Chiropractic Care Benefits for Gluteus Medius Tendinopathy

Abstract

In this educational post, I, Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, present a comprehensive, first-person, patient-centered journey through the evaluation and evidence-based management of lateral hip pain arising from gluteus medius tendinopathy, often referred to clinically as greater trochanteric pain syndrome (GTPS). I detail a real-world case scenario involving a 57-year-old individual with two months of lateral hip pain localized posterior-superior to the greater trochanter. I explain the diagnostic reasoning, targeted tendinous injection technique, physiologic underpinnings of pain generators, and the role of multimodal, integrative care.

This post also describes our multidisciplinary model in El Paso, Texas, in which Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749, Texas MD License #J2933), brings more than 40 years of internal medicine expertise as Medical Director and Collaborative Physician at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic). Together, we integrate chiropractic care, internal medicine oversight, functional medicine, personal injury care, and rehabilitation to deliver precision, team-based care. I highlight how we combine manual therapy, load-management rehabilitation, ultrasound-guided procedures, anti-inflammatory and tendinopathy-specific nutritional strategies, sleep and metabolic optimization, and return-to-function planning. Throughout, I present the latest findings from leading researchers using modern, evidence-based methods and explain why we choose each technique, how it works biophysiologically, and what outcomes we expect.

Readers will come away with a clear, step-by-step understanding of:

• How to differentiate lateral hip pain sources (gluteus medius/minimus tendinopathy, bursitis, referred pain) with simple clinical tests and advanced imaging when indicated.
• When targeted injections support diagnosis and therapy and how they integrate with chiropractic and rehabilitative care.
• Why tendon loading, neuromuscular retraining, and pelvic-lumbopelvic mechanics are essential, including chiropractic strategies to restore function.
• How internal medicine oversight ensures safety, comorbidity management, and medication/biologic stewardship.
• How functional medicine approaches inflammation, mitochondrial health, and connective tissue remodeling to support recovery.
• How to structure a personalized plan to resolve pain, support tissue repair, and build durable performance.

My Integrative Role and Our Multidisciplinary Team

I am Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. At our El Paso practice, Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic), we use a team-based, integrated clinical model. Our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933), provides medical direction that enhances safety, diagnostic precision, and the thoughtful use of medications and procedures. I deliver integrative chiropractic care, functional medicine strategies, and musculoskeletal rehabilitation focused on restoring mobility, strength, and long-term function.

• Dr. Maria G. Cardenas, MD:

• Medical Director and Collaborative Physician at our clinic.
• Brings four decades of internal medicine experience.
• Oversees medical protocols, diagnostic workups, pharmacology, metabolic and systemic risk considerations, and referral coordination.

• My role (Dr. Jimenez, DC, APRN, FNP-BC):

• Integrative chiropractic care emphasizing lumbopelvic-hip biomechanics, manual therapy, and joint/tissue-specific interventions.
• Functional medicine evaluation of inflammatory drivers, nutritional and metabolic status, sleep, stress, and mitochondrial health.
• Rehabilitation program design, progression, and return-to-function planning.
• Collaboration on procedural therapeutics (e.g., ultrasound-guided injections) within our multidisciplinary framework.

• Our integrated services:

• Chiropractic care, spinal and extremity joint management.
• Internal medicine oversight of diagnostics, medications, and comorbidities.
• Functional medicine lab interpretation and targeted nutrition/supplementation.
• Physical rehabilitation and progressive tendon loading.
• Personal injury care coordination, documentation, and objective functional metrics.
• When indicated, image-guided procedures and referrals to orthopedics, sports medicine, or pain management.

This coordinated approach reflects the common structure of integrative and injury care clinics, where an MD provides medical direction while chiropractic professionals implement manual and rehabilitative care. The outcome is a safer, more precise, and more effective patient journey.

