabilitative exercise. It’s important to note that repeated steroid injections into a tendon can have a degenerative effect themselves, potentially weakening the tendon. Therefore, use them judiciously, and view them as a tool to facilitate rehabilitation, not a standalone cure.

In recent years, regenerative medicine has offered alternatives to corticosteroids, such as Platelet-Rich Plasma (PRP) or prolotherapy, which aim to stimulate the body’s healing and regenerative processes rather than suppress inflammation. The choice of injectate depends on the condition’s chronicity, the patient’s overall health, and a shared decision-making process between the patient and our clinical team.

Immediate Post-Procedure Assessment: Gauging Success

The moments immediately following the injection are rich with diagnostic information.

“Now, let me massage the area here,” I said. This helps to disperse the medication within the tissues.

I then re-palpated the same spot that had been exquisitely tender just a few minutes earlier. “Okay. We are done. You had quite a bit of discomfort during that procedure. Okay. Does this hurt? What I’m doing right now.”

“Just a little,” he answered.

This was a positive sign. The anesthetic was already working. To quantify the improvement, I asked, “Is it less than it was earlier?”

“Yes, it was,” he confirmed.

This immediate feedback is invaluable. “All right. So that’s a good sign,” I explained to him. “That means that the numbing medicine is in the right spot for anesthesia. I’m encouraged by that.”

This accomplishes two things:

1. It confirms the diagnosis: We have successfully numbed the primary pain generator.
2. It builds patient confidence: The patient experiences immediate, tangible relief, which fosters trust in the treatment plan and motivates them to engage in the next, most critical phase: rehabilitation.

I placed a simple adhesive bandage over the site, and the interventional part of his visit was complete.

The Integrative Chiropractic and Rehabilitative Framework: The Path to Lasting Recovery

The injection is not the end of treatment; it is the beginning. The pain relief it provides is temporary if you don’t address the underlying biomechanical faults. This is where our integrative model, combining chiropractic care, functional medicine, and rehabilitation, truly shines.

Step 1: Chiropractic Assessment and Adjustment

As a chiropractor, my immediate next step is to assess the patient’s entire kinetic chain, starting with the foundation: the pelvis and lumbar spine. Hip muscle dysfunction rarely occurs in isolation. It is almost always linked to imbalances in the sacroiliac (SI) joints, lumbar spine misalignments (subluxations), or leg length discrepancies.

• Pelvic and Sacroiliac Joint Evaluation: I would assess for pelvic obliquity (an unleveling of the pelvis), SI joint fixation, or hypermobility. The gluteus medius is a key pelvic stabilizer, and its function is closely tied to SI joint stability. Specific chiropractic adjustments to the pelvis and SI joints (e.g., Diversified, Thompson Drop, Activator) can restore proper joint mechanics, allowing the hip musculature to function in a more balanced environment.
• Lumbar Spine Assessment: Nerve roots that exit the lumbar spine (specifically L4, L5, S1) form the superior gluteal nerve, which innervates the gluteus medius and minimus. Compression or irritation of these nerve roots from a disc bulge, foraminal stenosis, or spinal subluxation can inhibit and weaken these muscles. This neurological weakness is a primary driver of the tendinopathy. A chiropractic adjustment to the lumbar spine can help decompress these nerves, restoring proper nerve flow and “switching on” the inhibited gluteal muscles.
• Biomechanical Analysis: I would also observe the patient’s gait and perform functional tests like the single-leg squat. This reveals the compensatory patterns that have developed. Does the knee dive inward (valgus collapse)? Does the pelvis drop (Trendelenburg sign)? Does the trunk lean excessively? These observations guide the rehabilitation plan.

Step 2: A Phased Rehabilitation Program

With the injection controlling the pain and chiropractic adjustments improving biomechanics, the patient is now ready for therapeutic exercise. This must be carefully dosed and progressed. Trying to do too much too soon on a painful, degenerative tendon will only flare it up.

The program, supervised by our rehabilitation team, typically follows these phases:

