Gluteus Medius Tendinopathy Insights Using Chiropractic Care

Find out how chiropractic care for gluteus medius tendinopathy can enhance your recovery and reduce discomfort.

Abstract

Welcome to our educational series. I am Dr. Alex Jimenez, and I am honored to guide you through the intricate world of musculoskeletal health and integrative medicine. In this comprehensive discussion, we will explore a common yet often misdiagnosed cause of lateral hip pain: gluteus medius tendinopathy. Often mistaken for trochanteric bursitis, this condition can significantly affect mobility and quality of life. We will begin with a real-world clinical scenario involving a 57-year-old patient who presented at our clinic on September 15, 2026. From there, we will dissect the hip’s complex anatomy and biomechanics, unravel the pathophysiology of tendinopathy, and discuss the latest evidence-based diagnostic techniques, including physical examination and advanced imaging. A central theme of our discussion will be the power of an integrative treatment model. I will explain how our multidisciplinary team at Injury Medical Clinic PA, under the expert medical direction of Dr. Maria Guadalupe Cardenas, MD, combines chiropractic care, functional medicine, regenerative therapies like ultrasound-guided injections, and personalized rehabilitation to create a holistic and effective patient journey toward recovery. We will delve into the scientific rationale behind each treatment modality—from the cellular mechanisms of tendinopathy to the neurophysiological effects of spinal adjustments and the systemic benefits of functional medicine. Our goal is to give you a clear, scientifically grounded understanding of gluteus medius tendinopathy and to show how a collaborative, patient-centered approach can lead to profound, lasting healing.

A Collaborative Foundation for Healing: Our Integrative Practice

Before we delve into the clinical specifics of hip pain, I believe it is essential to provide context for our approach to patient care. At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas, our philosophy is built on multidisciplinary collaboration. This is not merely a buzzword; it is the very structure of our practice and the core of our success in treating complex musculoskeletal and systemic health issues.

I am Dr. Alex Jimenez, and my journey in healthcare has led me to embrace a wide spectrum of disciplines, earning credentials as a Doctor of Chiropractic (DC), Advanced Practice Registered Nurse (APRN) with a specialization as a Family Nurse Practitioner (FNP-BC), and certifications in Functional Medicine (CFMP, IFMCP), Anti-Aging/Regenerative Medicine (ATN), and Chiropractic Spinal Trauma (CCST). This diverse training has solidified my belief that no single specialty holds all the answers. The human body is deeply interconnected, and effective healthcare must reflect that integration.

A cornerstone of our integrative model is our collaboration with Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected, board-certified Internist with over four decades of clinical experience. She serves as our Medical Director and Collaborative Physician, providing essential medical oversight and deep expertise that strengthens our diagnostic and therapeutic capabilities. Her NPI is #1164426749, and her Texas Medical License is #J2933. This partnership between a Doctor of Chiropractic/Nurse Practitioner and a Medical Doctor is a powerful synergy. It bridges the gap between different philosophies of care, ensuring our patients receive a comprehensive, safe, evidence-based treatment plan that considers all aspects of their health.

Our team integrates a variety of services under one roof to create a seamless patient experience:

• Medical Oversight (Dr. Cardenas): Provides comprehensive medical evaluations, manages systemic conditions that may contribute to musculoskeletal pain, manages prescriptions when necessary, and provides overall medical direction for the clinic.
• Integrative Chiropractic Care (Dr. Jimenez): Focuses on restoring spinal and joint biomechanics, alleviating nerve interference, and improving nervous system function through specific adjustments and manipulations.
• Functional Medicine: We investigate the root causes of disease and dysfunction, looking at factors like nutrition, genetics, hormonal imbalances, and environmental exposures to restore health from the inside out.
• Personal Injury and Rehabilitation: Specialized care for individuals injured in accidents, focusing on pain management, functional restoration, and navigating the complexities of injury recovery.
• Advanced Diagnostics and Therapeutics: We utilize modern tools to pinpoint the source of pain, such as musculoskeletal ultrasound, and offer targeted treatments, including the guided injection we will discuss today.

