Injections for Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome can cause debilitating pain on the outside aspect of the hip. We’ve covered the nuts and bolts here and outlined the most effective route to recovery. Now let’s explain the role of injections for Greater Trochanteric Pain Syndrome. There are two types of injections for GTPS – PRP and cortisone and we’ll come onto that later.
What is Greater Trochanteric Pain Syndrome?
Before we discuss injections, it’s worth understanding a bit about what causes Greater Trochanteric Pain Syndrome. Our starting point is that muscles around the hip need to be able to absorb and support tremendous forces as we walk, run and jump! The muscles around the buttock and pelvis – ‘the glutes’ – are primarily responsible for this.
Once we get into our mid-forties and beyond 😳, the muscles become a bit less efficient and we can develop small ‘micro-tears’ of the tendon which reduces their capacity further. In turn this leads to pain and forces a reduction in function – making things like walking or running normal distances impossible.
There is really strong scientific evidence that shows that progressively re-training a muscle after injury is the most effective route to recovery and this has to be a key part of treatment – along with addressing the other factors that contribute to this condition.
How will injections for Greater Trochanteric Pain Syndrome help?
Cortisone is a powerful anti-inflammatory drug so where there is inflammation, cortisone can be a good treatment option. For many years, cortisone injections have been used for Greater Trochanteric Pain Syndrome. However, the truth is, it hasn’t really been a very successful treatment. There are a number of reasons for this.
Firstly, we now know that the pain is not usually caused by lots of inflammation. Improved imaging and better research has shown us that the injury is usually caused by small degenerative tears of the gluteus tendon and, whilst there may be a low grade inflammation and repair process going on, it is better to leave this process to heal gradually whilst recovering healthy tissue with exercise. The presence of cortisone might actually hinder normal healing too.
Secondly, clinicians are increasingly concerned about the potential harm cortisone might be doing to soft tissue – especially when the tendon is already injured. This is much more likely when cortisone injections are repeated for the same condition and this should always be avoided.
Thirdly, if the cortisone does help to reduce the pain, it can only provide short-term relief which means that once the effects of the drug wears off (usually after about a month) the pain often returns.
So they’re the reasons cortisone has a chequered history with this condition. Unsurprisingly, the scientific journals generally point to the short-term effects of cortisone and point management of the condition in a different direction.
PRP injections for Greater Trochanteric Pain Syndrome is much better supported in the scientific literature.
Platelet Rich Plasma (PRP) injections have emerged over recent years as a very successful way of treating a range of conditions that were previously difficult to treat with other treatments – particularly chronic injuries to tendons. This makes PRP a very suitable treatment for GTPS. You can find out much more about PRP as well as details about its primary benefits. In short, PRP brings a flood of platelets and bioactive proteins to the injured area which helps to accelerate healing and repair and has been shown to produce better outcomes in the shorter term (1 month post injection) and long term (1-2 years). This was in contrast to cortisone injections which were shown to provide maximum benefit at 6 weeks with no effect at all after 24 weeks.
We don’t recommend PRP injections to be the first line treatment, but where injury to the tendon has been established (gluteal tendinopathy) and the problem has failed to respond to the other conservative measures, its use certainly has an important role in treating the more resistant cases.
Finally when it comes to any injection therapy in the musculoskeletal system – the accuracy of the injection is important. This is particularly the case with injections for Greater Trochanteric Pain Syndrome due to the complexity and depth of the anatomy. That is what we always do these injections under ultrasound guidance (USG) to ensure the treatment reaches the injured tissue and better outcomes are obtained.
If you’re struggling with pain on the outside of the hip/thigh area and it is provoked by things like walking or running, you may have GTPS. The best thing you can do is see our team of physios for assessment and treatment. The chances are, they’ll direct you to conservative management in the first instance. However there are definately some cases where a PRP or cortisone injections may be the best treatment for Great Trochanteric Pain Syndrome.
Principal physiotherapist Paul Hattam leads our injection service where he combines his extensive experience in injection therapy with the latest technology and treatment advances. We have a dedicated area of our website where there is lots of information on injections and best practice.View more articles from Paul Hattam