Gluteus Medius Tendinopathy Injections | Prolotherapy

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, MMS, PA-C

Doctors in Australia give a good conventional medicine summary of the problems of gluteus medius and gluteus minimus tendinopathy. In the journal Sports Medicine they write that gluteus medius tendinopathy occurs mostly in middle-age. It can affect athletes as well as those middle-age patients who do not exercise.

Women are more prone to gluteus medius tendinopathy than men.

Do you have a question about Gluteus Medius Tendinopathy? Get help and information from our Caring Medical staff

The available evidence suggests that joint position (particularly excessive hip adduction – lateral outward movement – see below), together with muscle and bone degeneration, are key factors in gluteal tendinopathy and lateral hip pain.

Because there is a lack of consensus as to which clinical examination tests provide best diagnostic utility, clinical tests utilizing a combination of provocative compressive and tensile loads is currently best practice in its assessment. (The doctors are suggesting that the pain element be recreated in the office as opposed to MRI or scans).

Management of this condition commonly involves corticosteroid injection, exercise or shock wave therapy, with surgery reserved for difficult cases. As there is little evidence for any of these treatments, the approach we recommend involves managing the load on the tendons through exercise and education.1 (Platelet Rich Plasma Therapy (PRP) was not included see below for another study where PRP was included .

It is difficult to isolate on one part of the pelvic-hip-spine complex when treating a patient with problems of Gluteus Medius tendinopathy.  When the hip joint region becomes unstable, the muscles, including the Gluteus Medius, tries to create stability by tensing. As is the case with any joint of the body, ligament instability initiates muscle tension in an attempt to stabilize the joint. This compensatory mechanism to stabilize the hip joint eventually causes the gluteus medius, piriformis muscle, and iliotibial band/ tensor fascia lata muscles to tighten because of chronic contraction in an attempt to compensate for hip joint instability. The contracted gluteus medius can eventually irritate the trochanteric bursa, causing a trochanteric bursitis.

Overcompensation when walking and running

coronal plane

The coronal plane — This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Doctors at Dalhousie University measured the external hip adduction (lateral outward movement) during walking and found that it is greater in individuals with gluteal tendinopathy than pain-free patients. (So a compensation for gluteal tendinopathy pain is being made). Individuals with gluteal tendinopathy exhibit modified muscle activation patterns of the hip abductor muscles during walking, with potential relevance for gluteal tendon loading. Loading on the gluteal tendon will obviously cause Gluteus Medius Tendinopathy.

University researchers in Australia write in the Journal of electromyography and kinesiology: Musculoskeletal injuries in runners are common and may be attributed to the inability to control pelvic equilibrium in the coronal plane. (In simpler terms pelvic instability is causing running problems).

This lack of pelvic control in the frontal plane can stem from dysfunction of the gluteus medius. (The gluteus medius stabilizes the pelvis when one leg leaves the ground during the running stride).

Some points the researchers made:

Three studies recommend Platelet Rich Plasma Therapy for Gluteus Medius Tendinopathy

Doctors writing in the Orthopaedic journal of sports medicine discussed Platelet Rich Plasma Therapy (PRP) treatments for difficult to treat gluteus medius tendinopathy.

The “glutes” of the hip, that is the gluteus maximus and the smaller gluteus medius, are powerful muscles of the hip and pelvic region. Connecting theses powerful muscles are powerful tendons. When these tendons are damaged patients are diagnosed with a problem of hip or pelvic tendonopathy. Problems that can bring with it significant pain and disability.

In this study doctors at the Hospital of Special Surgery in New York monitored patients who received PRP treatments  for recalcitrant gluteus medius tendinosis (tendon damage without inflammation noted by “osis” and opposed to “itis” with inflammation,) and/or partial tears of the tendon associated with moderate to severe lateral hip pain for longer than 3 months.

In their study of 21 patients, the doctors concluded that “ultrasound-guided intratendinous PRP injections to be a safe and effective treatment option for chronic recalcitrant gluteus medius tendinopathy due to moderate to severe tendinosis and/or partial tendon tears.”(2)

In another study from November 2016, doctors at the University of Michigan examined Greater Trochanteric Pain Syndrome and its relationship to gluteal tendinosis.

In this study, two treatment  methods were examined, Percutaneous Tendon Fenestration (a surgical needling of the injured tendon to create healing) and PRP.

Both treatments were shown to be effective with 4 of 5 patients receiving the PRP injections showing significant improvement in hip pain and symptoms.(3)

In January 2018, university researchers in Australia went into their study with the idea that they can validate the idea that there would be NO difference between the effects of cortisone injection or PRP injection for gluteal tendinopathy. Both treatments would be given one chance to work, one injection. Here is a summary of their findings published in the American Journal of Sports Medicine.(4)

At 12 weeks a change occurred:

CONCLUSION: Patients with chronic gluteal tendinopathy for more than 4 months, diagnosed with both clinical and radiological examinations, achieved greater clinical improvement at 12 weeks when treated with a single PRP injection than those treated with a single corticosteroid injection.

Can you imagine the improvement if the had Comprehensive PRP Prolotherapy instead of one shot?

Do you have a question about Gluteus Medius Tendinopathy? Get help and information from our Caring Medical staff

1. Semciw A, Neate R, Pizzari T. Running related gluteus medius function in health and injury: A systematic review with meta-analysis. Journal of Electromyography and Kinesiology. 2016 Oct 31;30:98-110. [Google Scholar]

2 Lee JJ, Harrison JR, Boachie-Adjei K, Vargas E, Moley PJ. Platelet-Rich Plasma Injections With Needle Tenotomy for Gluteus Medius Tendinopathy: A Registry Study With Prospective Follow-up. Orthop J Sports Med. 2016 Nov 9;4(11):2325967116671692. eCollection 2016. [Google Scholar]

3 Jacobson JA, Yablon CM, Henning PT, Kazmers IS, Urquhart A, Hallstrom B, Bedi A, Parameswaran A. Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis. J Ultrasound Med. 2016 Nov;35(11):2413-2420. Epub 2016 Sep 23. [Google Scholar]

4. Fitzpatrick J, Bulsara MK, O’Donnell J, McCrory PR, Zheng MH. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. The American Journal of Sports Medicine. 2017:0363546517745525. [Google Scholar]


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