Chiropractic Care Tips for Gluteus Medius Tendinopathy

Discover the role of chiropractic care in managing gluteus medius tendinopathy and enhancing functional recovery.

Abstract

Welcome to our educational series where we explore the complexities of musculoskeletal health through the lens of integrative and functional medicine. I am Dr. Alex Jimenez, and today, we will take a deep dive into a very common yet frequently misunderstood source of hip pain: gluteus medius tendinopathy. This condition, often misdiagnosed as hip bursitis or even sciatic nerve issues, can cause significant discomfort and functional limitation. In this post, I will walk you through a real clinical case from my practice, explaining the diagnostic process, the anatomy and underlying causes, and a specific treatment approach—an ultrasound-guided injection. We will explore why this pain occurs, how we precisely identify the affected tissue, and the rationale behind targeted interventions. Furthermore, I will detail how this specific procedure fits into our broader, comprehensive care model at Injury Medical Clinic. This model integrates my expertise in chiropractic care, advanced practice nursing, and functional medicine with Dr. Mariae Cardenas, MD’s invaluable medical oversight. Together, we provide a multidisciplinary framework that encompasses diagnostics, targeted medical procedures, chiropractic adjustments, advanced rehabilitation, and functional medicine to address not just the symptoms, but the root causes of our patients’ health challenges. This journey will illuminate the intricate connections between biomechanics, inflammation, and chronic pain, offering a clear, evidence-based roadmap to recovery.

Our Integrative Care Philosophy: A Collaborative Approach to Healing

Before we delve into the specifics of hip pain, I believe it’s crucial to understand the foundation of our entire practice. At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in beautiful El Paso, Texas, we have cultivated a unique, multidisciplinary environment dedicated to providing the most comprehensive and effective care possible. This is a clinic; it’s a collaborative ecosystem where different medical disciplines converge for the singular purpose of patient-centered healing.

A cornerstone of this ecosystem is our partnership with Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected, board-certified Internist with over four decades of clinical experience. Her extensive knowledge and medical authority are indispensable to our practice. She serves as our Medical Director and Collaborative Physician, providing essential medical oversight for the advanced procedures and diagnostic pathways we utilize. This collaborative agreement is a common and highly effective structure in modern integrative and injury care settings. It allows a Doctor of Chiropractic like myself, with advanced training as a Family Nurse Practitioner (APRN, FNP-BC) and certifications in functional medicine (CFMP, IFMCP), to work in synergy with a medical doctor.

This integration allows us to offer a spectrum of care that a single-discipline clinic simply cannot match. Here’s a glimpse into how our team functions:

• Medical Oversight (Dr. Cardenas): Cardenas provides the medical framework for our practice. She reviews complex cases, provides consultations, and oversees the medical propriety of our treatment plans, especially those involving injections, prescription medications, and advanced diagnostic imaging. Her role ensures that all our interventions meet the highest standards of medical safety and efficacy.
• Chiropractic & Advanced Practice Nursing (Dr. Jimenez): My dual qualifications allow me to bridge the gap between different healing philosophies. As a Doctor of Chiropractic (DC), my focus is on the biomechanical integrity of the body—the relationship between the spine, the nervous system, and overall health. I utilize spinal adjustments, soft tissue manipulation, and ENT assessments to restore proper alignment and function. As an Advanced Practice Registered Nurse and Family Nurse Practitioner (APRN, FNP-BC), I can perform comprehensive physical examinations, order and interpret diagnostic tests, and administer advanced procedures like the ultrasound-guided injection we will discuss today.
• Functional Medicine: Both Dr. Cardenas and I are deeply invested in a functional medicine approach. This means we look beyond the diagnosis to understand why a patient’s condition occurs. We investigate underlying factors like systemic inflammation, nutritional deficiencies, hormonal imbalances, and gut health, which can all contribute to musculoskeletal pain and poor healing.
• Rehabilitation & Personal Injury: Our rehabilitation specialists guide patients through personalized exercise programs. We focus on strengthening weakened muscles, improving flexibility, and correcting faulty movement patterns that contribute to injury. This is particularly vital for personal injury cases, where our integrated approach ensures a thorough and well-documented recovery process.

By weaving these disciplines together, we create a powerful therapeutic tapestry. A patient with chronic hip pain doesn’t just receive a diagnosis; they receive a holistic evaluation that considers their structural alignment, muscular function, inflammatory status, and overall systemic health. This is the future of healthcare, and it’s the standard of care we provide every day.

