A tendon can undergo both catabolic and anabolic processes. Mechanical loading is a strong driver of the biological processes that occur within a tendon and these, in turn, determine its structural shape and load-bearing capacity. Pathomechanics of Gluteal Medius and Minimus Tendon Pathology We reviewed current literature regarding rehabilitation after gluteus medius and minimus tears as part of a conservative management or postoperative protocol. Understanding the pathomechanics of these conditions is mandatory to understand the principals for physical therapy for both conservative management and therapy after surgical treatment. ![]() Gluteus medius and/or gluteus minimus tendinopathy is now accepted as the most prevalent pathology in those with pain and tenderness over the greater trochanter. The clearest indication for surgical treatment of gluteus medius and or minimus tears seems to be loss of abductor power (Medical Research Council Grading of Power) less than 4 4 and Trendelenburg gait. 3 found that the prevalence of GTPS was 15% for unilateral disease and 8.5% for bilateral disease in women and 6.6% for unilateral disease and 1.9% for bilateral disease in men. 2 In a multicenter observational study, Segal et al. 1 GTPS affects between 10% and 25% of the general population, with a peak incidence between the fourth and sixth decades of life. Tears of the gluteus medius and minimus are included in what is now recognized as the greater trochanteric pain syndrome (GTPS), which includes a constellation of pathology ranging from greater trochanteric bursitis, tightness of the iliotibial band, and tendinitis to formal muscle and tendon tears of the hip abductors. Gluteus medius and minimus tears have been identified recently as an important source of lateral hip pain and in some cases gait problems that may be an important cause of disability. Similar physical therapy protocols to those used in conservative management are used postoperatively. Surgical treatment is indicated when conservative management fails or an abductor power deficit is associated with pain. Conservative management is based on protecting the hip abductor tendons from excessive tensile and compression stresses while applying progressive load in conjunction with physical and medical anti-inflammatory measures. Treatment of these of lesions is based on the knowledge of pathomechanics involved and the extent of injury to the tendon and muscle tissue. Gluteus medius and minimus tears are frequent and may be not diagnosed timely. Exorcise intervention seem to improve symptoms after 4 months to a year of therapy therefore a very close supervision of the rehabilitation protocol is mandatory. ![]() More severe tears typically require a more rigid and complex type of fixation. Surgical management has been performed both open and endoscopic with good reported clinical results. The clearest indication for surgical management is failure of conservative management and loss of abductor muscle power. The initial management strategy of the hip abductor tears is conservative, including different anti-inflammatory therapies such as physical therapy and cortisone and platelet-rich plasma injections. It may be related to tendinitis of the gluteus medius and minimus, greater trochanteric bursitis, or even formal tears of the hip abductor tendons. The greater trochanteric pain syndrome includes a constellation of pathologies that generate pain in the greater trochanteric region and may be accompanied by varying degrees of hip abductor disfunction. We reviewed the current literature regarding rehabilitation after gluteus medius and minimus tears as part of a conservative management or postoperative protocol.
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