hip3The use of “Trochanteric Bursitis” as a diagnosis for lateral hip pain is extremely common in orthopaedics and manual therapy.  In fact, a simple google image search of the terms “hip” and “greater trochanter” led mostly to diagrams pertaining to such condition. However, given the numerous anatomical structures in the region of the lateral hip, recent literature has moved towards labeling a collection of signs and symptoms in this region as greater trochanter pain syndrome (likely to the chagrin of my colleague Dr. Andreo Spina, developer of Functional Anatomic Palpation Systems)

Greater Trochanter Pain Syndrome (GTPS) is described to include the following:

• Chronic continuous or intermittent pain local to the greater trochanter region
• Radiation to the lateral hip or thigh
• Pain increase with activity
• Pain aggravated by lying on the affected side
• Pain reproduced upon local palpation of the greater trochanter
• Supine resisted hip external rotation and single-legged stance may be positive for tendinous or bursal involvement
• Higher prevalence in women and those 40-60 years of age
• Patients may also present with tenderness of the iliotibial band and osteoarthritis of the knee (usually due to altered biomechanics of the lower extremities).

Treatment for GTPS commonly consists of an initial course of non-steroidal anti-inflammatory medication, electrotherapeutic modalities, and rehabilitative therapy. Local injection of corticosteroids has been regarded as the standard of care, however, its beneficial effect has yet to be validated by controlled research methods.

In practice, I generally utilize the approach taken by Dr. Spina (above) and aim for specificity in my diagnosis. Understandably, advanced imaging may be necessary to be 100% precise, however, as my colleagues at F.A.P. preach:

Specificity of Diagnosis = Specificity of Treatment = Specificity of Results!!!

*note: My review on the recently published study entitled “Home Training, Local Corticosteroid Injection, or Radial Shockwave Therapy for Greater Trochanter Pain Syndrome” from the American Journal of Sports Medicine will be posted shortly on Research Review Service

6 Responses to Its Not Always Bursitis: Greater Trochanter Pain Syndrome

  1. Mark Young says:

    I have to agree with your friends at F.A.P. Without a specific diagnosis ideal treatment of a condition cannot be possible. Instead you’ll end up using a shotgun approach and in many cases these methods only treat symptoms instead of causes.

    Whether through diagnosic imaging, palpation, or movement screening I think finding the root cause is more important than creating a sweeping recommendation for a general condition.

  2. Finding the root cause as Mark states is KEY.

    Many times, esp in chronic cases, the source is rarely the issue.

    Here is something to try
    1) find the exact movement that is painful for the athlete (say a hip “issue”)

    2) for the hip, go to the opposite shoulder

    3) do a mobility drill at the shoulder, with it in the OPPOSITE position.

    Say Right leg, internal rotation, with the knee bent (flexion) is an issue and can recreate the pain.

    Try
    LEFT shoulder, EXTERNAL rotation, elbow straight, WHILE having the athlete make a very slow circle moving only the shoulder (AC) joint.

    Have them walk a bit (about 20 seconds)

    Retest–note ROM difference and pain difference

    In my experience, I find an improvement at least 50% of the time just by doing that. This is based on some Z Health work using interlimb coupling and perhaps central pattern generators in the nervous system.

    Anything I can do to help, let me know!
    rock on
    Mike T Nelson PhD(c)
    http://www.ExtremeHumanPerformance.com

  3. jcubos says:

    Sweet…Mike, I’m looking in to the R phase and will likely place an order sometime soon. Once I do, expect a message from me.

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