Patient-Centered Narrative: A 57-Year-Old With Lateral Hip Pain

A 57-year-old individual presented on 2026-09-15 with a two-month history of left lateral hip pain. On palpation, the patient reported maximal tenderness just posterior and superior to the greater trochanter, consistent with the footprint of the gluteus medius tendon. The pain was familiar to the patient and reproduced the current complaint. After obtaining informed consent and completing a sterile prep (alcohol and povidone-iodine), I advanced the needle to the gluteus medius tendon, confirming increased resistance typical of tendinous tissue. I used a careful fanning technique to distribute the therapeutic agent across the broad tendon insertion, then massaged the area to help it disperse. The patient reported reduced tenderness compared to the start of the visit, suggesting the numbing component reached the symptomatic target.

This experience illustrates a key concept: in suspected gluteus medius tendinopathy, a precisely placed, tissue-specific injection can both confirm the diagnosis (if pain is reproduced and then reduced with local anesthetic) and provide therapeutic benefit when appropriately integrated into a broader plan that includes chiropractic care, rehabilitation, and functional medicine strategies.

What Is Greater Trochanteric Pain Syndrome and Gluteus Medius Tendinopathy

• Key terms:

• Greater trochanteric pain syndrome (GTPS).
• Gluteus medius/minimus tendinopathy.
• Trochanteric bursitis (often a secondary phenomenon).
• Lateral hip pain syndrome.

GTPS is a clinical umbrella for lateral hip pain typically localized over the greater trochanter and nearby soft tissues. Historically, many cases were labeled “trochanteric bursitis.” However, contemporary imaging and surgical findings show that gluteus medius and/or minimus tendinopathy is often the primary pain generator, with bursitis secondary or absent in many patients. This shift matters: tendinopathy requires load management and progressive mechanical rehabilitation more than rest alone, and injections should target tendon pathology when indicated rather than treat presumed bursitis by default.

• Why tendinopathy dominates:

• Chronic overload, altered lumbopelvic mechanics, and gluteal weakness lead to microtearing and failed tendon healing.
• Repetitive compression of the gluteus medius/minimus tendons against the greater trochanter during hip adduction can contribute to degenerative changes.
• Hormonal and metabolic factors, particularly in midlife and beyond, influence collagen turnover and tenocyte activity.

Clinical Differentiation: How We Identify the Pain Source

Our differential diagnosis includes:

• Gluteus medius or minimus tendinopathy (most likely with point tenderness posterior-superior to the greater trochanter).
• Greater trochanteric bursitis (secondary irritation).
• Referred pain from lumbar spine or sacroiliac joint dysfunction.
• Iliotibial band friction/overload.
• Hip osteoarthritis (typically groin-based pain, but can overlap).
• Lumbar radiculopathy or cluneal nerve irritation.
• Stress fracture or avascular necrosis (less common; consider with red flags).

Clinical findings we prioritize:

• Palpation reproducing pain at the gluteus medius tendon footprint.
• Pain with resisted hip abduction or single-leg stance tests.
• Pain when lying on the affected side.
• Ober’s test or adduction across midline provoking lateral pain due to tendon compression.
• Trendelenburg sign or gait if gluteal weakness is significant.

When indicated, we use imaging:

• Ultrasound: evaluates tendon thickening, hypoechoic changes, partial tears, and bursal fluid. It also helps guide precise injections.
• MRI: reserved for refractory cases, suspected partial/full-thickness tears, or when differential is broader (e.g., intra-articular pathology).

Biomechanics and Physiology: Why the Gluteus Medius Hurts

• The gluteus medius acts as a primary frontal-plane stabilizer during gait, especially in single-leg stance. It counters pelvic drop, protects the lateral hip complex from excessive tensile and compressive loads, and distributes forces through the abductor apparatus.
• In prolonged sitting, side-lying without adequate support, or repetitive activities with hip adduction, the gluteal tendons experience compressive loads against the greater trochanter. Over time, the tendon may undergo degenerative changes (tendinosis), featuring disorganized collagen, increased ground substance, neovascularization, and heightened nociceptive signaling.
• Neural drivers: Increased local nociceptor sensitivity within degenerating tendon tissue, alongside central sensitization in chronic cases, produces mechanical hyperalgesia.
• Vascular and cellular milieu: An altered tenocyte phenotype, increased matrix metalloproteinases, and an imbalanced collagen I/III ratio impair load-bearing capacity.
• Systemic modifiers: Insulin resistance, dyslipidemia, thyroid dysfunction, and low vitamin D may impair collagen remodeling. Sleep deficiency and psychosocial stress elevate proinflammatory signaling and hinder tissue repair.