This collaborative framework ensures that when a patient walks through our doors, they don’t see a chiropractor, a medical doctor, or a therapist in isolation. They are entering a cohesive ecosystem of care where all practitioners communicate and work together toward a common goal: the patient’s optimal health and well-being. This is the context in which we approach every case, including the one we will now explore in detail.

A Clinical Encounter: Identifying the Source of Lateral Hip Pain

On the morning of September 15, 2026, a 57-year-old gentleman came into my office with a chief complaint that is all too common in my practice: persistent hip pain. He described a two-month history of a nagging, deep ache in his left hip. When a patient says “hip pain,” I immediately need to understand what they mean, because “hip” can refer to a wide anatomical region. True intra-articular hip joint pain, originating from the ball-and-socket joint itself, typically presents as groin pain. In contrast, pain on the side of the hip often points to different structures.

My first step was to ask him to pinpoint the exact location of his discomfort. He pointed not to his groin or his buttock, but to the bony prominence on the side of his hip—the greater trochanter. More specifically, he indicated an area just behind and slightly above this landmark. This localization was a critical clue, immediately shifting my diagnostic focus away from the hip joint itself and toward the surrounding soft tissues.

The Diagnostic Power of Palpation

To confirm the source of his pain, I began a focused physical examination using one of medicine’s oldest and most valuable diagnostic tools: palpation. With the patient lying on his right side, I applied firm, targeted pressure to the suspected area.

“Does this reproduce your pain?” I asked, pressing into the soft tissue just posterior and superior to the trochanter.

“Slowly, yes,” he confirmed, wincing slightly. “Right in there.”

His response was exactly what I was looking for: a positive “jump sign,” where palpation of a specific point precisely replicates the patient’s primary complaint. This powerfully confirms that we are physically touching the structure responsible for the pain signals sent to his brain. I marked this precise spot with a surgical marker. This location corresponds directly to the insertion point of a key hip muscle: the gluteus medius.

This gentleman’s presentation is a classic example of Greater Trochanteric Pain Syndrome (GTPS). For many years, pain in this region was almost universally diagnosed as “trochanteric bursitis.” The assumption was that the fluid-filled sacs, or bursae, that cushion the area had become inflamed. However, modern imaging studies, particularly MRI and ultrasound, have revolutionized our understanding. Research has consistently shown that in the majority of patients with lateral hip pain, the primary pathology is not bursitis but rather a degenerative condition of the gluteus medius and/or gluteus minimus tendons—a condition known as tendinopathy (Long, Surrey, & Nazarian, 2013). While secondary bursitis can coexist, the root cause is often the tendon itself.

Therefore, my working diagnosis for this patient shifted from a generic “hip pain” to a much more specific gluteus medius tendinopathy. This diagnosis carries significant implications for treatment. Injecting a bursa with corticosteroids might provide temporary relief, but it doesn’t address the underlying degenerative process in the tendon. Our goal is to target the true source of the pathology.

The Anatomy of the Hip Abductors: More Than Just Movement

To understand why this area causes so much trouble, we must first understand the intricate anatomy and biomechanics of the lateral hip. The greater trochanter of the femur isn’t just a bony knob; it is a crucial docking station for some of the body’s most important muscles.

The stars of this region are the hip abductor muscles: the gluteus medius and the gluteus minimus. These muscles originate from the broad, fan-shaped surface of the ilium (the large pelvic bone) and converge downward into powerful tendons that attach to distinct facets on the greater trochanter.

