Conservative treatment of lateral hip pain
Greater trochanteric pain syndrome (GTPS) is characterized as lateral hip pain with discomfort focalized around the greater trochanter. Previously believed to be due to bursitis or IT band friction, our understanding of GTPS has continued to evolve and ongoing research now shows GTPS to encompass many conditions including: bursitis, tendinosis, tendinopathy, and nervous involvement. In accordance with the lack of agreement on its true causation there exists no consensus on the most practical conservative treatment protocol. In the present study, the authors attempted to consolidate our current understanding on the conservative treatment of GTPS. Overall it was shown that steroid injections, shockwave therapy and exercise had promising results at different reporting periods, while there was a lack of available research to support the use of orthotics.
A search strategy of randomized controlled trials (RCT’s) on conservative treatments of GTPS was conducted using MEDLINE, CINAHL, AMED and EMBASE. English studies from any year were included. Only those patients over the age of 16 with a positive diagnosis of trochanteric bursitis and GTPS were analyzed. 8 studies were assessed; corticosteroid injections (n=6), shockwave therapy (n=2), exercise (n=1) and orthotics (n=1).
Due to the multifactorial nature of GTPS, conservative treatments vary and are often inconclusive. The present study found that corticosteroid injections demonstrated superior outcomes at 3 months while shockwave therapy was more effective from 4 to 15 months; furthermore, home training had promising outcomes at 15 months. Despite a lack of studies and treatment modalities, the current review may give clinicians an indication of when to incorporate different treatment practices depending on the longevity of their patient’s condition. The authors concluded that further studies with less risk of bias and enhanced methodological rigor are necessary to draw more conclusions.
> From: Barratt et al., Br J Sports Med 51 (2017) 97-104(Epub ahead of print). All rights reserved to BMJ Publishig Group Ltd. Click here for the online summary.