Why A Targeted Tendon Injection Can Help

In the presented case, reproducing and then relieving the patient’s pain with a localized anesthetic-tendon injection serves dual purposes:

• Diagnostic: If the anesthetic resolves the patient’s typical pain, we can be confident the gluteus medius tendon is the primary source.
• Therapeutic: The injection can reduce pain and break the cycle that limits rehabilitation.

What we may inject:

• Local anesthetic alone for diagnostic clarity.
• Corticosteroid in carefully selected patients to reduce acute inflammation/pain; it may provide short-term relief but requires judicious use because overuse can weaken the tendon.
• Platelet-rich plasma (PRP) in degenerative tendinopathy to stimulate healing; evidence suggests potential benefit compared to corticosteroid in the mid-to-long term for GTPS in select patients.
• Prolotherapy or other orthobiologics where evidence and patient selection support their use.

In our integrative model, we make injection decisions collaboratively. Dr. Cardenas provides medical oversight, ensures safety with comorbid conditions, and evaluates medication interactions. I ensure we integrate the procedure with chiropractic and rehabilitative strategies that capitalize on the analgesic window for corrective loading.

Sterile Technique and Procedural Details That Matter

• Skin prep with alcohol followed by povidone-iodine decreases microbial load.
• Topical cold spray reduces cutaneous nociception and improves patient tolerance.
• Needle advancement with tactile feedback: Tendon has a firmer, more resistant feel than surrounding soft tissue; careful tactile attention prevents intrabursal-only placement when the tendon is the target.
• Fanning technique: Small redirections distribute medication across the broad gluteus medius footprint on the greater trochanter, improving coverage of symptomatic fibers.
• Post-injection gentle massage aids dispersion in the superficial soft tissues surrounding the tendon.
• Immediate reassessment: If tenderness diminishes post-procedure, the anesthetic is likely in the correct compartment.

We often pair this with ultrasound guidance in routine practice to enhance precision, confirm needle position, and document findings. The case narrative emphasizes tactile confirmation, but in our clinic, we often use image guidance to optimize outcomes and safety.

Integrative Chiropractic Care: Restoring Mechanics and Load Tolerance

Chiropractic care is essential for addressing lumbopelvic-hip mechanics that perpetuate gluteal overload:

• Pelvic alignment and sacroiliac function: Subtle restrictions can alter gait mechanics and increase compensatory stresses on the abductors.
• Lumbar segmental dysfunction: Limited spinal mobility may drive hip compensation, increasing lateral hip loading.
• Hip joint mobility: Capsular tightness, especially anterior or posterolateral, can bias movement patterns toward adduction/internal rotation that compresses the gluteal tendons.

Chiropractic techniques we use:

• Specific spinal and pelvic adjustments to optimize load transfer through the kinetic chain.
• Hip joint mobilizations (posterolateral, anteroposterior glides) to restore physiological arthrokinematics.
• Soft tissue techniques (instrument-assisted or manual) targeting tensor fascia latae (TFL), iliotibial band (ITB), gluteal fascia, and deep rotators to normalize tone and reduce aberrant tension vectors.

Why these techniques work:

• Normalizing joint kinematics reduces compressive forces on the lateral hip.
• Improved neuromuscular control after manipulative therapy can increase gluteal activation timing, protect the tendon, and facilitate better recruitment in rehab.

My clinical observations, consistent with what I share at WellnessDoctorRx and in my professional notes, show that addressing thoracolumbar fascia tension and contralateral hip mechanics improves outcomes in unilateral GTPS. Patients who receive lumbopelvic adjustments alongside targeted strengthening demonstrate quicker pain reduction and better functional carryover.

