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Dry Needling SIG

Dry Needling vs. Cortisone Injection for treating GTPS

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This topic contains 5 replies, has 6 voices, and was last updated by  JACQUELINE DOIDGE 2 months ago.

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  • #1819

    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

    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

    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

    Jane Test
    Participant

    Hey guys 🙂

    Just wanted to check if forum post replies are working…

  • #1845

    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.

     

     

  • #2501

    JACQUELINE DOIDGE
    Participant

    I’d love to add to this conversation; even though much after the fact.  I’d like to agree with Valerie’s posting.  Yes, sometimes the DN works beautifully, other times, not.  I find that if there is a fairly extensive pattern of trigger points, there’s a good chance that the dry needling will resolve it, but of course, the presence of a true bursitis often creates that pattern.  If, from your examination, the history sounds like it originated with an acute event, then lead to chronicity, often the inflammatory process has resolved, which may lead to only a pattern of trigger points as the pain generators.  However, if the bursa still truly has pathology, which may be scarring, etc., the injection may be the most helpful.

    I always feel that if I don’t get a major improvement after 2-3 DN sessions, it may need to go to injection.

    The point that you have made about the comprehensive program is so important!  Your muscle retraining to re-establish the right synchrony around that joint should occur with your first treatment.  This is where we can truly ‘cure’ these conditions, and often quickly, which is of course what was missing in the study.

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