Evaluation and management of lateral hip pain

Greater trochanteric pain syndrome (GTPS) is a common but often misunderstood cause of lateral hip pain. It is believed that the most common cause of this syndrome is the degenerative tendinopathy of the lateral hip muscles, similar to the changes seen with degenerative rotator cuff changes in the shoulder. As with the shoulder, the condition may be intensified due to compressive forces being exaggerated by biomechanical changes and compensations. Considering these things, the authors of the present study sought to consolidate the current literature available on GTPS to better understand the diagnosis and treatment of GTPS.

With regards to the physical exam, seeing as the underlying pathology is so poorly understood previous studies have generally indicated that diagnosis should be based on the collective presentation of several indicators: pain at end range of abduction and adduction or internal rotation and external rotation, a positive FABER sign, pain with resisted abduction, and non-radicular patterns of pain.

Treatment should consist of a multimodal approach that addresses both the primary and secondary pain contributors. Therapists should look to address biomechanical and lumbopelvic impairments resulting in poor movement patterns and compensation through a generalized strength and stretching approach. Manually, previous studies show that relieving the compressive force over the trochanteric bursae may lead to positive outcomes.

As with most physical therapy studies, further investigation to identify risk factors, establish adequate treatment parameters and predict outcomes is needed however the current study provides an up to date foundation to logically base our treatment sessions in patients with GTPS.

> From: Mulligan et al., Phys Ther Sport (2015) 10(Epub ahead of print). All rights reserved to Elsevier Ltd.. Click here for the Pubmed summary.