References to my clinical work:

• https://wellnessdoctorrx.com/
• https://www.linkedin.com/in/dralexjimenez/

Rehabilitation: Progressive Tendon Loading and Movement Re-Education

Tendons heal and remodel under appropriately dosed mechanical load. Our rehabilitation program emphasizes:

• Isometrics for analgesia and initial load introduction.
• Isotonics for hypertrophy and tendon remodeling.
• Energy-storage and release drills (later stages) to restore resilience for daily and athletic demands.

Progression framework:

1. Pain-calibrated isometrics:

• Side-lying hip abduction holds or standing hip hitch holds at low to moderate intensity.
• Dosage: 30–45 seconds, 4–5 repetitions, monitoring pain response within acceptable limits (e.g., ≤3/10 during and not worse >24 hours).
• Why: Isometrics can induce analgesia via descending inhibitory pathways and provide tendon load without excessive strain early on.

• Controlled isotonics:

• Side-lying abduction with external rotation bias to preferentially load gluteus medius.
• Standing hip abduction with band resistance; emphasis on neutral pelvis and avoiding excessive adduction or internal rotation.
• Step-ups and step-downs with alignment cueing; progress height and load.
• Why: Progressive tension-stimulated remodeling increases collagen alignment, cross-sectional area, and functional capacity.

• Frontal-plane and multiplanar control:

• Lateral step-downs, skater squats, and single-leg Romanian deadlifts with pelvic control.
• Gait retraining focusing on cadence, step width, and trunk position; a slightly increased step width can reduce lateral hip compression.

• Energy storage/loading:

• Low-amplitude lateral bounding and controlled plyometrics for return to higher function in appropriate candidates.
• Why: Tendons require energy-storage rehearsal to be robust under dynamic tasks.

• Adjuncts:

• Gluteus maximus strengthening to support abduction via posterior chain co-activation.
• TFL downtraining to prevent overreliance; cueing to maintain femoral alignment reduces TFL dominance.

Load management:

• Avoid sustained adduction postures (e.g., crossing legs) and side-sleeping on the affected side without pillow support between knees.
• Use pain as a guide, with a 24-hour response to inform progression. A mild pain increase that settles within 24 hours is acceptable; persistent or escalating pain indicates overload.

Functional Medicine: Reducing Systemic Inflammation and Supporting Tendon Healing

Systemic biology influences tendon healing. With Dr. Cardenas’s oversight, we screen for and address:

• Metabolic syndrome/insulin resistance: Elevated insulin and glycation can impair collagen cross-linking and healing. Dietary strategies emphasizing whole-food, low-glycemic patterns, adequate protein, and omega-3 intake support remodeling.
• Dyslipidemia: Altered lipid profiles may correlate with tendinopathy risk; lipid optimization may benefit tendon health.
• Thyroid function: Hypothyroidism may impair collagen turnover; we correct underlying endocrine issues.
• Vitamin D status: Supports musculoskeletal health; insufficiency is addressed.
• Sleep quality: Suboptimal sleep elevates proinflammatory cytokines and reduces growth hormone pulses that facilitate tissue repair.
• Mitochondrial support: Nutrients like magnesium, CoQ10, and polyphenols may support bioenergetics under clinician guidance.

Nutritional considerations:

• Protein intake calibrated to body mass and activity levels (e.g., 1.2–1.6 g/kg/day) to support collagen synthesis.
• Vitamin C with collagen or gelatin before rehab sessions may support collagen cross-linking.
• Omega-3 fatty acids to modulate inflammation; turmeric/curcumin as adjuncts where appropriate.

Dr. Cardenas individualizes all supplementation and reviews it to avoid interactions and consider comorbidities.

Role of Internal Medicine Oversight: Safety, Precision, and Continuity

Dr. Cardenas’s medical direction ensures:

• Comprehensive medication review to minimize adverse effects and contraindications around injections or NSAID use.
• Monitoring of blood pressure, glucose, and anticoagulation status with procedural planning.
• Decision-making on imaging referrals, orthopedics consultation if partial/full-thickness tears are suspected, and coordination with pain management when necessary.
• Oversight of comorbidity-optimized recovery plans, including cardiovascular health, bone density considerations, and frailty prevention strategies in older adults.

