Alternative treatment for greater trochanteric pain syndrome
Why Prolotherapy is the Best Alternative Treatment for Greater Trochanteric Pain Syndrome
Ross A. Hauser, M.D.
For the person who has side-of-the-hip pain especially when lying on that side while in bed, the most likely culprit will be gluteus medius tendinosis. The pain syndrome that occurs from a structure that attaches to the greater trochanter is often called greater trochanteric pain syndrome. Most pain management or sports medicine articles on this condition state that the cause is either a tendinopathy or bursitis and then go discuss how treating with NSAIDs and cortisone shots helps the condition. These articles do the public a great disservice. I completely disagree with these types of statements. For one thing, a true bursitis is unbelievably painful. In other words, the patient will not let you touch the area because it is so hot, red, and inflamed. The number of true bursitis cases of the greater trochanter I have seen in all my years of practice has been one. This means that 99.9% of greater trochanter pain syndrome cases are due to a tendinosis of the gluteal muscles, which is generally the gluteus medius muscle. The gluteus medius muscle abducts the hip, so pulling the leg away from the body is typically painful in patients who have gluteus medius tendinosis. The diagnosis can be easily found on physical examination, but it does show up on MRI.
Here is the MRI report of one of our recent patients with greater trochanteric pain syndrome:
ORTHOPEDICS MRI REPORT
MRI: Left Hip
History: Rule out soft tissue lesion left gluteal and SI. Pain not resolving with treatment over the last four months.
Comparative studies: None.
Technique: Multiplanar sequences with T1, intermediate, T2, and /or T2 weighted image contrast.
Osseous: No evidence of osteonecrosis, fracture, or neoplasm.
Joint: Left femoral head is intact and normally aligned with intact articular cartilage. No significant hip joint effusion. Insertional gluteus medius tendinosis with mild left greater trochanteric bursitis.
General: Contralateral hip is intact and normally located with mild right gluteus medius insertional tendinosis. No pathologic endopelvic mass. Musculature structures of the buttocks and upper thighs are otherwise normal appearing.
IMPRESSION: Bilateral gluteus medius insertional tendinosis slightly more severe on the left with mild bilateral trochanteric bursitis. No abnormality of either hip articulation noted. No occult fracture identified.
Anatomy of the hip: regeneration vs degeneration. If one looks at the anatomy around the greater trochanter it is easy to see that a lot of muscles and tendons attach onto it. For illustration, we have included a figure (21-5) from our sports Prolotherapy book called Prolo Your Sports Injuries Away!
If physical examination of the hip reveals tenderness on the greater trochanter to palpation and the hip is without heat or redness or evidence of inflammation, then the cause of the patient’s chronic side-of-the-hip pain must be degenerative. The degeneration of a tendon or muscle attachment (or origin) is termed tendinosis. Tendinosis means a degenerated tendon. What does a degenerated tendon need? Regeneration, of course! The treatment that regenerates structures is Prolotherapy. The treatments that degenerate tendons are NSAIDs and corticosteroid shots. Receiving a corticosteroid shot or taking an NSAID when the problem is already degenerative in nature, makes no sense. That is why the best treatment alternative for greater trochanteric pain syndrome caused by gluteus medius tendinosis or other muscle tendinosis is Prolotherapy.
What else should you know about greater trochanteric pain syndrome?
Contributing factors to greater trochanteric pain syndrome include the following:
- Snapping hip syndrome
- Hip instability
- Hip ligament injury
- Myofascial pain syndrome
- Iliotibial band syndrome
- Osteoarthritis of the hip
- Osteoarthritis of the lumbar spine
- Degenerative disc disease of the lumbar spine
The key point in treating greater trochanteric pain syndrome is determining what caused the gluteus medius or muscle or tendon attachment on the hip to be injured in the first place? They say a picture is worth a thousand words, so let’s look at another figure (21-7) from Prolo Your Sports Injuries Away!
From the figure you can see that the patient has a sprain of the hip ischiofemoral ligament. This injury causes reflex inhibition of muscle contraction around the hip, thus the patient’s hip feels weak. The ligament injury causes the hip joint to be unstable, which puts further pressure onto the muscle support of the hip to stabilize the hip. Guess what happens next? You are correct – the hip muscles become degenerated. Think about it: the muscle demand on the hip muscles that attach to the greater trochanter increases, but yet at the same time the body is inhibiting their contraction by the ligament-muscle reflex. It is a set up for tendinosis. So in this scenario if you just did Prolotherapyonto the greater trochanter the problem would continue because the “real cause” of the condition is hip joint instability caused by injury or weakness of the hip ischiofemoral ligament. We would do Prolotherapy to that area as well. I feel the best type of Prolotherapy to treat this injury is Hackett-Hemwall Prolotherapy because it is the most thorough. This is the type of Prolotherapy that we use at Caring Medical. All the structures contributing to the pain are treated. A patient such as this in our office would be seen every four weeks or so and typically three to six visits are needed to resolve the problem. Often the treatment is curative. This is why patients around the world are saying that they have Prolo’ed their greater trochanteric pain away after seeing Dr. Hauser for Prolotherapy at Caring Medical!
If you have any questions concerning how we use Hackett-Hemwall Prolotherapy to help greater trochanteric pain syndrome, hip instability, hip ischiofemoral ligament sprain, gluteus medius tendinosis, gluteus minimus tendinosis or any greater trochanter tendinopathy, feel free to contact us here.