A Clinical Encounter: Identifying the Source of Lateral Hip Pain

This morning, September 15, 2026, perfectly illustrated our diagnostic process in action. A 57-year-old gentleman came into my office with a primary complaint of left hip pain that had been troubling him for about two months. When a patient presents with “hip pain,” my first objective is to get extremely specific. The hip is a complex region, and the pain’s precise location is the first major clue in our diagnostic puzzle.

He described the pain as being located on the outer aspect of his hip. I began to palpate the area with my hands. Palpation is a fundamental diagnostic skill; it uses touch to detect abnormalities in temperature, texture, tenderness, and tissue tension. I started by locating the greater trochanter, a prominent bony landmark on the side of the hip. It’s part of the femur (thigh bone) and serves as a major attachment site for several powerful muscles that move and stabilize the hip.

The patient pointed to an area just posterior (behind) and superior (above) the most prominent part of the greater trochanter. This is a critical detail. Pain directly over the bony prominence often suggests trochanteric bursitis, where the fluid-filled sac (bursa) that cushions the bone becomes inflamed. However, his pain was concentrated slightly away from that point, in the soft tissue region where the gluteal tendons insert.

I applied firm, targeted pressure to that specific spot. “Does this reproduce the pain you’ve been experiencing?””I asked.

He winced slightly. “Slowly, yes,” he confirmed. “”hat’s the spot.””

This is what we call provocative testing. We are intentionally trying to replicate the patient’s exact pain. When manual pressure on a specific anatomical structure perfectly reproduces the patient’s chief complaint, it strongly suggests that structure is the source of the problem. I marked the area with a surgical pen. In this gentleman’s case, all signs pointed not to the bursa, but to the tendons of the gluteus medius and possibly the gluteus minimus muscles.

Why Gluteus Medius Tendinopathy is So Common

To understand why this area is so susceptible to injury, we need to understand the hip’s anatomy and biomechanics. The gluteus medius muscle originates from the iliac crest (the top of your pelvic bone) and runs downward and forward to insert onto the lateral facet of the greater trochanter. Its primary job is not to extend the hip (that’s the gluteus maximus), but to abduct the hip (lift the leg out to the side) and, most importantly, to stabilize the pelvis when you are standing on one leg.

Think about the simple act of walking. Every time you take a step, you are momentarily balancing on one leg. During that single-leg stance phase, the gluteus medius on your standing leg contracts powerfully to prevent your opposite hip from dropping. This prevents a Trendelenburg gait. Without a strong, functional gluteus medius, your pelvis would tilt downward on the unsupported side, leading to a waddling gait and placing tremendous stress on your lower back, hip, and knee joints.

This constant, repetitive load makes the gluteus medius tendon vulnerable to micro-trauma and degenerative changes over time. This process is called tendinopathy, a more accurate term than “tendinitis.””“Tendinitis”” implies that the primary problem is inflammation (-itis). However, modern research, including histopathological studies of tendon biopsies, has shown that in chronic tendon pain, the issue is more often a degenerative process. This is characterized by:

• Collagen Disorganization: Healthy tendons have tightly packed, parallel collagen fibers that give them immense tensile strength. In tendinopathy, these fibers become disorganized, tangled, and separated.
• Neovascularization: New, dysfunctional blood vessels grow in. While this might sound like a good thing (more blood flow), these vessels often come with new nerve endings, which can cause pain.
• Increased Ground Substance: The matrix between the collagen fibers swells with water-retaining molecules, thickening the tendon without improving function.

This degenerative state is often termed tendinosis. It’s a failed healing response. The tendon tries to repair itself from repetitive strain, but the repair process is incomplete and disorganized, resulting in a structurally weaker, often painful tendon. This condition is particularly common in middle-aged and older adults, especially women, due to factors like pelvic width and hormonal changes. It’s also prevalent in runners and other athletes who place high repetitive loads on their hips.

In our patient’s case, the two-month history of pain, his age, and the precise location of his tenderness strongly suggested gluteus medius tendinopathy. He was experiencing pain from a weakened, degenerated tendon that was struggling to cope with the daily demands of walking and standing.

The Treatment Strategy: A Targeted Injection for Diagnosis and Therapy

Once we have a strong clinical suspicion, we confirm the diagnosis and initiate treatment. For tendinopathies, one of the most effective tools in our arsenal is an ultrasound-guided injection. This procedure serves a dual purpose: it is both diagnostic and therapeutic.