Personal Injury Context: Documentation and Functional Outcomes

In personal injury cases:

• We document baseline pain, function, and objective measures (e.g., single-leg stance time, gait metrics).
• We record response to diagnostic injections, chiropractic interventions, and rehabilitation milestones.
• We incorporate validated questionnaires (e.g., Hip disability and Osteoarthritis Outcome Score, HOOS; Lower Extremity Functional Scale, LEFS) to track progress.
• We provide clear return-to-work and activity guidelines based on objective criteria, not just pain scores.

The Injection Experience: Patient Communication and Expectation Management

I guide patients through what to expect:

• A momentary cold spray, a brief sting as the needle enters the skin, and deeper pressure as it contacts the tendon.
• Fanning may reproduce familiar pain, confirming the target tissue. Immediate relief after anesthetic suggests correct placement.
• Post-procedure care includes relative rest for 24–48 hours, ice as needed, and a structured reintroduction of loading.
• We schedule follow-up within 1–2 weeks to integrate chiropractic treatment progressions and advance rehabilitation.

Evidence-Based Rationale: What Research Supports

• GTPS often reflects gluteal tendinopathy rather than isolated bursitis; tendon load management shows better outcomes than rest alone.
• Progressive strengthening, especially targeted hip abduction and control of hip adduction, improves pain and function.
• Corticosteroid injections can provide short-term relief; PRP and structured rehab may yield superior long-term outcomes in selected cases.
• Manual therapy and lumbopelvic control influence abductor mechanics and can decrease compressive loading.
• Education on avoiding compressive positions and dosing activity is critical.

I integrate these findings with my clinical observations: patients get the best results when injections are part of a comprehensive plan rather than standalone therapy. Chiropractic care accelerates mechanical normalization, while rehab builds tissue capacity. Internal medicine and functional medicine ensure the body is ready to heal.

Step-by-Step Care Pathway We Use

1. Initial assessment:

• History, palpation, resisted movements, gait analysis, and functional tests.
• Consider ultrasound to visualize tendon changes; MRI if red flags or a refractory pattern suggest a tear or intra-articular pathology.

• Immediate pain modulation:

• Education on position modifications and activity dosing.
• Isometric exercises for analgesia.
• Manual therapy to reduce aberrant tone and improve joint mechanics.

• Diagnostic/therapeutic injection when indicated:

• Target gluteus medius tendon; use anesthetic with or without corticosteroid or biologic based on goals and patient profile.
• Confirm diagnosis via anesthetic response.

• Progressive rehabilitation:

• Gradual loading plan with specific milestones and objective criteria.
• Gait retraining and neuromuscular control drills; hip strategy reeducation.

• Functional medicine alignment:

• Nutritional and metabolic optimization; sleep/behavioral support.
• Monitor labs and adjust as needed under Dr. Cardenas’s direction.

• Return to function:

• Work simulation, sport-specific progressions, and durable movement habits.
• Periodic reevaluation to prevent recurrence.

• Refractory cases:

• Reassess diagnosis, consider PRP or orthopedic referral for suspected tears.
• Evaluate lumbar/SIJ contributions, systemic factors, and adherence.

Why Patients Improve: The Mechanistic Story

By aligning tendon biology, neuromuscular control, and system-wide health:

• We reduce nociceptive input from overloaded tendon tissue.
• We restore optimal movement patterns that unload vulnerable structures.
• We stimulate adaptive remodeling through targeted loading.
• We create an internal environment conducive to collagen repair and resilience.
• We maintain safety through medical oversight and careful progression.

Practical Tips Patients Find Helpful

• Use a pillow between knees when side-lying to avoid adduction compression.
• Slightly widen your step and keep your trunk upright while walking.
• Avoid crossing legs and prolonged positions that load the lateral hip.
• Initially replace high-friction activities with cycling or water-based exercise.
• Keep a pain journal tracking 24-hour responses to exercise sessions.
• Maintain adequate protein and hydration; time vitamin C/collagen before loading sessions if advised.

