Caring Medical - Where the world comes for ProlotherapyGluteus Medius Tendinopathy | Hip tendinitis injections

Ross Hauser, MD  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David N. Woznica, MD | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Katherine L. Worsnick, MPAS, PA-C  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois

Gluteus Medius Tendinopathy

You went to your health care provider or doctor with chronic hip pain that is becoming more and more of a challenge to your daily routine. You tell your health care provider that the pain concentrates on the outer side of your hip and this nagging injury that has bothered you for some time, is getting worse and worse.

Based on this evidence, the health care provider will likely suspect that you have “hip tendinitis.” An inflammation of a hip tendon.

Adding to this evidence is if you are:

The focus will then turn to the Gluteus Medius Tendon of the hip as this is the most common and likely tendon injury causing your hip tendinitis and outer hip pain. 

Gluteus Medius Tendinopathy | The white Gluteus Medius Tendon attaches the Gluteus Medius muscle to the hip bone. When this tendon is torn or damaged, inflammation, pain and instability follows.

The traditional and conservative care treatments of Gluteus Medius Tendinopathy

For some people, these treatments will be effective in the first go round, for others it will make your hip pain worse.

Very likely you will get the first of your anti-inflammatory medication prescriptions or over-the-counter recommendations. You may get a referral to physical therapy. For some people, these treatments will be effective in the first go round, for others it will accelerate a damaging osteoarthritis breakdown of your hip.

Anti-inflammatory medications, painkillers, rest, cortisone injections, physical therapy, are parts of the conservative care treatment options patients are routinely offered in traditional care doctor’s offices. If you are reading this article it is likely that you are well into your treatment options and have found that many do not work.

We have written extensively on these treatment options: Please see our articles:

The failure of these treatments are no just our opinion. We cite numerous medical references from studies performed at leading hospitals and medical universities around the world to back up these treatments lack of long-term success.

Getting to the evidence: Does Gluteus Medius tendinopathy treatments makes your hip, lower back, knee and ankle hurt and hurt worse?

Often a runner or active person with outer hip pain comes into our office. He/she is here because:

How did you get here? Because everyone wanted to treat your tendon and not your hip problem

When this patient comes into our clinic, we talk with them about the difficulties in isolating one part of the pelvic-hip-spine complex as the main culprit of their problem. This we find especially true in 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, cramping or going into spasm. When the muscle tenses, you have “pull” on the tendon. If the tendon is damaged, it will be very painful. That painful tendon starts sending signals to the hip and spine and knee and leg and ankle that it needs help taking some of the load. Suddenly you have pain messages going up and down your leg from spine to foot.


Gluteus Medius tendinopathy is now making your lower back, knee and ankle hurt

coronal plane

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

At this point we hope you realize that isolating and determining a treatment plan for the Gluteus Medius tendon should include the whole hip. The Gluteus Medius tendinopathy you are suffering from is part of or a cause of a rapidly deteriorating hip situation. As we like to say, if you have four flat tires, fixing one is not fixing the whole problem.

The science of overcompensation and why your knee, ankle, hip and knee hurt.

Above we briefly explained the compensatory mechanism your hip is trying to provide you in your walking and running. It is compensating for your tendon problems. Now let’s look at what that compensation is doing to the rest of you.

University researchers in Australia write in the Journal of electromyography and kinesiology: (1

Some points the researchers made: This instability in the hip is causing:

Treatments for Gluteus Medius Tendinopathy

Above we described the problems of conservative care in the treatment. Let’s touch on surgery. Surgery maybe the right option for some people. It is usually not the first treatment people pick. There is a reason there is conservative non-surgical care. The medical research tells us that “elective,” surgery is just that. You elect to have it, it is usually not considered an essential treatment to fix your problems but it is offered for those people who believe surgery is the only way.

Here is research from September 2018, The Physician and sportsmedicine, (2) lead by the Michigan State University College of Human Medicine. It discusses what happens when conservative care does not work and why surgery may be an option.

Here is an October 2018 study from German doctors in the journal Operative Orthopädie und Traumatologie,(3) (a journal dedicated to Orthopedic and trauma surgery.)

What this study points out is who are the three candidate types surgery will help and how long the surgical recovery will take:

Who should consider surgery?

Who surgery should not be recommended for:

After the surgery:

Expected results: Success rates of 80-90% can be expected in cases with no or only minor muscle atrophy.

Surgery or regenerative medicine options?

