An indirect evaluation between corticosteroid injections and gluteal exercises in the management of pain in greater trochanteric pain syndrome

Abstract

Introduction

Greater trochanteric pain syndrome (GTPS) is an umbrella term used to describe several pathologies contributing to lateral hip pain. The most prevalent pathology is gluteal tendinopathy. Conservative management of GTPS is predominantly now focused on the use of corticosteroid injections (CSIs) and gluteal exercises.

Aim

To compare CSIs and gluteal exercises on pain in adults with GTPS.

Method

A systematic search of AMED, CINAHL, MEDLINE, EMBASE, TRIP and the Cochrane Library was conducted from inception to January 2021. Critical appraisal was completed using the Critical Appraisal Skills Programme tool. Data were extracted to obtain population characteristics and procedural details.

Results

Seven articles met the eligibility criteria out of a total of 336; five articles were randomised control trials (RCT) and two were cohort studies, equivalent to 758 and 70 participants, respectively. Studies generally reported significant benefits of CSIs <12 weeks and gluteal exercises >8 weeks for the reduction in lateral hip pain (p < .05). Critical appraisal demonstrated varied study quality and significant heterogeneity.

Conclusion

CSIs appear to be a successful treatment intervention in the short-term to decrease lateral hip pain but not in the long-term. Gluteal exercises plus education on avoiding tendon compression appears to be as successful as CSIs in the short and superior in the long-term.

Keywords:

• Greater trochanteric pain syndrome
• gluteal tendinopathy
• corticosteroid injection
• physiotherapy
• conservative management

Acknowledgements

The authors would like to thank Gareth Stephens for his time and expertise in the topic in helping to achieve full-text publication of this review. The authors would also like to thank Dr. Toby Smith and Dr. Rachel Chester for their guidance and support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Thomas Samuel Collier

Thomas Samuel Collier graduated in Sport Health and Exercise with a first-class undergraduate degree with honours in 2013. He then graduated from the University of East Anglia with a Pre-Registration Masters degree in Physiotherapy in 2017 with a distinction. Tom is perusing a career as a clinical academic where he is currently funded by Health Education England as a Pre-Masters Internship Fellow. Tom has an interest in prognostic factors associated with musculoskeletal outcomes in primary care where his research interests are currently immersed. Tom works within the NHS as a first contact physiotherapist and maintains a keen interest in musculoskeletal pathologies.

Bradley Poole

Bradley Poole graduated in Sports Therapy and Rehabilitation BSc (Hons) with first class honours in 2014. He then graduated in physiotherapy (MSc) with distinction in 2017 from the University of East Anglia. Bradley currently works as a senior musculoskeletal physiotherapist at Oxford Manor Hospital, Oxford, UK.

Ben Bradford

Ben Bradford graduated from the University of East Anglia with first-class honours in 2014. He has since completed an NIHR-Funded Clinical Research Master's, where he looked at the efficacy of two, isometric exercises in immediate pain reduction in Achilles tendinopathy. He presented the findings of this at Virtual Physiotherapy UK 2020, and acted as clinical supervisor for two pre-registration master's students who also presented at Physiotherapy UK. Ben works within the NHS as a first contact physiotherapist and maintains a keen interest in management of lower limb tendon pain.