• Gluteus Medius: This broad, thick, radiating muscle lies on the outer surface of the pelvis. It has three distinct fibrous partitions, often described as anterior, middle, and posterior. These parts converge into a strong, flattened tendon that primarily inserts onto the lateral facet of the greater trochanter. A portion also inserts onto the superoposterior facet.
• Gluteus Minimus: This is the smallest of the three gluteal muscles, located immediately beneath the gluteus medius. It is also fan-shaped and inserts via its own tendon onto the anterior facet of the greater trochanter.

The Crucial Role in Biomechanics: The Pelvic Stabilizers

While these muscles do abduct the hip (move the leg out to the side), this is not their most important function in daily life. Their primary, most critical role is to stabilize the pelvis during single-leg stance, which occurs with every step we take.

Imagine you are walking. As you lift your right foot off the ground to take a step, your left leg supports your entire body weight. At that moment, gravity tries to pull the right side of your pelvis downward. If this happens, your pelvis drops, a phenomenon known as a Trendelenburg gait. To prevent this pelvic drop, the gluteus medius and minimus on your stance leg (the left leg) must fire powerfully and isometrically. They act like strong guy-wires, holding the pelvis level.

This means that with every step, the gluteus medius and minimus tendons experience immense tensile and compressive forces. The tensile force comes from the muscle contraction pulling on the tendon. The compressive force comes from the overlying iliotibial (IT) band pressing the tendon against the bony prominence of the greater trochanter; the IT band is a thick, fibrous band of fascia that runs down the outside of the thigh.

The Pathophysiology of Tendinopathy: A Failed Healing Response

Now, let’s connect this biomechanical strain to what happens at a cellular level. When we hear the suffix “-itis,” as in “tendinitis,” we think of inflammation. For decades, people believed tendon pain was caused by an inflammatory process driven by inflammatory cells like neutrophils and macrophages. This led to the widespread use of anti-inflammatory treatments, such as NSAIDs (like ibuprofen) and corticosteroid injections.

However, a wealth of histopathological research over the past two decades has completely changed this paradigm. When scientists examine biopsies of chronically painful tendons under a microscope, they do not find a significant presence of inflammatory cells. Instead, they find disorganization and degeneration. This condition is more accurately termed tendinopathy.

Cook and Purdam’s (2009) seminal work proposed a continuum model for tendinopathy, providing an elegant framework for understanding how a healthy tendon becomes painful and dysfunctional.

The Tendinopathy Continuum

1. Reactive Tendinopathy: This is the initial stage, often seen in response to an acute overload or a sudden increase in activity (e.g., starting a new running program). The tendon cells (tenocytes) and the extracellular matrix respond by proliferating and producing more proteoglycans. These molecules draw in water, causing the tendon to swell. This protective response increases the tendon’s cross-sectional area to distribute the load. At this stage, the underlying collagen structure is largely intact. This phase is reversible if the load is appropriately managed.
2. Tendon Dysrepair: If the tendon is not adequately unloaded and remains under excessive strain, it enters a state of failed healing. Matrix breakdown increases, with more blood vessels (neovascularization) and nerve fibers (neoinnervation) growing into the tendon. These new nerves are often nociceptive (pain-sensing), which helps explain why the tendon becomes painful. The collagen fibers begin to lose their organized, parallel alignment.
3. Degenerative Tendinopathy: This is the final stage, often seen in older individuals or those with a long history of chronic tendon pain. Large areas of the tendon are now acellular, filled with disorganized collagen, new blood vessels, and breakdown products. The tendon loses its structural integrity and its capacity to handle load. At this stage, the risk of partial- or full-thickness tendon tears increases significantly.

A patient can have elements of all three stages present in the same tendon. For instance, an older individual with underlying degenerative tendinopathy might experience an acute overload, leading to a superimposed reactive tendinopathy.

This model explains why anti-inflammatory treatments often provide only temporary relief or fail altogether. They do not address the core problem: structural failure of the tendon matrix and a dysfunctional cellular response. Modern treatment aims not to suppress inflammation but to stimulate a more productive healing response and restore the tendon’s capacity to manage load.