Preparing for the Procedure

With the patient’s consent, we decided to proceed with an injection into the gluteus medius tendon insertion. The first and most critical step is ensuring a sterile field to prevent infection. This is non-negotiable.

1. Cleansing the Skin: I began by prepping the marked area on his hip. I first used several swipes of an alcohol pad to remove surface oils and debris.
2. Antiseptic Application: Following the alcohol, I used povidone-iodine Povidone-iodine is a powerful, broad-spectrum antiseptic that is highly effective at killing bacteria, viruses, and fungi on the skin. I applied it in expanding concentric circles, starting at the intended injection site and Working Outward. This ensures we don’t miss the periphery and protects the sterile field.
3. Topical Anesthesia: To make the procedure as comfortable as possible, I used a vapocoolant spray, often referred to as a “freeze spray.”This spray rapidly cools the skin’s surface. The intense cold sensation travels along the same small nerve fibers that transmit sharp pain signals. By overwhelming these fibers with the cold signal, it effectively “gates ”  or blocks the pain signal from the needle prick from reaching the brain. It’s a simple but effective application of the Gate Control Theory of Pain. I warned him, “This is going to feel very cold.”He confirmed it did. This simple step can significantly reduce the anxiety and discomfort associated with a needle.

Performing the Ultrasound-Guided Injection

The real key to a successful injection is precision. Unthinkingly injecting into a general area of pain is a guessing game. It’s inefficient and can lead to suboptimal results or even complications. This is why musculoskeletal ultrasound is an indispensable tool in my practice. Ultrasound lets us visualize soft tissues—muscles, tendons, ligaments, and bursae—in real time. It’s like X-ray vision for soft tissues.

For this procedure, I would use a linear-array ultrasound transducer. I’d apply a layer of ultrasound gel to the skin (which helps transmit the sound waves) and place the transducer over the greater trochanter. On the screen, I can clearly see:

• The bright, hyperechoic (white) line of the cortical bone of the greater trochanter.
• The tendons inserting onto the bone. A healthy tendon appears as a bright, fibrillar structure with tightly packed, parallel fibers.
• In tendinopathy, the ultrasound image changes dramatically. The tendon may appear hypoechoic (darker than normal), thickened, and lose its organized fibrillar pattern. Tiny calcifications or tears may be visible within the tendon substance. I can also use Doppler imaging to look for neovascularization (abnormal blood vessel growth), which is a hallmark of tendinosis.
• I can also visualize the trochanteric bursa, which appears as a thin, dark line between the gluteal tendons and the iliotibial (IT) band. This allows me to rule in or rule out significant bursitis definitively.

With this clear roadmap, I can guide the needle with millimeter accuracy directly to the pathologic tissue, avoiding nerves, major blood vessels, and healthy structures.

For this patient’s injection, I wasn’t just “in the area”; I was precisely at the interface between the tendon and bone—the enthesis. This is where the degenerative process is often most active.

I carefully advanced the needle. I told the patient, “Okay, I’m advancing the needle now. You’ll feel some pressure.” My other hand palpated the tissue, feeling for the change in resistance as the needle passed from subcutaneous fat into the denser, more fibrous muscle and tendon. There’s a distinct tactile feedback. “I feel it enter the muscle, the tendon, right there,” I noted.

Even without ultrasound, an experienced clinician can use this tactile feedback. I explained this to my team: “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.” That increased resistance told me I had reached the target tissue.

The Diagnostic and Therapeutic Payload

The syringe contents are just as important as placement. For this type of procedure, I use a combination of a local anesthetic (like lidocaine or bupivacaine) and often a corticosteroid.

• The Local Anesthetic (The Diagnostic Component): The injection’s primary immediate purpose is diagnostic. I injected a small amount of the solution and asked the patient, “Does that actually feel like the pain that you have?” He responded, “Yes.” This is a crucial confirmation. The pressure of the expanding injectate within the diseased tendon reproduces his specific pain, confirming we are at the “culprit” site. The anesthetic will then numb the area. If the patient’s pain is significantly reduced or eliminated within a few minutes, it provides near-certain proof that we have correctly identified the pain generator.
• The Corticosteroid (The Therapeutic Component): While the primary pathology in tendinopathy is degenerative (tendinosis), there is often a secondary inflammatory component, particularly at the enthesis or in the surrounding tissues. Corticosteroids are powerful anti-inflammatory agents. By injecting a small amount directly into the site of pathology, we can:

• Reduce Local Inflammation: This helps to break the pain-inflammation cycle.
• Decrease Pain Signaling: Corticosteroids can have a direct inhibitory effect on the nociceptive (pain-sensing) nerve fibers that have grown into the diseased tendon.
• Facilitate Rehabilitation: By providing a window of significant pain relief, the injection allows the patient to engage more effectively in the physical therapy and chiropractic care that is essential for long-term healing. The patient can perform strengthening and stretching exercises without being limited by severe pain.

