Load Modification Versus Standard Exercise for Greater Trochanteric Pain Syndrome
| Status: | Recruiting |
|---|---|
| Conditions: | Chronic Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - 70 |
| Updated: | 8/24/2018 |
| Start Date: | July 17, 2018 |
| End Date: | March 31, 2020 |
| Contact: | Stephanie Di Stasi, PhD, PT |
| Email: | stephanie.distasi@osumc.edu |
| Phone: | 614-685-9779 |
Load Modification Versus Standard Exercise to Inform Treatment for Individuals With Greater Trochanteric Pain Syndrome
Greater trochanteric pain syndrome (GTPS), or lateral hip pain, is associated with muscle
weakness, altered movement patterns and painful daily activities. The disability associated
with GTPS is comparable to end stage hip osteoarthritis, primarily affecting young and middle
aged women. Few non-operative treatments have demonstrated long-term lasting or satisfactory
results. For those who do improve, recurrence rates of pain and disability can be as high as
50%.
Gluteal tendinopathy is the most common condition associated with a GTPS diagnosis. High
compressive loads of the gluteal tendons during common activities like walking,
stair-climbing, and running are the theorized mechanism for GTPS. These compressive loads are
exacerbated with postures and movement patterns that involve the lateral tilting of the
pelvis or movement of the thigh across the midline of the body. There is recent evidence that
load modification through education and exercise is superior to a corticosteroid injection
for reducing pain in these patients. However, it is unknown whether the possible effects of
the load modification program were due to exercise alone or the reduction in compressive
loads. As current physical therapy interventions for GTPS commonly incorporate high load
postures and exercise activities, there is an urgent need to compare outcomes of standard of
care physical therapy to load modification.
The goal of this study is to evaluate the short-term effects of load modification education
on pain and function in individuals with GTPS. Participants will be randomized to receive
either standard exercise education or load modification education. Both groups will complete
a series of questionnaires about their pain and function, and undergo a brief 2-dimensional
assessment of their posture and movement. Between follow-up sessions, participants will be
asked to respond to brief weekly online surveys to document their home program compliance,
pain, and function. It is hypothesized that the group of participants receiving load
modification will have the highest proportion of individuals with significant improvements in
pain and function, and will demonstrate improved posture and movement.
weakness, altered movement patterns and painful daily activities. The disability associated
with GTPS is comparable to end stage hip osteoarthritis, primarily affecting young and middle
aged women. Few non-operative treatments have demonstrated long-term lasting or satisfactory
results. For those who do improve, recurrence rates of pain and disability can be as high as
50%.
Gluteal tendinopathy is the most common condition associated with a GTPS diagnosis. High
compressive loads of the gluteal tendons during common activities like walking,
stair-climbing, and running are the theorized mechanism for GTPS. These compressive loads are
exacerbated with postures and movement patterns that involve the lateral tilting of the
pelvis or movement of the thigh across the midline of the body. There is recent evidence that
load modification through education and exercise is superior to a corticosteroid injection
for reducing pain in these patients. However, it is unknown whether the possible effects of
the load modification program were due to exercise alone or the reduction in compressive
loads. As current physical therapy interventions for GTPS commonly incorporate high load
postures and exercise activities, there is an urgent need to compare outcomes of standard of
care physical therapy to load modification.
The goal of this study is to evaluate the short-term effects of load modification education
on pain and function in individuals with GTPS. Participants will be randomized to receive
either standard exercise education or load modification education. Both groups will complete
a series of questionnaires about their pain and function, and undergo a brief 2-dimensional
assessment of their posture and movement. Between follow-up sessions, participants will be
asked to respond to brief weekly online surveys to document their home program compliance,
pain, and function. It is hypothesized that the group of participants receiving load
modification will have the highest proportion of individuals with significant improvements in
pain and function, and will demonstrate improved posture and movement.
Inclusion Criteria: Unilateral diagnosis of GTPS, as confirmed by physician using the
following criteria:
- Lateral hip pain, worst over greater trochanter, for >/= 3 months
- Pain with palpation over greater trochanter
- Average pain intensity of >/= 4/10 most days of the week
- Lateral hip pain reproduced during a 30 second single leg stance, or at least one of
the following positive tests:
1. >/= 2/10 lateral hip pain reproduce with passive hip flexion, adduction, and
external rotation (ie. FADER)
2. lateral hip pain reproduced with resisted internal rotation in the passive hip
flexion, adduction, and external rotation position (ie. FADER-R)
3. lateral hip pain reproduce with overpressure into passive hip adduction in
sidelying (ie. ADD)
4. lateral hip pain reproduced with resisted hip abduction in the hip hip adducted
position (ie. ADD-R)
5. lateral hip pain reproduced with hip flexion, abduction, external rotation (ie.
FABER)
Exclusion Criteria:
1. Any of the following treatments within the last 3 months:
1. corticosteroid injection in the affected hip
2. physical therapy or other skilled exercise intervention by a medical or
rehabilitation professional
2. Any of the following concomitant impairments or conditions:
a) Known or observed advanced spine, hip, knee, or ankle joint pathology,
including: i. Spinal or lower extremity surgery within the last 6 months ii.
Imaging data showing Kellgren Lawrence grade >/=2 in any lower extremity joint
with concurrent complaint >/=2/10 most days of the week.
iii. Groin pain as the primary hip pain complaint >/=2/10 most days of the week.
iv. <90 degrees of active hip and knee flexion bilaterally v. <0 degrees of
active ankle dorsiflexion
b) Systemic inflammatory diseases, or any systemic disease that affects the
nervous or musculoskeletal system or uncontrolled diabetes, or active malignancy
c) Individuals who cannot tolerate or should not assume the positions required
for the exercises for any reason other than hip discomfort
We found this trial at
1
site
Columbus, Ohio 43202
Principal Investigator: Stephanie Di Stasi, PT, PhD
Phone: 614-685-9779
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