• Phase 1: Isometric Loading (Weeks 0-2): Immediately post-injection, we start with isometrics. These are muscle contractions without moving the joint. For example, the patient might lie on their back with a belt around their thighs and try to push their legs apart against the belt, holding the contraction for 30-45 seconds. Research by Rio et al. (2015) shows that heavy isometric loading has a profound analgesic effect on tendinopathic pain, reducing pain for several hours after exercise. This allows the patient to begin strengthening without irritation.
• Phase 2: Isotonic Strengthening (Weeks 2-6): As pain subsides, we introduce isotonic exercises (muscle contractions with movement) in a limited, pain-free range of motion. Classic examples include clamshells, sidelying leg raises, and bridges. The key here is form. We vigilantly prevent compensation from the TFL or lower back. The goal is to isolate and strengthen the gluteus medius.
• Phase 3: Functional and Compound Movements (Weeks 6-12): In this phase, we integrate the newly acquired gluteal strength into functional movements. This includes exercises like squats, lunges, and step-ups, with a strong focus on maintaining a level pelvis and proper knee tracking. We might also introduce weighted exercises like deadlifts or kettlebell swings to teach the patient to hinge at the hips and engage the entire posterior chain correctly.
• Phase 4: Return to Activity/Sport: The final phase gradually reintroduces the specific activities the patient loves, whether it’s running, playing tennis, or simply going for long walks without pain. We analyze the specific demands of their chosen activity and ensure their body can handle those loads without reverting to old, dysfunctional movement patterns.

Step 3: The Functional Medicine Perspective

At the same time, my functional medicine hat prompts me to ask: Why did this patient’s tendon fail to heal in the first place? Tendons, like all tissues, require specific nutrients for repair and are susceptible to damage from systemic inflammation.

• Anti-Inflammatory Diet: We provide guidance on adopting a diet rich in anti-inflammatory foods like omega-3 fatty acids (found in fish oil, flaxseeds), polyphenols (found in colorful fruits, vegetables, green tea), and spices like turmeric and ginger. We also advise reducing pro-inflammatory foods like processed sugars, refined carbohydrates, and unhealthy fats.
• Targeted Supplementation: Based on the patient’s history and, if appropriate, lab testing, we may recommend specific supplements to support tendon health. These can include:

• Collagen Peptides: The building blocks of tendon tissue.
• Vitamin C, Zinc, and Copper: Essential co-factors for collagen synthesis.
• Glucosamine and Chondroitin: Often associated with cartilage, but also support the health of the extracellular matrix in tendons.
• Magnesium: Crucial for muscle relaxation and energy production.

• Addressing Systemic Issues: We screen for underlying conditions that can impair healing, such as insulin resistance, hypothyroidism, or autoimmune conditions. Uncontrolled blood sugar, for example, leads to the formation of Advanced Glycation End-products (AGEs), which can cross-link with collagen fibers, making tendons stiff, brittle, and prone to injury (Abate et al., 2013). Addressing these systemic drivers is often the missing piece in resolving chronic musculoskeletal pain.

Conclusion: A Synthesis of Disciplines for Optimal Outcomes

The case of the 57-year-old gentleman with left hip pain perfectly illustrates our philosophy at Injury Medical Clinic PA. It shows a journey that begins with a precise, evidence-based diagnosis, moves to targeted medical intervention to control symptoms, and then pivots to address the root cause through an integrated program of chiropractic care, targeted rehabilitation, and functional medicine.

The injection was technically successful, as the patient confirmed with immediate feedback. But its true value lies in its role as a catalyst. It opened a window of opportunity, allowing us to correct the underlying biomechanical and physiological dysfunctions that led to the pain in the first place.

Under the collaborative medical direction of Dr. Maria Cardenas, our clinic is uniquely positioned to offer this level of comprehensive care. We are not just “pain managers”; we are health restorers. By seamlessly blending the best of conventional medicine, chiropractic, and functional health principles, we guide our patients away from a cycle of recurring pain and toward a future of resilient, durable, and vibrant health. The goal is not just to get a patient out of pain for a few weeks but to empower them with the strength, stability, and knowledge to prevent recurrence and live their life to the fullest.

References

• Abate, M., Schiavone, C., Salini, V., & Andia, I. (2013). Occurrence of tendon pathologies in metabolic disorders. The Open Sports Medicine Journal, 4(1), 101-109. https://benthamopen.com/contents/pdf/TOSPMJ/TOSPMJ-4-101.pdf
• Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409–416. https://bjsm.bmj.com/content/43/6/409
• Finnoff, J. T., Hall, M. M., Adams, E., Berkoff, D., Conlee, K., & Onishi, K. (2015). American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. Clinical Journal of Sport Medicine, 25(1), 6-22. https://journals.lww.com/cjsportsmed/Fulltext/2015/01000/American_Medical_Society_for_Sports_Medicine.3.aspx
• Longo, U. G., Risi, Ambrogioni, L., & Denaro, V. (2021). Greater trochanteric pain syndrome. Journal of Clinical Medicine, 10(7), 1358. https://www.mdpi.com/2077-0383/10/7/1358
• Rehman, H., & Finnoff, J. T. (2016). The logic of using corticosteroid injections for greater trochanteric pain syndrome. PM&R, 8(9), 896-902. https://onlinelibrary.wiley.com/doi/abs/10.1016/j.pmrj.2016.03.003
• Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283. https://bjsm.bmj.com/content/49/19/1277

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