The gluteus medius is the most important hip abductor, essential for maintaining a level pelvis during walking and running. Gluteus medius weakness produces the Trendelenburg gait — the pelvis drops to the contralateral side during single-leg stance on the weak side, causing the trunk to lean toward the weak side as compensation. Gluteal tendinopathy at the greater trochanter — the new name for greater trochanteric pain syndrome — affects the gluteus medius and minimus insertions.
| Origin | Outer ilium between the anterior and posterior gluteal lines (upper two-thirds of the lateral ilium) |
|---|---|
| Insertion | Lateral surface of the greater trochanter (primary insertion) with anterior and posterior tendon components |
| Nerve Supply | Superior gluteal nerve (L4, L5, S1) |
| Blood Supply | Superior gluteal artery |
| Actions | Hip abduction (primary function — all fibres); Hip internal rotation (anterior fibres); Hip external rotation (posterior fibres); Prevents pelvic drop (Trendelenburg) during single-leg stance — the most important clinical function |
|---|
During the single-leg stance phase of walking, the gluteus medius must generate a force 1.8-2.5× body weight to counteract the contralateral hip drop from the ground reaction force. Weakness from hip OA, hip replacement, IT band tightness, or deconditioning produces the Trendelenburg lurch that increases energy expenditure by up to 25%.
Gluteal tendinopathy (GTPS) management: load management (avoid positions that compress the tendon against the trochanter — crossed-leg sitting, lying on the affected side, adduction stretching), progressive hip abductor strengthening, and corticosteroid or PRP injection. High volume image-guided injection (HVIGI) with 40 mL normal saline disrupts neovascularisation and provides sustained relief.
The gluteus medius is palpable as the lateral hip bulk from the iliac crest to the greater trochanter, becoming firm during resisted hip abduction or single-leg stance.
Gluteus medius insertion degeneration at the greater trochanter producing lateral hip pain managed with load modification, strengthening, and HVIGI.
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