Best Treatment for Greater Trochanteric Pain Syndrome
The best treatment Greater Trochanteric Pain Syndrome (GTPS), comes through thoroughly assessing and clearly diagnosing which structure is at fault. As highlighted in our previous blog, Greater Trochanteric Pain Syndrome is a fairly recent term, replacing the old and overly used Trochanteric Bursitis.
Traditionally, if you have lateral hip pain then you’re most likely to be diagnosed with Trochanteric Bursitis. Giving you a diagnosis of ‘Trochanteric Bursitis’, meant the likely treatment was a corticosteroid injection. Research shows that the effectiveness of this treatment is pretty limited in providing a long term solution.
Evidence now shows us that the likely structure causing most of this lateral hip pain and dysfunction comes from the Gluteal Tendon. In particular at its attachment into the Greater Trochanter (bony protrusion on the outside of the thigh). As a result, the more accurate diagnosis of Gluteal Tendinopathy is preferred, with bursitis a secondary consequence.
In order to choose the best treatment for Greater Trochanteric Pain syndrome we need to understand a little bit about tendon healing. As explained in our previous blogs on Achilles Tendinopathy & Patella Tendinopathy, treatment depends upon what stage of healing the tendon is in.
Tendons (and in general all soft tissues in the body) are in a constant continuum of healing. When a tendon becomes painful in the first 3-6 weeks, be it a first time episode or a flare up of a persistent problem, we class this as the ‘reactive phase’. Typically when lateral hip pain symptoms are more acute and irritable. For example when walking with every step or struggling to sleep due to pain lying on your side.
Over time the inflammation turns to scar tissue, which if happens repetitively without good treatment, turns into a phase of ‘disrepair’ and eventually ‘degeneration’ of the tendon. Hence creating a chronic cycle as the new tissue formed is not strong enough to do its job.
Therefore, when it comes to an effective and targeted plan, the best treatment for GTPS should follow the 3 simple steps set out below.
Best treatment for Greater Trochanteric Pain Syndrome
If you’re in the ‘reactive phase’ it is essential to avoid aggravating positions and postures that may continue to compress and irritate the tendon and bursa. Classic positions such as hip hanging, crossing legs and lying on your side can all contribute to lateral hip pain. Reducing these repetitive postures throughout the day can help to offload undue pressure and strain.
Begin some light-load, strengthening exercises called ‘isometrics’. Sustained muscle contractions in comfortable positions. Evidence has shown that isometric strengthening can help to reduce the high levels of lateral hip pain associated with this phase. Helping to get you started on a progressive loading programme ready for the next stage of treatment.
*Our experienced Physiotherapists will guide you on the appropriate level of exercise to begin with*
As pain and irritability are the dominant characteristics of the ‘reactive phase’, occasionally Corticosteroid Injections can provide a very effective, short-term relief. Although, as highlighted in our GTPS injection blog, this is not the full solution. It essentially helps to reduce pain, opening up the window for a more effective, long-term treatment.
Classically, symptoms can last for months, and has been doing so by the time most people seek treatment for Greater Trochanteric Pain Syndrome. As a result, the gluteal tendons have usually entered a phase we call ‘disrepair’ and ‘degeneration’. This is when immature soft tissue thats created to try and heal the area doesn’t live up to its needs. A build up of poorly aligned and sensitive scar tissue in the area subsequently develops.
At this stage the tendon needs some external help to reset the healing process and start a fresh. This is when Shockwave therapy is a very effective treatment option.
Extracorporeal Shockwave Therapy (ESWT) is a relatively new treatment with scientifically proven, excellent results for chronic tendon conditions. These include Plantar Fasciitis, Tennis Elbow, Achilles Tendinopathy.
Shockwave Therapy owes its heritage to lithotripsy where focused shockwaves were used to break apart gall stones so they can be passed. Fast forward a number of years later and with a bit of lateral thinking and there is now growing evidence for SWT as the ‘gold standard’ treatment for chronic tendon problems.
Current research shows a more beneficial effect from combining Shockwave Therapy with a strengthening programme as best treatment for Greater Trochanteric Pain Syndrome. Read more here about our Shockwave specialist service.
There is also a growing body of evidence for Platelet Rich Plasma (PRP) injections for the treatment of chronic tendon conditions. PRP injections harness the healing potential of our blood by infiltrating the area with 1000’s of platelets and bioactive proteins which are the building blocks of healing. Do check out our GTPS injection blog for more info.
Undoubtedly the best treatment for Greater Trochanteric Pain Syndrome is strengthening. Occasionally patients will have to follow steps 1 & 2 in differing levels. However, ALL will have to commit to step 3 if they are to gain a long term solution. Strengthening over a period of months is the only way to reverse the physiological changes that have occurred in the Gluteal Tendon from the repetitive strains and compressions.
Research over the years has played around with differing types of strength work for tendons. The best results now come from heavy, slow resistance training which are tailored to the patient. Initially this begins with isometric work as mentioned in stage 1.
Progressing to ‘isotonics’ (constant strength work through range of movements) geared for tasks such as walking distances, hills, stairs, etc. As well as ‘plyometrics’ (jumping or hopping) should patients goal be to return to sporting activities.
*Our experienced Physiotherapists with guide you on the appropriate level to be targeting*
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