Gluteal Loading Exercise May Not Improve Greater Trochanteric Pain Syndrome

Adding an exercise regimen to a comprehensive educational program for the management of greater trochanteric pain syndrome may not bring significant benefit.

Adding an exercise regimen to a comprehensive educational program for the management of greater trochanteric pain syndrome may not bring significant benefit, according to a randomized controlled trial published in the Journal of Women’s Health.

A group of postmenopausal women with lateral hip pain were assigned to follow the Gluteal La Trobe University exercise program (GLoBE; n=38) or a sham exercise (control; n=43) twice a day at home for a period of 10 to 15 minutes.

The GLoBE program involved isometric loading of the gluteus medius and minimus and kinetic chain strengthening exercises and was structured in 4 stages (isometric hip hitch hold; hip hitch with dynamic movement progression with toe taps, followed by hip swings; single leg wall squat).

Participants in the sham exercise group followed a 4-stage seated exercise program not focused on therapeutic loading. Sessions lasted for 12 weeks, with follow-up examinations occurring at 12 weeks and 52 weeks.

All participants received an education booklet regarding prevention tips as well as sitting, standing, and lying guidelines aimed at reducing compressive tendon load. The study’s primary outcome was pain intensity during gluteal tendon loading, assessed with the Victorian Institute of Sport Assessment-Gluteal Tendon questionnaire (higher scores indicating reduced pain and dysfunction). Secondary outcomes included assessment of hip pain (with the Lateral Hip Pain questionnaire), hip function (with the Hip Dysfunction and Osteoarthritis Outcome Score), perceived improvement (with the Oxford Hip Score), and quality of life (with the Assessment of Quality of Life).

Participants following both the GLoBE program and the sham exercise reported improvements for all outcomes (with the exception of the sports assessment part of the Lateral Hip Pain questionnaire) at 12 and 52 weeks, compared with baseline (P <.01 for all). In addition, pain intensity during gluteal tendon loading, hip function, perceived improvement, and quality of life were comparable between the GLoBE and control groups.

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At 52 weeks, both the GLoBE and control groups reported being “quite a bit better” with the Global Rating of Change (median [interquartile range]: 5.0 [0.5-7.0] and 5.0 [0.75-7.0], respectively), but no between-group differences were found at 12 weeks and 52 weeks.

The small cohort and lack of adjustment for medication use represent potential limitations of the analysis.

”The primary structure contributing to nociceptive input could alter the response to exercise intervention. Since the cause of tendon pain is not known and the pathophysiology of [greater trochanteric pain syndrome] is poorly understood, it is plausible that responders in the GLoBE group had primary tendon pathology known to benefit from isometric exercise,” concluded the investigators.

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Ganderton C, Semciw A, Cook J, Moreira E, Pizzari T. Gluteal loading versus sham exercises to improve pain and dysfunction in postmenopausal women with greater trochanteric pain syndrome: A randomized controlled trial [published online May 1, 2018]. J Womens Health (Larchmt). doi: 10.1089/jwh.2017.6729