The gluteus minimus is the smallest and deepest of the three gluteal muscles. It functions primarily as a hip abductor, moving the leg away from the body and stabilizing the pelvis during walking. A tear or tendinopathy of this muscle is a common cause of chronic lateral hip pain, often grouped under Greater Trochanteric Pain Syndrome (GTPS). Due to its stabilizing role, this injury is frequently called a “Rotator Cuff of the Hip” tear. Treatment focuses on reducing pain and inflammation before progressively restoring strength and function.
Initial Non-Surgical Approaches
The initial phase of treatment focuses on alleviating pain and protecting the tendon from further stress. Activity modification is necessary, requiring patients to avoid movements that compress the tendon, such as prolonged standing, crossing the legs, or lying directly on the affected hip. Reducing weight-bearing activities allows acute inflammation to settle.
Pharmacological management often involves nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, to reduce short-term pain. While effective for immediate symptom control, NSAIDs do not alter the long-term outcome of tendon healing. For localized pain, injection therapies may be considered.
Corticosteroid injections provide rapid relief by delivering an anti-inflammatory agent directly to the painful area, aiding the start of physical therapy. However, this relief is often temporary. Platelet-Rich Plasma (PRP) injections are an alternative, using concentrated growth factors from the patient’s own blood. PRP may offer more sustained clinical improvement than corticosteroids for chronic tendinopathy, though its effectiveness for full-thickness tears is less certain.
Structured Physical Therapy and Rehabilitation
Physical therapy (PT) is the core component of conservative treatment, focusing on a staged, progressive increase in load to strengthen the damaged tendon and muscle unit. Rehabilitation begins with gentle activation exercises aimed at reducing pain and achieving isolated muscle control without high compressive forces. Patients start with low-load isometrics, such as supine hip abduction isometrics, pushing the leg against an immovable object. This phase also includes gentle glute bridges, performed without full hip extension.
Strengthening Phase
The next stage introduces controlled movement and gradual resistance to build the tendon’s capacity to handle load. Exercises like the clamshell, side-lying leg lifts, and banded lateral steps (“Crab Walks”) are introduced using light resistance bands. The emphasis shifts to controlled, slow movements, focusing particularly on the eccentric phase (muscle lengthening under tension). This controlled loading is crucial for stimulating tendon repair.
Functional Integration
The final stage integrates hip strength and stability into functional, weight-bearing movements required for daily life and sport. This includes exercises like single-leg balance, single-leg squats, and hip hikes, which challenge the gluteus minimus to stabilize the pelvis during gait. Improving core strength and pelvic stability is woven throughout these phases to prevent future recurrence. The entire program typically lasts several months, with noticeable improvement often taking four months to a year.
Surgical Repair and Recovery Expectations
Surgical intervention is reserved for patients with a confirmed full-thickness tear or those who fail to improve after at least six months of non-operative management. The procedure uses an arthroscopic or open technique to reattach the torn tendon to the greater trochanter of the femur using suture anchors. In chronic cases where the tendon is severely retracted or degenerative, the surgeon may use a tissue graft or perform a gluteus maximus transfer to restore abductor function.
Post-Operative Restrictions
Post-operative recovery is lengthy and stringent to protect the repaired tendon while it heals. Patients are typically restricted to non-weight-bearing or partial weight-bearing with crutches for the first six weeks. A hip abduction brace may be worn to limit movement and protect the repair site. Range of motion is severely restricted initially, limiting hip flexion (no more than 90 degrees) and adduction (crossing the midline) to prevent stress on the reattached tendon.
Long-Term Recovery
The recovery process involves a staged return to physical therapy, with active gluteal strengthening usually avoided until around three months post-surgery. Full return to unrestricted activities, including high-impact sports, generally occurs between seven to nine months. Timelines vary based on the extent of the original tear and the quality of the repair. Potential complications include re-tear, infection, and heterotopic ossification (abnormal bone growth in soft tissue).