The Procedure: An Ultrasound-Guided Gluteus Medius Tendon Injection

With a strong working diagnosis of gluteus medius tendinopathy, the goal of our intervention for the 57-year-old gentleman was twofold:

1. Diagnostic Confirmation: Injecting a local anesthetic into the suspected site of pathology should provide significant, albeit temporary, pain relief. If the patient’s pain resolves after the injection, it strongly confirms that we have identified the correct pain generator.
2. Therapeutic Benefit: The injection itself is intended to initiate a healing cascade and reduce pain long-term.

Preparation and Sterilization

After identifying and marking the point of maximum tenderness, the next step was to prepare the area for injection to minimize infection risk. I take this step with meticulous care.

1. Alcohol Prep: I began by cleansing the skin with an alcohol swab to remove surface oils and transient bacteria.
2. Povidone-Iodine: I followed with two passes using pads saturated with povidone-iodine, an antiseptic. I started at the center of the injection site and worked my way outward in expanding circles. This “dirty to clean” technique ensures we don’t drag contaminants back over the sterilized area.
3. Topical Anesthetic: To make the procedure as comfortable as possible, I applied a vapocoolant spray (like ethyl chloride) to the skin. This spray evaporates instantly, rapidly cooling the skin and providing a brief but effective numbing effect. “This will be cold,” I warned him, just before the sharp chill hit his skin.

The Injection Technique: Precision is Key

For this procedure, I prepared a syringe containing a mixture of a local anesthetic and a therapeutic agent. The choice of therapeutic agent is crucial and depends on the underlying treatment philosophy.

• Local Anesthetic: I used lidocaine, a fast-acting anesthetic. Its purpose is primarily diagnostic. If the patient’s pain is significantly reduced within minutes of the injection, it confirms we are in the right spot.
• Therapeutic Agent: In traditional practice, clinicians often use a corticosteroid. Corticosteroids are powerful anti-inflammatory agents. While they can provide short-term pain relief, their long-term effects on tendon health are controversial. Studies have shown that corticosteroids can be catabolic, meaning they can inhibit collagen synthesis and potentially weaken the tendon over time, increasing the risk of future rupture (Coombes, Bisset, & Vicenzino, 2010).

Given our understanding of tendinopathy as a degenerative, not inflammatory, condition, our practice often favors regenerative medicine approaches. These might include:

• Platelet-Rich Plasma (PRP): This involves drawing the patient’s blood, centrifuging it to concentrate platelets, and injecting the solution into the damaged tendon. Platelets are rich in growth factors that can signal the body to initiate a more robust healing and repair process.
• Prolotherapy: This involves injecting a mild irritant solution (often dextrose) into the tendon and ligament attachments. The goal is to create a small, controlled inflammatory response that stimulates the body’s natural healing mechanisms to repair and strengthen the connective tissue.
• Traumeel/Zeel: In this case, I used a combination of homeopathic preparations that are thought to modulate inflammation and support tissue healing without the catabolic effects of corticosteroids.

The procedure itself requires a tactile feel developed over many years of practice. As I advanced the needle, I could feel the different tissue layers. “Now I feel it enter the muscle, the tendon, right there,” I noted. The needle tip passes from the subcutaneous fat into the dense, fibrous tissue of the tendon, and the resistance changes. It is a subtle but palpable sensation, like a pencil pushing into a rubber eraser.

Once I believed I was in the correct location within the tendon sheath, I injected a small amount of the solution. “Does that actually feel like the pain that you have?” I asked.

“Yes,” he confirmed.

This is another vital piece of diagnostic information. The distension of the pathological tissue by the fluid from the injection often recreates the patient’s characteristic pain. This provides further confirmation that we are targeting the precise source of his symptoms.

