What type of orthopedic specialist should a full-time exercise instructor with mild insertional left gluteus medius and minimus tendinosis and mild left common hamstring tendinosis be referred to for non-surgical management and physical therapy?

Orthopedic Referral for Gluteal and Hamstring Tendinosis

You should request a referral to a sports medicine orthopedic surgeon or an orthopedic surgeon with musculoskeletal/tendon specialization, specifically noting expertise in hip and lower extremity tendinopathies. 1, 2

Why This Specific Type of Orthopedist

Sports medicine orthopedic surgeons are the optimal choice because they routinely manage tendinopathies in active patients and have established relationships with specialized physical therapists who focus on eccentric strengthening protocols for gluteal and hamstring tendinosis. 2, 3 This subspecialty has the most experience with non-surgical tendon rehabilitation pathways and can facilitate the physical therapy referral you need while maintaining surgical backup if conservative management fails after 3-6 months. 4, 2

What to Include in Your Referral Request

When placing the referral, specifically state:

• Primary diagnosis: Mild insertional left gluteus medius/minimus tendinosis and mild left common hamstring tendinosis 1, 2
• Patient occupation: Full-time exercise instructor (high functional demands) 4
• Specific request: Need assistance establishing physical therapy referral with sports medicine or orthopedic-specialized PT 2
• Goal: Non-surgical management with supervised eccentric strengthening program 1, 2

Why Physical Therapy Referral Through Orthopedics Makes Sense

Approximately 80% of patients with overuse tendinopathies like yours fully recover within 3-6 months with appropriate supervised physical therapy. 2, 5 Orthopedic surgeons, particularly those in sports medicine, typically have direct lines to physical therapists who specialize in tendon rehabilitation and can expedite appointments. 2 The orthopedist can also provide a specific prescription for eccentric strengthening exercises targeting the gluteus medius/minimus and hamstrings, which have proven beneficial in reversing degenerative changes in tendinosis. 2, 3

Alternative Acceptable Subspecialties

If sports medicine orthopedics is unavailable, acceptable alternatives include:

• General orthopedic surgeon with hip/lower extremity focus 4
• Musculoskeletal medicine specialist (if available in your system) 1

Avoid requesting pediatric orthopedics (irrelevant to adult tendinopathy) or orthopedic trauma surgeons (focused on fractures/acute injuries rather than chronic tendinopathies). 4

What the Orthopedist Should Facilitate

The orthopedic surgeon should coordinate:

• Referral to physical therapist with sports medicine or orthopedic specialization for supervised eccentric strengthening protocol 2
• Progressive return-to-work protocol that gradually reintroduces your full exercise instruction workload as symptoms improve 2
• Activity modification education specific to movements that should be avoided or modified during healing 2
• Imaging if not already obtained: Ultrasound can effectively detect both trochanteric bursitis and gluteal tendinosis, though MRI provides more comprehensive assessment of peritrochanteric structures including both gluteal tendons and hamstring insertions 1

Important Caveat About Timing

The orthopedist should understand that surgical consultation is only warranted if symptoms persist or worsen after 3-6 months of appropriate supervised physical therapy. 4, 2, 6 The primary role at this stage is facilitating conservative management, not surgical evaluation. 2

Common Pitfall to Avoid

Do not accept a referral for corticosteroid injection as the primary intervention. While injections may provide short-term pain relief, they do not alter long-term outcomes and may actually inhibit tendon healing. 4, 2, 5 The goal is relative rest with guided exercise, not complete rest or injection-based management. 2