Physical Therapy superior to injection or wait and see for patients with lateral hip pain
Pain located on the outside of the hip has previously been diagnosed as trochanteric bursitis, but more recent research reports less than 10% of patients demonstrate bursal inflammation. This condition is more accurately diagnosed as greater trochanter pain syndrome indicating a breakdown of the glut tendons as they attach into the hip. This condition commonly affects mid aged females with a history of low back pain. Residual weakness in the glut musculature leads to poor walking mechanics and tendon overload. Physical Therapy remains the gold standard treatment for this condition and a recent study compared its' effectiveness to usual care.
A recent study in the British Medical Journal randomized 204 patients with gluteal tendinopathy to one of three groups: a wait and see approach, a steroid injection, or a Physical Therapy education and exercise program (Mellor et al. 2018). Authors reported patients in the Physical Therapy group demonstrated higher rates of improvement at 8 and 52 weeks compared to either the injection and wait and see approach. These findings are consistent with the literature on tendinopathy. These tendon injuries do not respond to injections and are best managed through Physical Therapy exercises to promote optimal loading and healing of the injured tissues.