Hip Pain - New Information To Knock It Out
A new, integrated approach to hip pain looks to get rid of the pain
Let’s talk about hip pain and an under-recognized cause of it. There are several different reasons patients come to see us with hip pain. It can be labral tears, osteoarthritis, cam deformities, avascular necrosis, just for starters But one of the most common reasons, especially for hip pain that hurts toward the outside or lateral part of the hip, is called Gluteal Tendinopathy (GT).
My friends at ChiroUp.com recently put out an wonderful rundown of GT through their email list which can be found here for our super curious audience members: https://chiroup.com/blog/what-is-the-most-common-cause-of-hip-pain
After I completed the Orthopedic Fellowship program, GT has been on my radar and it’s amazing to think; once you know to look for GT, you’re going to find it EVERYWHERE! Literally everywhere. As a provider we want to know everything we can know so that we are better equipped to help our patients. But no one single provider can be an expert at everything and the bottom line is that you just don’t know what you don’t know. I simply was unaware of GT before my Fellowship training. But I filled that hole and now we are making a difference for our patients with hip pain!
First, Why do people get it? The research says that patients develop GT from excessive tension or compression of the hip area.
So, how do you know if you have Gluteal Tendinopathy? What does it look like?
- GT is lateral hip pain and is tendinopathy of the glute medius or minimus.
- It hurts to walk but very tellingly, it hurts to lay on the painful hip because of the compression
- It also hurts to lay on the opposite side because we tend to lay with the top leg stretched over the other one so there is tension and pull on the painful hip.
- Pain on going up and down stairs is a sign of GT. One of our patients could barely get into and out of their RV and she was unhappy.
- Also, there is usually significant pain on palpation of the area. You can get their attention very quickly by poking around on it.
Gluteal Tendinopathy used to be commonly thought to be bursitis. In fact I still hear orthopedic surgeons gluteal tendinopathy bursitis. I heard it just a few weeks prior to compiling this information.
Current thinking is AWAY from bursitis and more toward GT. If bursitis IS present, it’s probably more a symptom of GT rather than the cause of the Gluteal Tendinopathy. This thinking is fresh enough that I found myself in a disagreement with an orthopedic surgeon about whether it’s bursitis or it’s gluteal tendinopathy. In an effort to simply disagree rather than be disagreeable, I told the patient what the research shows and said that ultimately, the terminology used doesn’t matter because the condition will be treated the same. For that patient, that worked and we were able to get them feeling better fairly quickly.
Some orthopedic doctors and pain management doctors are currently injecting corticosteroids and/or hyaluronic acid into the hip joints of these GT patients and they’re miffed that they have no effectiveness. Many times, the lack of effectiveness is going to be because the problem isn’t in the joint. It’s in the connection on the posterior aspect of the greater trochanter fo the hip. Meaning - IT'S GLUTEAL TENDINOPATHY AND NOT INSIDE THE JOINT!
- The first thing we do here at Creek Stone Integrated Medical once the diagnosis of gluteal tendinopathy is made, is that we use the Drop Release tool, a tool that was invented by my friend, Dr. Chris Howson from North Dakota. I use it to 'rough up' the area just a little bit in a gentle way.
- Then, I use regular spinal manipulative therapy to make sure joints in the region are moving well.
- Then, I strongly recommend gluteal tendinopathy patients opt to have low level laser performed on the area to work down some inflammation.
- We combine the treatment with with very targeted rehab exercises specifically made for gluteal tendinopathy.
- And then finally, we combine everything with trigger point injections from our Nurse Practitioner.
We have test this procudure on a signficant number of our patients and it's a game changer! This formula that we have generated only here at Creek Stone Integrated Medical has shown to be a true winner in helping our gluteal tendinopathy patients get completely out of pain in many cases.
IN ADDITION - Recent research is showing, that PRP injections at the site of Gluteal Tendinopathy show impressive promise in helping chronic GT recover quickly as well. That’s exciting because we do PRP here at Creek Stone Integrated Medical! I have the luxury of those not responding to the trigger points and my help to also try PRP now. That means that if all treatments I previously mentioned fails, we still have an excellent opportunity to get these patients out of pain without resorting to pain management, pills, or surgery. That's exciting.
In the research project, the researchers concluded, "Patients with chronic gluteal tendinopathy for greater than 4 months, diagnosed with both clinical and radiological examinations, achieved greater clinical improvement at 12 weeks when treated with a single PRP injection than those treated with a single corticosteroid injection"
If you or someone you love is suffering from hip pain, send them to the orthopedic specialist at Creek Stone Integrated Medical and let us get you on the path to feeling better right now. Just call 806-355-3000 and we'll get you on our schedule typically within 48 hours.
(1) Fitzpatrick J, B. M., O'Donnell J, McCrory PR, Zheng MH, (2018). "The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection." Am J Sports Med 46(4): 9336-9939.
Dr. Jeff Williams, DC, FIANM, DABFP is double Board Certified as a Fellow in Neuromusculoskeletal Medicine and Orthopedics as well as a Diplomate of the American Board of Forensic Professionals, and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020 & 2021. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Medical at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.
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