INTRODUCTION
Gluteal tendinopathy, often called greater trochanteric bursitis or greater trochanteric pain syndrome, has a prevalence of 10-25% and is experienced by one in four women over the age of 50. The disorder presents as pain and tenderness over the greater trochanter and often interferes with sleep and physical function. The level of disability and quality of life is equivalent to that of severe hip osteoarthritis, 3 and effective management strategies are required.
Corticosteroid injections are commonly used to manage gluteal tendonitis and although the early results are promising, the medium-term benefits are significantly less and the long-term results are no better than a wait-and-see approach.
A contemporary approach to managing other tendinopathies combines education to reduce loading on the tendon during sustained posture and function (i.e., load management) with exercises6 that target the underlying pathology. This approach has not been tested in randomized clinical trials for gluteal tendinopathy.
A non-randomized clinical trial compared a home exercise program with the use of corticosteroids and radial shock wave treatment, reporting that home exercise performed poorly compared to one and four months. No load management advice was provided and the exercise was not specific to the gluteal tendons and muscles involved.
We conducted a randomized clinical trial to compare the effects of a tendon load management education program plus targeted exercise, a single corticosteroid injection, and a wait-and-see approach on pain and overall improvement in individuals with gluteal tendinopathy. .
The hypothesis was that the use of education plus exercise and corticosteroids would be better than a wait-and-see approach in the short term (after eight weeks), while education plus exercise would be better than the use of corticosteroids in the long term ( after 52 weeks).
SUMMARY
Lateral hip pain is sometimes called "greater trochanteric bursitis," but the preferred term now is greater trochanteric pain syndrome (because this disorder is usually caused by gluteal tendinopathies, sometimes with adjacent bursitis).
Although corticosteroids are often used in patients with increased trochanteric pain syndrome, the best treatment is unknown. In this multicenter trial from Australia, investigators randomized 204 patients (82% women, mean age, 55) with lateral hip pain for more than 3 months to education plus exercise, corticosteroid injection, or no treatment.
Education plus exercise participants received 14 educational sessions over 8 weeks on progressive tendon loading plus a specific exercise program; injection participants received an ultrasound-guided corticosteroid injection.
At 8 weeks, both the education plus exercise and injection groups reported significantly greater overall improvement in their "hip condition" than the no treatment group (77% and 58% vs. 29%), as well as significantly greater pain. lower intensity; The differences between the education plus exercise group and the injection group were also significant.
At 52 weeks, education plus exercise was superior to both injection and no treatment for overall hip improvement (79% vs. 58% and 52%).
Primary outcome measure: Global Rating of Change in Hip Condition (GROC). Proportion (%) of participants in each group reporting “moderately better,” “much better,” or “much better” on GROC (i.e., defined as success) over time. The test groups were education plus exercise (EDX), use of corticosteroid injection (CSI), or wait and see approach (WS). Supplementary Figure S6 shows the data plot of all GROC categories
Primary outcome measure: hip pain intensity. Pain in the past week for each group over time was reported on a numerical pain rating scale from 0 to 10 (where 0 = no pain and 10 = worst pain). Test groups were education plus exercise (EDX), use of corticosteroid injection (CSI), or wait-and-see approach (WS).
Conclusions and health implications
In gluteal tendinopathy, education plus exercise and corticosteroid use led to higher rates of patient-reported overall improvement and lower pain intensity in the short term (at eight weeks) compared with a wait-and-see approach. see. Education plus exercise was also better than using corticosteroid injection.
Education plus exercise showed better overall improvement than long-term corticosteroid use (52 weeks), but with no difference in pain intensity between the two groups. These results support the use of education plus exercise as an effective management approach for gluteal tendinopathy.
What is already known about this topic?
What this study adds
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COMMENT
In this randomized trial, education plus exercise resulted in better hip function and greater pain relief than corticosteroid injection or no treatment in patients with major trochanteric pain syndrome, with benefit for hip function sustained at 52 weeks.
While these results support education and exercise as the preferred approach, it is unclear whether routine physical therapy referrals will yield the results obtained in this trial (in which an intensive program was delivered by highly trained therapists).