To ensure the therapeutic solution reached the entire affected area, I employed a fanning technique. The gluteus medius tendon has a broad, paintbrush-like insertion. A single-point injection might miss parts of the damaged area. By slightly withdrawing the needle and redirecting it to different points within the tendon—fanning it out superiorly, inferiorly, anteriorly, and posteriorly—I could distribute the medication across a wider volume of tissue, bathing the entire degenerative region in the therapeutic solution.

“Let me do it one more time, and advance right there. Injection is in,” I announced as I delivered the final portion of the medication. “Right, I’m out. The needle is out.”

The entire injection process took less than a minute. Immediately afterward, I gently began massaging the area. This helps distribute the medication further within the tissues and can also ease some of the immediate post-injection soreness.

Immediate Post-Procedure Assessment

The final and most crucial part of the procedure is the immediate reassessment. This is where the local anesthetic’s diagnostic power comes into play.

“You had quite a bit of discomfort during that procedure,” I acknowledged. “How does this feel now when I press here?” I pressed on the exact spot that had been so tender minutes before.

“Just a little,” he replied.

“Is it less than it was earlier?”

“Yes, it was,” he confirmed.

“Okay. All right. So that’s a good sign,” I exAnestheticThat means the numbing medicine is in the right spot.”

This immediate, significant reduction in tenderness to palpation was the confirmation we needed. It validated our diagnosis of gluteus medius tendinopathy and gave us confidence that we delivered the therapeutic intervention to the correct anatomical location. I placed a simple adhesive bandage over the site, and the procedural part of his visit was complete.

The Integrative Path Forward: Beyond the Injection

The injection, while a critical component of our treatment plan, is not a standalone cure. It is a catalyst. It ” reboots” the local tissue environment, reduces pain signals, and creates a window of opportunity for the most important phase of healing: rehabilitation and addressing the root cause. This is where the true power of our integrative model, combining chiropractic care, functional medicine, and physical rehabilitation, comes to the forefront.

Lasting recovery from gluteus medius tendinopathy requires a comprehensive approach that addresses the biomechanical and systemic factors that led to the tendon overload in the first place.

1. The Role of Integrative Chiropractic Care

A common question I receive is, “How can chiropractic care help my hip pain?” The answer lies in the interconnectedness of the kinetic chain. The hip does not function in isolation. The alignment and function of the pelvis, sacroiliac (SI) joints, and lumbar spine profoundly influence its stability and movement.

• Lumbopelvic Biomechanics: The gluteus medius is a key pelvic stabilizer. If there are dysfunctions in the lumbar spine or SI joints—such as joint restrictions, misalignments (subluxations), or instability—the nervous system may alter muscle firing patterns to compensate. This can inhibit the gluteus medius. When the gluteus medius is inhibited or weak, other muscles must work harder to try and stabilize the pelvis. This includes muscles like the tensor fasciae latae (TFL) and the quadratus lumborum (QL). This pattern of synergistic dominance creates faulty movement patterns and places abnormal stress on the gluteus medius tendon, predisposing it to overload and injury.
• Neurological Input: Chiropractic adjustments are not just about “moving bones.” A specific spinal adjustment delivers a precise mechanical impulse into a restricted joint. This impulse stimulates a barrage of sensory nerve receptors (mechanoreceptors) in the joint capsule and surrounding tissues. This afferent information travels to the spinal cord and brain, where it can effectively “reset” the neurological control of the surrounding musculature. By restoring proper motion to the lumbar spine and SI joints, we can improve neurological drive to the gluteal muscles, helping “wake up” an inhibited gluteus medius and restore its function.
• Our Approach: In my clinical practice, after an intervention like the one described, I would perform a thorough chiropractic assessment of the patient’s entire lumbopelvic region. I would check for joint play, motion restrictions, and muscle imbalances. If I find restrictions in the SI joints or lumbar facet joints, I would apply specific chiropractic adjustments to restore normal mechanics. This is a foundational step in correcting the faulty biomechanics that contributed to the tendinopathy. This ensures the foundation on which the hip operates is stable and functional.

