Lateral hip pain, often termed “Greater Trochanteric Pain Syndrome” (GTPS) by clinicians, is a common condition seen by physiotherapists. Patients with GTPS typically experience pain on the outer side of the hip, which can sometimes radiate down the leg toward the knee. This discomfort may be felt during prolonged sitting, lying on the affected side, or during physical activity.
GTPS can be related to various soft tissue structures around the hip, including the gluteus medius and minimus tendons, local bursae, and the iliotibial band (ITB), and less commonly the gluteus Maximus tendon. While it was once believed that inflammation of the bursa was the primary cause of GTPS, recent research suggests that the main contributors are the hip abductor tendons, specifically the gluteus medius and minimus.
CAUSES AND RISK FACTORS:
Several factors can contribute to the development of GTPS.
Compressive and tensile loads
Certain positions that involve hip adduction (e.g., crossing the leg over the body’s midline) can physically compress the gluteal tendons. Examples include lying on the affected side, sitting or standing with legs crossed, and standing with weight shifted to one hip.
Decreased muscle strength and bulk of the hip abductors (glutes)
Females > 40 y.o.
There is initial research to suggest that the hormonal changes occurring around menopause can influence the incidence of this condition.
PHYSIO TREATMENT FOR GTPS:
Education - Incl. Load Management Advice.
Education on avoidance of adduction related compressive positions. This includes sitting or standing with the legs crossed, sitting with knees together or laying on the sore hip to sleep. Hip adduction stretches should also be avoided. Education on activity modification should be provided and is client dependent, it is important not to completely rest as this will lead to further muscle weakness and imbalance. You should work with your physiotherapist to identify your personal threshold for exercise and work to improve this gradually over time.
Manual therapy & Dry Needling.
Physiotherapists can help with short term pain relief by using strategies such as soft tissue release and dry needling to increase blood flow, decrease tissue tightness and reduce pain. As your condition improves, the demand for treatment such as this should too decrease over time.
Exercise.
Early intervention with a gradual tendon loading program is key to reducing pain around the outside of the hip, and improving tendon loading capacity.
A GTPS exercise program should include a combination of isometric loading (for pain relief), slow, heavy loading exercises and movement retraining exercises to be successful in the long term. In the initial phases of recovery, it is important that such exercises are completed in positions that avoid hip adduction as this can be pain provocative.
By addressing GTPS with a targeted and multi-faceted treatment plan, patients can manage their symptoms effectively, improve their quality of life and reduce the likelihood of injury recurrence.
コメント