It’s important to note that using corticosteroids in tendons is widely discussed. Overuse or improper placement can potentially weaken the tendon tissue. This is another reason why ultrasound guidance is so critical—it ensures we are placing the medication in the correct plane, often in the peritendinous sheath or the adjacent bursa, rather than directly into the core substance of the tendon, minimizing risk.

Fanning the Injection for Broader Coverage

The gluteus medius tendon doesn’t insert as a splice; it has a broad, fan-shaped insertion on the greater trochanter. To ensure medication covers the entire affected area, I used tendon corening.

After the initial injection, I slightly withdrew the needle without exiting the skin and then re-advanced it at a slightly different angle, a few millimeters away from the first spot. “I’m going to fan it just a little bit,” I informed the patient. “Give you a little bit right here,” I repeated this process a couple of times, creating a series of small medication depots throughout the diseased portion of the tendon insertion. This ensures a more comprehensive therapeutic effect than a single, large bolus of fluid.

After delivering the medication, I smoothly withdrew the needle. “The needle is out,” I announced. I immediately applied gentle pressure and massaged the area. This helps to disperse the medication evenly within the tissues and can also provide some immediate sensory relief.

The Immediate Post-Procedure Assessment: Gauging Success

The moments immediately following the procedure are invaluable for assessment. The local anesthetic starts working within minutes, giving us a powerful diagnostic window.

The patient had expressed significant discomfort during the needle placement, which is not uncommon when injecting into sensitive, inflamed tissue. But the real test came next.

I asked him, “Does this hurt? What I’m doing right now.” I was applying firm pressure to the exact spot that had been exquisitely tender just a few minutes earlier.

“Just a little,” he replied.

This was excellent news. I pressed again, replicating the initial provocative test. “How about here? Is it less than it was earlier?”

“Yes, it is,” he confirmed.

“That’s a good sign,” I explained to him and my team. “That means the numbing medicine is in the right spot.” This immediate and significant reduction in palpation tenderness is a positive anesthetic response. It confirms our diagnosis of gluteus medius tendinopathy and indicates that the therapeutic component of the injection is also precisely where it needs to be. I was very encouraged. This positive response predicts a good outcome.

We finished by cleaning the area one last time and applying a simple adhesive bandage.

The Comprehensive Treatment Plan: Beyond the Injection

It is absolutely critical to understand that the injection is not a “cure.” It is a powerful tool to break a cycle of pain and inflammation, but it does not fix the underlying biomechanical problems or the degenerative state of the tendon. Long-term recovery requires a comprehensive, multifaceted approach that addresses the root causes. This is where our integrative approach at Injury Medical Clinics shines; after the injection, the patient’s journey is just beginning.The next phase of his care will look like:

1. Chiropractic Care: Restoring Biomechanical Harmony

As a chiropractor, I focus on the body’s structure and how it affects function. The hip does not exist in isolation. Its function is intimately linked to the pelvis, the lumbar spine (lower back), and the entire kinetic chain down to the feet.

• Spinal and Pelvic Adjustments: I will thoroughly assess the patient’s spinal and pelvic alignment. Often, sacroiliac (SI) joint dysfunction or misalignment in the lumbar vertebrae can alter pelvic biomechanics. This can lead to improper muscle firing patterns, causing the gluteus medius to become overworked and strained. A specific chiropractic adjustment can restore proper joint motion, take pressure off nerves, and allow the pelvic girdle to function symmetrically. This reduces the abnormal load on the gluteus medius tendon, creating an environment conducive to healing.
• Soft Tissue Mobilization: I will use techniques like Active Release Technique (ART) to relieve nerve pressure and improve blood flow in the gluteus medius muscle belly and surrounding fascia. The painful tendon often results from chronic tightness and trigger points within the muscle itself. Releasing this muscular tension reduces the constant pull on the tendon insertion, providing significant relief and improving blood flow to the entire muscle-tendon unit.