2. The Crucial Role of Rehabilitation and Load Management

The single most important evidence-based treatment for any tendinopathy is a progressive loading program (Littlewood et al., 2015). Tendons adapt to the loads they experience. The goal of rehabilitation is to gradually increase load on the gluteus medius tendon to stimulate matrix remodeling and improve its capacity to handle the demands of daily activity.

The injection provides a “window of opportunity” where the patient’s pain is reduced, allowing them to engage in this crucial rehabilitation without a significant pain flare-up.

Our rehabilitation protocol for gluteus medius tendinopathy is typically phased:

• Phase 1: Isometric Loading: Initially, we start with isometric exercises. These involve contracting the muscle without moving the joint. A classic example is a “clamshell” exercise where the patient lies on their side with knees bent and simply squeezes the gluteal muscles to hold the top knee slightly lifted, or a side-lying hip abduction hold. The key is to hold the contraction for an extended period (e.g., 30-45 seconds) at a tolerable intensity. Isometrics have been shown to have a significant analgesic (pain-reducing) effect and can begin to load the tendon safely.
• Phase 2: Isotonic (Heavy, Slow Resistance) Loading: As the patient tolerates isometrics, we progress to isotonic exercises, where the muscle contracts through a range of motion. Current evidence strongly supports heavy, slow resistance (HSR) training for tendinopathy. This involves using a challenging weight (e.g., an 8-12 repetition maximum) and performing the movement very slowly (e.g., 3 seconds up, 3 seconds down). Exercises might include weighted side-lying hip abduction, standing hip abduction with a cable machine or resistance band, and single-leg press variations. This type of loading has been shown to promote collagen synthesis and improve tendon structure compared with traditional high-repetition, low-load exercises.
• Phase 3: Energy Storage and Release (Plyometrics): Once the tendon has built sufficient strength and load capacity, we may introduce exercises that involve more rapid loading and release, mimicking the demands of walking, running, or sport. This could include exercises like jumping and landing, focusing on pelvic control. This phase isn’t necessary for all patients but is crucial for those returning to higher-level activities.
• Patient Education: Modifying Compressive Loads: A critical part of rehabilitation is educating the patient on how to avoid positions and activities that compress the gluteus medius tendon against the greater trochanter. This includes:

• Avoiding sleeping on the affected side.
• Placing a pillow between the knees when sleeping on the unaffected side to prevent the top leg from adducting (dropping down) and compressing the tendon.
• Avoiding crossing the legs when sitting.
• Avoid “hip hanging,” where you stand with all your weight shifted onto one leg, pushing the hip out to the side.

3. The Functional Medicine Perspective: Systemic Influences on Tendon Health

Our integrative approach, guided by Dr. Maria Cardenas’s collaborative oversight and my functional medicine training, compels us to look beyond local biomechanics. Must we ask: Are systemic factors impairing this patient’s ability to heal and predisposing them to tendinopathy?

Tendon health isn’t just about load; it is also about the body’s intrinsic capacity to repair. Many systemic factors can influence this capacity.

• Nutritional Status: Healthy tendons depend on proteins (specifically collagen), vitamins, and minerals.

• Vitamin C: Essential for the hydroxylation of proline and lysine, a critical step in collagen synthesis. Without adequate Vitamin C, the body cannot form stable collagen.
• Zinc and Copper: These minerals are cofactors for the enzyme lysyl oxidase, which creates the cross-links between collagen fibers that give tendons tensile strength.
• Amino Acids: Glycine, proline, and hydroxyproline are the most abundant amino acids in collagen. Adequate protein intake, or supplementation with hydrolyzed collagen or specific amino acids, can provide the raw materials needed for tendon repair.

