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Hip function improvement was greater with education plus exercise than with corticosteroid injections. Lateral hip pain sometimes is called “greater trochanteric bursitis,” but the preferred term now is greater trochanteric pain syndrome (because this disorder usually is caused by gluteal tendinopathies, sometimes with adjacent bursitis). Although corticosteroids often are used in patients with greater 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 >3 months to education plus exercise, to corticosteroid injection, or to no treatment. Education-plus-exercise participants received 14 education sessions during 8 weeks on progressive tendon loading plus a targeted exercise program; injection participants received one 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 did the no-treatment group (77% and 58% vs. 29%), as well as significantly lower pain intensity; differences between the education-plus-exercise group and the injection group also were significant. At 52 weeks, education plus exercise was superior to both injection and no treatment for global hip improvement (79% vs. 58% and 52%). |
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In this randomized trial, education plus exercise resulted in better hip function and greater pain relief than did corticosteroid injection or no treatment in patients with greater trochanteric pain syndrome, with the benefit for hip function sustained at 52 weeks. Although these results support education plus exercise as the preferred approach, whether routine physical therapy referrals will yield the outcomes achieved in this trial (in which an intensive program was delivered by highly trained therapists) is unclear.