The gluteus medius is one of three major muscles in the buttocks, situated on the outer surface of the pelvis. Its primary function is to abduct the thigh (moving the leg away from the body’s midline) and stabilize the pelvis during walking and running. Tears in the tendon connecting this muscle to the greater trochanter of the femur are common, especially in middle-aged women, causing significant lateral hip pain. This condition is frequently misdiagnosed as trochanteric bursitis, which can delay appropriate treatment. Whether a gluteus medius tear can heal without surgery depends entirely on the degree of damage to the tendon.
Defining Gluteus Medius Tears and Severity Grading
Gluteus medius tears can occur due to acute trauma, such as a fall, but they more commonly develop over time from chronic degeneration or tendinopathy. Persistent stress and overuse cause inflammation that eventually leads to a tear. Because the prognosis is directly tied to the extent of the injury, medical professionals classify tears based on a severity grading system, often confirmed using Magnetic Resonance Imaging (MRI).
The severity is graded into three levels: Grade I, Grade II, and Grade III. Grade I tears are minor partial-thickness tears, presenting with mild pain and no loss of mobility. Grade II tears are also partial-thickness but involve a larger portion of the tendon, often accompanied by some loss of strength and flexibility. A Grade III tear signifies a full or complete rupture where the tendon may have retracted away from its attachment point on the greater trochanter.
Non-Surgical Paths to Healing
For low-grade partial-thickness tears (Grade I and II), healing is possible through conservative management. This approach is the first line of treatment and should be pursued for at least six months before considering surgery. Conservative treatment focuses on reducing stress on the tendon, managing pain, and restoring strength and function.
Initial management involves activity modification to avoid movements that worsen symptoms, such as prolonged standing or lying on the affected side. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain and inflammation in the short term, but they do not repair the tendon itself. Rest and ice can help control acute pain, though the RICE protocol is less emphasized for chronic tendon issues.
The most important component of non-surgical healing is a dedicated physical therapy program. Therapy first focuses on gentle range of motion exercises to maintain hip mobility. As the tendon tolerates more load, the program progresses to specific strengthening exercises, particularly eccentric strengthening. This progressive loading improves the tendon’s ability to tolerate stress and facilitates better tissue structure.
Supplementary treatments like injections may be used to alleviate pain. Corticosteroid injections provide short-term pain relief. Platelet-rich plasma (PRP) injections, which use concentrated growth factors, may stimulate natural repair processes. These injections help manage the healing environment, but the actual repair of the tendon fibers is driven by the body’s response to controlled exercise and time.
Surgical Repair and Post-Operative Recovery
A complete, full-thickness tear (Grade III) or a chronic partial tear that has failed six months of rigorous conservative management typically requires surgery. Full-thickness tears rarely heal adequately because the torn tendon end often retracts, making reattachment necessary to restore hip abductor strength. The primary goal of surgery is to reattach the torn tendon back to its insertion point on the greater trochanter using small suture anchors.
The surgical approach can be performed using an open technique (larger incision) or an arthroscopic (minimally-invasive) technique. The choice depends on the tear’s severity and chronicity, as open repair may be necessary for long-standing tears that have significantly retracted. Repairing the tendon is the first step, followed by a lengthy and strict post-operative recovery protocol.
The initial post-operative period focuses on protecting the repair, requiring a non-weight-bearing phase for about six weeks, often utilizing crutches and a hip brace. During this time, the patient must avoid active hip abduction to prevent tension on the newly repaired tendon. Physical therapy begins almost immediately, consisting initially of passive range of motion and gentle muscle activation exercises.
Progression to full weight-bearing and aggressive strengthening is gradual to allow the tendon to heal securely to the bone. Active strengthening against gravity, such as side-lying leg lifts, is usually avoided for at least eight weeks. Resisted exercises are often delayed until 10 to 12 weeks post-surgery. A complete return to unrestricted activity, including sports or heavy labor, often takes between seven to twelve months to achieve full functional recovery.