2. Targeted Rehabilitation: Rebuilding a Stronger Foundation

The pain relief from the injection provides a crucial window of opportunity to begin strengthening the weakened tissues. Our rehabilitation team will guide the patient through a progressive program tailored specifically to gluteus medius tendinopathy. The goal is not just to hinjection’s eal the tendon; it creates resilience to future pain and will progress through several phases:

• Phase 1: Isometric Loading: Initially, we will start with isometric exercises. This involves contracting the muscle without changing its length (i.e., no joint movement). An example is having the patient lie on their side and gently press their leg into a wall or my hand, holding the contraction for 30-45 seconds. Research by leading tendon experts like Dr. Jill Cook has shown that heavy isometric loading has a direct analgesic (pain-relieving) effect and can stimulate positive cellular changes in the tendon without aggravating it (Cook & Purdam, 2009).
• Phase 2: Isotonic Strengthening: As thepatient’ss pain subsides, we will progress to isotonic exercises, where the muscle contracts through a range of motion. This includes exercises like clamshells, side-lying leg raises, and banded side-stepping. The key is proper form and slow, controlled movements to ensure the gluteus medius is the primary muscle working, not other compensators like the tensor fasciae latae (TFL).
• Phase 3: Functional and Heavy Slow Resistance Training: The final phase involves integrating the strengthened gluteus medius back into functional movement patterns. We will incorporate exercises like squats, lunges, and single-leg balance work. We will also use heavy slow resistance (HSR) training, which has been shown to be highly effective for promoting collagen synthesis and tendon remodeling (Beyer et al., 2015). This involves using a heavier weight but moving very slowly through both the concentric (lifting) and eccentric (lowering) phases of the movement.

3. Functional Medicine: Addressing Systemic Factors

Chronic tendinopathy is not always just a local mechanical problem. Systemic factors can significantly impair the body’s ability to heal and repair tissue. As a certified functional medicine practitioner, I will investigate these underlying drivers of poor healing.

• Systemic Inflammation: We may run blood tests like C-Reactive Protein (CRP) and ESR to assess the patient’s overall inflammatory load. If inflammation is high, we will implement an anti-inflammatory diet, rich in omega-3 fatty acids, phytonutrients from colorful plants, and spices like turmeric and ginger. We will also work to reduce inflammatory triggers like processed foods, sugar, and unhealthy fats.
• Nutrient Deficiencies: Proper tendon healing requires specific nutritional building blocks. We will assess for and replete key nutrients, including:

• Vitamin C: Essential for collagen synthesis.
• Zinc and Copper: Important co-factors for the enzymes that cross-link collagen fibers.
• Amino Acids: Particularly glycine, proline, and lysine, which are the primary components of collagen. We may recommend a high-quality collagen or gelatin supplement.

• Gut Health: The health of the gut microbiome has a profound impact on systemic inflammation. A condition known as “leaky gut ” increases intestinal permeability, allowing inflammatory molecules to enter the bloodstream and contribute to pain and dysfunction throughout the body. We may use stool testing to assess this and implement a gut-healing protocol if necessary.

By addressing these systemic issues, we are not just treating the painful hip; we are improving the patient’s overall health and creating an internal environment optimized for tissue resilience. Ifnd respersists persistseded, Symphonreliefng reliwomanr a womaneman with gluteus medius tendinopathy is a microcosm of our entire treatment philosophy. It began with a precise, hands-on diagnostic process, honed by years of clinical experience. It progressed to a technologically advanced, minimally invasive procedure—an ultrasound-guided injection—performed to the highest standards of safety and precision under the medical direction of Dr. Cardenas. This intervention served to both confirm the diagnosis and provide a powerful therapeutic on-ramp to recovery.

However, the journey does not end there. The injection is merely the opening act. The main performance is the comprehensive, integrative care that follows: the chiropractic treatment to restore mechanical balance, provide rehabilitation, nd m build a stronger, more resilient tendon, and the functional medicine approach to optimize the body’s innate healing capacity from the inside out.

This is not a linear, one-size-fits-all protocol. It is a dynamic, responsive, and deeply personalized symphony of care, orchestrated by a collaborative team of dedicated professionals. By weaving together the best of conventional medicine, chiropractic, and functional medicine, we can move beyond simply managing symptoms. We can guide our patients on a transformative journey from pain and limitation to renewed function, vitality, and lasting health.

References

Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy slow resistance versus eccentric training for the treatment of patellar tendinopathy: a randomized controlled trial. The American Journal of Sports Medicine, 43(7), 1704–1711. https://doi.org/10.1177/0363546515584111

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://doi.org/10.1136/bjsm.2008.051193

Disclaimer: The information in this post is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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