Treatment approaches for gluteal tendinopathy
Tendinopathy management has quickly evolved over the past several years to include load management and exercises rather than simply cortisone injections.
The current trial sought to determine the outcomes of managing gluteal tendinopathy by comparing three different management approaches (exercise and education, cortisone and wait-and-see) and found that overall, education and exercise demonstrated the greatest short-term and long-term gains.
Community-dwelling participants recruited into the study were between 35-70 years, experienced lateral hip pain for greater than 3 months, had a clinical diagnosis of gluteal tendinopathy and had a minimum pain score of 4/10. A total of 204 participants were recruited randomized into one of the following groups:
- Education and exercise (EDX) – 14 sessions over 8 weeks with an experienced physiotherapist which included education regarding tendon care and load management as well as an exercise program focusing on hip abductor strengthening and dynamic hip adduction control during functional activities;
- Cortisone injection (CSI) – one injection was administered by an experienced radiologist;
- Wait-and-see approach (WS) – one session with a physiotherapist who provided general information about tendinopathy and reassurance that the condition will resolve over time.
The Global rating of change (GROC) demonstrated the greatest improvement in the EDX at 8 weeks (77%) and at 52 weeks (78%). Whilst the CSI group also had a significant improvement (58%) initially at 8 weeks, the change was similar to the WS group at 52 weeks (57% CSI vs. 52% WS).
Pain intensity was also evaluated and found to be quickest to reduce at 8 weeks in the EDX group, however by 52 weeks the EDX and CSI were found to be similar (2.1 EDX vs. 2.3 CSI).
Overall, this study supports the use of an exercise and education program for the management of gluteal tendinopathy over a cortisone or wait and see approach.
> From: Mellor et al., BMJ 361 (2018) . All rights reserved to British Medical Journal . Click here for the online summary.