• Metabolic Health: Conditions like insulin resistance and type 2 diabetes have been strongly linked to an increased risk of tendinopathy. High blood sugar levels lead to the formation of Advanced Glycation End-products (AGEs). These AGEs can cross-link with collagen fibers in the tendon, making them stiff, brittle, and more susceptible to injury. Assessing a patient’s metabolic health (e.g., fasting glucose, insulin, HbA1c) is a standard part of our functional medicine workup.
• Hormonal Balance: Hormones play a significant role in connective tissue health. For example, in post-menopausal women, the decline in estrogen is associated with a decrease in collagen synthesis and an increased prevalence of tendinopathy. In men, low testosterone can also impact tissue repair.
• Systemic Inflammation: While local tendon pathology is degenerative, chronic, low-grade systemic inflammation can impair the body’s ability to heal. Poor diet (high in processed foods, sugar, and unhealthy fats), gut dysbiosis (an imbalance in gut bacteria), chronic stress, or hidden infections can drive this inflammation. A functional medicine approach would assess and address these sources of systemic inflammation.

In our practice, we may use advanced laboratory testing to evaluate these factors and then create a personalized plan that might include dietary modifications, targeted nutritional supplementation, and lifestyle changes to optimize the patient’s systemic environment for healing. This is a clear example of how Dr. Cardenas’s medical expertise and functional medicine approach complement biomechanical and procedural interventions.

Conclusion: A Journey of Integrated Healing

The case of the 57-year-old gentleman with left hip pain powerfully illustrates our clinical philosophy. What began as a seemingly simple complaint of “hip pain” was carefully investigated through a detailed history and a precise physical examination, leading to a specific diagnosis of gluteus medius tendinopathy. We performed an ultrasound-guided injection with the dual purpose of confirming the diagnosis and initiating treatment.

However, the journey does not end with the injection. In fact, it truly begins there. The temporary pain relief it provides opens the door to a comprehensive, integrative treatment plan. This plan is built on several pillars:

1. Chiropractic Care to restore the foundational biomechanics of the lumbopelvic-hip complex and optimize neurological function.
2. Targeted Physical Rehabilitation to progressively load the tendon, stimulate structural repair, and build its capacity to handle daily demands.
3. Patient Education to empower the individual to modify aggravating activities and participate actively in their own recovery.
4. A Functional Medicine Approach, guided collaboratively by our full medical and chiropractic team, to identify and address systemic factors—nutritional, metabolic, or inflammatory—that may be hindering healing.

This is the essence of modern, evidence-based, patient-centered care. It moves beyond treating symptoms and instead focuses on a deep understanding of anatomy, biomechanics, and pathophysiology. It recognizes the body as an integrated whole and draws on multiple disciplines, from the hands-on precision of a chiropractor to the systemic oversight of a medical doctor and the root-cause analysis of functional medicine.

At Injury Medical Clinic PA, we believe this collaborative, multidisciplinary model provides the most robust and effective path for patients to not only find relief from pain but also achieve lasting health, function, and resilience.

References

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](https://bjsm.bmj.com/content/43/6/409)

Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials. The Lancet, 376(9754), 1751–1767. [https://doi.org/10.1016/S0140-6736(10)61160-9](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(10\)61160-9/fulltext)

Littlewood, C., Malliaras, P., Bateman, M., Stace, R., May, S., & Walters, S. (2015). The central nervous system–An additional consideration in ‘rotator cuff tendinopathy’ and a potential basis for understanding the link between pain and function. Manual Therapy, 20(6), 839-840. [https://doi.org/10.1016/j.math.2015.08.005](https://www.sciencedirect.com/science/article/abs/pii/S1356689X1500122X) Note: While this reference discusses rotator cuff, the principles of progressive loading for tendinopathy are universal and widely cited.

Long, S. S., Surrey, D. E., & Nazarian, L. N. (2013). Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. American Journal of Roentgenology, 201(5), 1083–1086. [https://doi.org/10.2214/AJR.12.9998](https://www.ajronline.org/doi/10.2214/AJR.12.9998)

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