Typically a success rate of 80-90% can be expected in cases with no or only minor muscle atrophy in non-surgical treatment as well. In this section we are going to explore regeneartive medicine injections. Let’s be clear, this is not cortisone, nor should this be considered a single shot therapy of anything. Regenerative medicine injections are part of a comprehensive problem of treatments that we offer in our clinics.

Platelet Rich Plasma injections and Prolotherapy injections for Gluteus Medius Tendinopathy

In basic terms, Platelet Rich Plasma injections are the application of concentrated blood platelets, which contain and release growth factors to stimulate recovery in non-healing injuries. The video describes the technique, the research below describes the results.

We do not use PRP treatments in isolation. As we have discussed in this article, gluteus medius tendinopathy is a problem that single injections, for the most part, have not been shown to be effective in the long-term as attested to in the research above.

This video was created nine years ago. The basic concepts of healing remain the same. We have been treating sports related injuries with regenerative medicine injections for 26+ years.

In this video you will see the application of Platelet Rich Plasma injections and the use of Prolotherapy injections. Prolotherapy is the injection of dextrose, or a simple sugar, to irritate damaged hip ligaments. Hip ligaments provide stability, damaged hip ligaments provide INSTABILITY.

The dextrose in the Prolotherapy solution, when injected around the injury, causes a mild inflammatory response, mimicking what the body does naturally in response to soft-tissue injuries. The immune system is drawn to the area of injury and immune cells and platelets release growth factors to build new healthy tissue.  The ligaments and tendons become thicker and stronger from this inflammatory response. Again, this is explained in the video above, and further below.

Research on PRP injections as a non-surgical option:

This is from a study from doctors at the Hospital of Special Surgery in New York published in the Orthopaedic journal of sports medicine. (4)

First a discussion on surgery from this research: (This research is from a surgical hospital.)

Results achieved with PRP injections

PRP vs Cortisone

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.(6)

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.

Again, let us point out in this research that this was a single cortisone injection  vs. a single PRP injection. The video above is reflective of our treatments.

PRP and Prolotherapy for Gluteus Medius Tendinopathy – How we do it.

As mentioned, the above research compares one injection of cortisone to one injection of PRP. One injection of PRP is not our treatment methods.

Why treat with Prolotherapy when we inject PRP? Because Prolotherapy makes the PRP work better, the PRP makes the Prolotherapy work better.

Prolotherapy helps repair tendons:

A multi-national team of researchers including those from Rutgers University, Virginia College of Osteopathic Medicine, and the University Regensburg Medical Centre in Germany tested the effects of Prolotherapy on tenocytes repair (tendon cells). Published in the journal Clinical orthopaedics and related research(7) what the team was looking for was how did Prolotherapy injections change the immune system’s response to a difficult to teal tendon injury.

These are the highlights:

In our own published research, we reported in the Clinical medicine insights. Arthritis and musculoskeletal disorders, (8) we reported that the consensus is growing regarding the effectiveness of dextrose Prolotherapy as an alternative to surgery for patients with chronic tendinopathy who have persistent pain despite appropriate rehabilitative exercise.

Platelet Rich Plasma Therapy and Prolotherapy

Platelet Rich Plasma therapy (PRP) can be added to the traditional Prolotherapy solution to expedite the process, in specific cases.

Do you have a question about tendon damage and repair?  Get help and information from Caring Medical

Prolotherapy Specialists Tendinitis and Tendinosis treatments - Injections for Chronic Tendinopathy

Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | Ross Hauser, MD | David Woznica, MD

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 LaPorte C, Vasaris M, Gossett L, Boykin R, Menge T. Gluteus medius tears of the hip: a comprehensive approach. The Physician and sportsmedicine. 2018 Oct 5:1-6. [Google Scholar]
Gollwitzer H, Hauschild M, Harrasser N, Banke IJ. Surgical refixation of gluteal tendon tears by mini-open double-row technique. Operative Orthopadie und Traumatologie. 2018 Oct.
[Google Scholar]
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]
5 Walsh MJ, Walton JR, Walsh NA. Surgical repair of the gluteal tendons: a report of 72 cases. The Journal of arthroplasty. 2011 Dec 1;26(8):1514-9. [Google Scholar]
6 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]
7 Ekwueme EC, Mohiuddin M, Yarborough JA, Brolinson PG, Docheva D, Fernandes HA, Freeman JW. Prolotherapy Induces an Inflammatory Response in Human Tenocytes In Vitro. Clinical Orthopaedics and Related Research®. 2017 Apr 27:1-1. [Google Scholar]
8 Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-59. Published 2016 Jul 7. doi:10.4137/CMAMD.S39160 [Google Scholar]


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