Refer to a Physical Therapist with Sports Medicine or Orthopedic Specialization
For this patient with mild gluteus medius/minimus and hamstring tendinosis who is highly motivated and prefers non-surgical management, referral to a physical therapist—specifically one with sports medicine or orthopedic training—is the most appropriate specialist choice. 1, 2
Why Physical Therapy is the Primary Referral
Physical therapists are as effective as orthopedic surgeons for managing non-surgical musculoskeletal conditions, with 80% satisfactory outcomes in mechanical musculoskeletal disorders at 6-12 months, and they can appropriately triage patients who may eventually need surgical consultation 3, 4
Gluteal tendinopathy responds best to load management through exercise and education on pathomechanics, making PT the first-line treatment rather than injections or surgery 1
Patients with milder disease (like this case with "mild" tendinosis on MRI) and symptoms less than 1 year have better PT outcomes, though this patient's 8-month duration is approaching the threshold where earlier intervention is preferable 2
The Orthopedic Surgeon Referral You've Already Made
The orthopedic referral you've placed serves as appropriate backup for surgical consultation if conservative management fails after 3-6 months, or if the surgeon identifies any red flags you may have missed 5
Approximately 80% of patients with overuse tendinopathies fully recover within 3-6 months with appropriate outpatient PT, meaning most patients like yours will not ultimately need the orthopedic surgeon 5
Critical Action: Facilitate the PT Referral Immediately
The patient's frustration with phone tag at the PT clinic is the primary barrier to appropriate care. You should:
Call the PT clinic directly yourself (as you attempted) and request a specific appointment time for the patient, then communicate this directly to the patient 6
Request a physical therapist with sports medicine or orthopedic specialization who has experience with gluteal tendinopathy and works with athletes, as this patient is a full-time exercise instructor 1, 7
Emphasize to the PT clinic that this is an active professional athlete (exercise instructor) with occupational implications, which may expedite scheduling 7
What the Physical Therapist Will Provide
The PT will implement:
Eccentric strengthening exercises targeting the gluteus medius/minimus and hamstrings, which have proven beneficial in reversing degenerative changes and increasing strength in tendinosis 5
Load management education focusing on avoiding excessive hip adduction positions that compress the gluteal tendons, which is the primary pathomechanic driver of this condition 1
Activity modification specific to her work as an instructor (yoga, barre, pilates), teaching her which movements to avoid or modify during the healing phase 5, 1
Progressive return-to-work protocol that gradually reintroduces her full teaching load as symptoms improve 7
When to Escalate to the Orthopedic Surgeon
The orthopedic surgeon becomes necessary if:
Symptoms persist or worsen after 3-6 months of appropriate supervised PT, at which point surgical consultation is warranted 5
New symptoms develop suggesting complications (severe weakness, neurologic changes, inability to weight-bear) 1
The patient cannot tolerate the rehabilitation program due to pain severity 2
Common Pitfall to Avoid
Do not allow this patient to remain in limbo without PT simply because of administrative barriers with phone scheduling—this is a motivated patient with mild disease who is in the optimal window for conservative treatment success 2
Avoid corticosteroid injections at this stage, as they provide only short-term pain relief, do not alter long-term outcomes, and may inhibit tendon healing 5
Do not recommend complete rest, as this accelerates muscle atrophy and deconditioning; relative rest with guided exercise is the goal 5