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Dry Needling SIG

Dry Needling vs. Cortisone Injection for treating GTPS

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This topic contains 4 replies, has 5 voices, and was last updated by Profile gravatar of Valerie Ann Phelps Valerie Ann Phelps 3 months, 2 weeks ago.

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  • #1819
    Profile gravatar of Joel Gaines
    Joel Gaines
    Keymaster

    Hi everyone!

    I saw this in a recent JOSPT and thought you’d find it interesting. Love to hear your thoughts.

  • #1821
    Profile gravatar of Stephen Thompson
    Stephen Thompson
    Participant

    I frequently use DN for treatment of trochanteric hip pain.  I am generally successful and able to provide relief for my patients.  The treatment is, of course, paired with a comprehensive POC.  There are definitely times that I have not been successful and referred a patient on for injection.  I don’t have full awareness of the success of their treatments, but I have been able to f/u with some who did report successful relief with the injection.  I feel that it is a logical progression of care if my PT POC is unsuccessful.

  • #1829
    Profile gravatar of Talin
    Talin
    Participant

    I agree with Stephen. I have had success with this condition, but as said previously, a complete POC including motor control, strengthening, and JST as needed is typically required to really see improvement in these patients.

    I have also seen many patients that have “failed” with the steroid injection. Not sure all of the reasons, but could be related to non-US-guided injection and inaccurate diagnosis of GTPS that my be mistaken for lumbar spine pathology.

  • #1840
    Profile gravatar of Jane Test
    Jane Test
    Participant

    Hey guys 🙂

    Just wanted to check if forum post replies are working…

  • #1845
    Profile gravatar of Valerie Ann Phelps
    Valerie Ann Phelps
    Participant

    Greater trochanteric pain syndrome, also known as recalcitrant lateral hip pain, has been more recently described as a ‘tendobursitis’. So it would make a lot of sense that at times dry needling will provide optimal effects and at other times a cortisone injection, and often both may be needed. We are aware that a bursitis will occur in a joint complex as a barometer of that complex being ‘out of synchrony’. It will be important for the clinician to address dysfunction in the hip joint, SI joint/pelvic ring complex, and lower quarter. Some research associates this chronic condition with a history of low back pain and/or nerve root compression; consider the summation effect of nociceptive input into the neurological segment.

     

     

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  • I appreciate the above analysis and support the use of the term “doctor” while differentiating what that specifically means. While I am cautious to avoid contradicting an orthopedic surgeon to a patient, I also resent the idea that physical therapists specifically should not refer to themselves as doctor. This was the opinion of one ortho surgeon with whom I shared a patient in the past year. His initial statement was that only a “doctor” (MD or DO) should refer to themselves as doctor when dealing with healthcare, but it turns out he did not agree with his own statement once challenged on the subject. He did not want the physical therapists to call themselves doctors, to avoid “confusing the patient.” When asked, however, he seemed to have no problem with an optometrist, podiatrist, psychologist, or any number of other providers referring to themselves as doctor. I believe the problem arises from the fact that Physical Therapy as a profession is in a transition, and we must understand that some time must be given to allow for acceptance of this transition.

  • One of the take home messages for me is ‘never give up!’, treat what you know, and don’t let the imaging keep you from being confident in well rounded conservative care.