Posts tagged bursitis
Dry Needling versus Steroid Injection for Hip Pain
boulder-dry needling-hip pain-treatment

Dry needling is an effective Physical Therapy intervention for the treatment of muscle pain and injury.  Our previous post described a recent review article supporting its' use for the reduction of short term pain and disability in multiple body parts including the spine and hip.  Painful trigger points and muscle pain can also be treated with corticosteroid injections performed by physicians with similar intentions of short term pain relief.  A recent study compared the effects of dry needling and steroid injections for the treatment of lateral hip pain (greater trochanter pain syndrome).  

hip pain-outer-bursitis-treatment-greater trochanter pain syndrome

Greater trochanter pain syndrome is a diagnostic term used to include many injuries to the outer hip including glut muscle and tendon pain, bursitis, and hip muscle tears.  Steroid injections are commonly performed in this area to reduce pain and allow an easier transition into Physical Therapy.  Brennan and colleagues in the Journal of Orthopedic and Sports Physical Therapy compared the effects of steroid injections to dry needling for patients with lateral hip pain (2017).  50 hips were randomized to one of the two treatments including either dry needling or steroid injection for up to 6 weeks based on provider choice.  The study showed similar results between groups for either dry needling or steroid injection at short and long term follow up.  The authors report dry needling is a viable treatment alternative for hip pain.

Contact your local Physical Therapist to learn more about dry needling for hip pain

Lateral Hip Pain and Bursitis

Patients with outer hip, lateral, pain have previously been diagnosed with trochanteric bursitis indicating the fluid filled sack between our hip muscle tendons and our thigh bone is to blame for their symptoms.  In addition the -itis ending in the diagnosis leads us to believe there is an inflammatory process taking place in the hip.   Interventions designed to combat inflammation where previously utilized in an attempt to reduce pain and improve function.  Based on the recent research experts have moved toward a more accurate diagnoses for symptoms in the lateral hip which is changing our understanding of the pathology and treatment interventions for this common condition.  

boulder physical therapy lateral hip pain bursitis

Experts are currently moving away from the diagnosis bursitis due to the lack of confirming findings on diagnostic imaging.  Bird et al. reported only 8% of patients with lateral hip pain had bursitis on ultrasound imaging (Arthritis and Rheum. 2001).  A recent study by Long et al. found 80% of close to 800 patients with lateral hip pain did not show any signs of bursitis.  Conversely these imaging studies, including MRI, are finding more chronic, degenerative (scar tissue) changes in the tendons on the gluteus medius and minimus tendons as well as the IT band.  These changes explain the limitations of interventions designed to treat inflammation in these patients.  

The diagnosis Greater Trochanteric Pain Syndrome (GTPS) is now being utilized to more accurately describe these chronic changes among patients with lateral hip pain.  GTPS accounts for a small amount of sports injuries but has its' highest incidence among individuals aged 40-60 years old (Mulligan et al. 2014).  In our Physical Therapy practice we commonly see this condition among individuals with a prior history of low back pain and IT band pain.  These patients often demonstrate weakness in their hip musculature leading to muscle imbalances across the lower quarter.  The degenerative changes in the tendon represent a decrease in the tendon's ability to tolerate loading in movement and athletic events.  Interventions should focus on correcting hip muscle imbalances and poor movement patterns which perpetuate this condition.   When appropriate, progressive resistance exercises should be implemented to improve these tissues' ability to tolerate stress and help remodel the tendon.

To learn more about how to accurately diagnose and treat your lateral hip pain contact your local Boulder Physical Therapists at Mend.