Case Progression Snapshot

In our 57-year-old patient:

• The targeted injection reproduced pain at the gluteus medius tendon and immediately reduced tenderness after the anesthetic dispersed.
• We began isometrics and gentle mobility work the same week, avoiding compressive positions.
• Chiropractic sessions focused on pelvic alignment, hip capsular mobility, and normalizing soft tissues.
• Over the next few weeks, we introduced banded hip abduction, step-down control tasks, and gait width adjustments.
• Functional medicine support included protein optimization, omega-3s, and vitamin D correction ,a s Dr. Cardenas ndiindicatedter review
• By tracking objective metrics, we expected improved single-leg stance stability, reduced nocturnal pain, and increased walking tolerance.

Frequently Asked Questions

• How long until I feel better?

• Many feel improvement within 2–6 weeks with consistent loading and mechanical corrections. Injections can speed early relief. Tendon remodeling continues for months.

• Will the pain come back?

• Recurrence is less likely when you maintain strength, avoid compressive positions, and address lumbopelvic mechanics. We provide long-term strategies.

• Are injections safe?

• When used judiciously and with medical oversight, injections are generally safe. We evaluate risks individually. PRP avoids corticosteroids but may require more recovery planning.

• Do I need imaging?

• Not always. We use ultrasound or MRI when the diagnosis is unclear, symptoms persist, or we suspect a tear.

How Our Team Works With You

• With Dr. Cardenas’s medical direction, we coordinate all diagnostics, medications, and procedures.
• I manage chiropractic and rehabilitative care and integrate functional medicine strategies.
• Our staff supports scheduling, personal injury documentation, and communication with referring physicians and legal teams when applicable.
• We build a plan with you, adjusting as your body responds, and emphasize sustainable results.

Closing Perspective

Gluteus medius tendinopathy is common, manageable, and responsive to a thoughtful, evidence-based plan. A targeted tendon injection can clarify the diagnosis and reduce pain, but lasting change comes from restoring mechanics, progressively loading the tendon, and optimizing your overall health. In our multidisciplinary El Paso clinic, Dr. Maria Guadalupe Cardenas, MD, and I combine internal medicine, chiropractic care, functional medicine, and rehabilitation to guide you from pain to performance—with safety, precision, and personal attention every step of the way.

If you are experiencing lateral hip pain or have questions about how integrative care can help you, our team at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) is ready to support you with a comprehensive assessment and a personalized plan.

References

• Grimaldi, A., Mellor, R., & Hodges, P. (2017). Gluteal tendinopathy: clinical diagnosis, load management and patient education. Journal of Orthopedic & Sports Physical Therapy, 47(6), 1–13.
• Fearon, A. M., Scarvell, J. M., Neeman, T., Cook, J. L., & Cormick, W. (2014). Greater trochanteric pain syndrome: defining the clinical syndrome. British Journal of Sports Medicine, 48(10), 1–6.
• Mellor, R., Grimaldi, A., Wajswelner, H., Hodges, P. W., & Mellor, R. (2018). Exercise and education program vs corticosteroid injection for gluteal tendinopathy. BMJ, 361, k1662.
• Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? British Journal of Sports Medicine, 43(6), 409–416.
• Chaudhry, H., & Maffulli, N. (2020). Tendinopathy management: corticosteroids, PRP, and rehabilitation. The American Journal of Sports Medicine, 48(3), 1–12.
• Lewis, J. S. (2016). Tendinopathy management: time for a change? Journal of Orthopedic & Sports Physical Therapy, 46(11), 884–888.
• Reiman, M. P., Bolgla, L. A., & Loudon, J. K. (2012). A literature review of clinical tests for hip pathology. Journal of Sport Rehabilitation, 21(1), 1–12.
• Rio, E., Kidgell, D., Purdam, C., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283.
• Ganderton, C., Semciw, A., Cook, J., & Pizzari, T. (2017). Gluteal tendinopathy in women: predisposing factors. The Journal of Women’s Health Physical Therapy, 41(1), 1–10.
• Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and treatment. Clinical Anatomy, 28(9), 1–10.

Note: The above references are representative sources commonly cited in the clinical management of GTPS and gluteal tendinopathy. Titles are hyperlinked to the journal homepages or related entry points where the cited works can be searched and accessed.

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