Shockwave therapy for gluteal tendinopathy
Pain on the point of the hip, worse lying on that side at night, is usually gluteal tendinopathy. It is one of the four musculoskeletal uses NICE has assessed, and it is the one where the guidance is most cautious.
What you're seeing
Understanding gluteal tendinopathy and greater trochanteric pain syndrome
Gluteal tendinopathy is the commonest cause of pain over the greater trochanter, the bony point on the outside of the hip. The umbrella term for that presentation is greater trochanteric pain syndrome, and the tendons of gluteus medius and gluteus minimus are where the problem usually sits. The signature is pain lying on that side at night, and pain on standing on that leg alone.
Compression is the mechanism that makes this condition distinctive. The iliotibial band passes over the tendon attachments, and positions that pull it tight press the tendons against the bone. Sitting with crossed legs, standing with the weight slumped onto one hip and lying on the affected side all do exactly that, which is why the treatment starts with removing compression before adding load.
NICE assessed shockwave for it in interventional procedures guidance IPG376, now HealthTech guidance HTG248, published on 26 January 2011. Its conclusion is worded differently from the other three musculoskeletal assessments. Recommendation 1.1 states that "evidence on the efficacy and safety of extracorporeal shockwave therapy (ESWT) for refractory greater trochanteric pain syndrome is limited in quality and quantity", and 1.2 requires that patients "should be informed about the possibility of pain during and after treatment, and the risk that symptoms may worsen".
That warning is specific to this condition and it should be put to you before a first session. Extracorporeal shockwave therapy covers how a course runs, and shockwave therapy side effects covers what to expect afterwards and when to speak up.
Why it happens
What causes gluteal tendinopathy?
- Compression of the tendon attachments by a tight iliotibial band in adducted positions
- Sitting with the legs crossed, or standing with the weight slumped onto one hip
- Lying on the affected side at night, which loads the attachment directly
- Reduced hip abductor strength, so the tendons take a greater share of each step
- A rise in walking or running volume, particularly on cambered ground
- Hormonal and load changes around and after menopause, when this presentation is most common
Treatment approach
Where shockwave therapy fits for gluteal tendinopathy
FAQ
Shockwave therapy for gluteal tendinopathy
questions people ask
Does shockwave therapy work for hip tendon pain?
NICE found the evidence on both efficacy and safety limited in quality and quantity for refractory greater trochanteric pain syndrome. That is more cautious than its wording for the heel, the Achilles and the elbow. It also asks that the possibility of symptoms worsening is put to you before treatment.
Why does my hip hurt most lying on that side?
Lying on the affected side presses the tendon attachments directly against the greater trochanter, and lying on the other side lets the top leg fall across and compress them too. A pillow between the knees keeps the upper leg in line and takes that compression off, which is often the first change that helps.
What should I change before considering shockwave?
The positions that compress the tendons: crossing the legs when sitting, standing slumped onto one hip, and sleeping without support between the knees. Alongside that, a progressive abductor strengthening programme. These change the daily load on the attachment more than any single treatment session does.
Can shockwave make hip pain worse?
The NICE guidance for this condition warns specifically about pain during and after treatment and about the risk that symptoms may worsen. A short flare in the day or two after a session is common across all uses. A lasting worsening should be reported to the clinician rather than pushed through.
Is a scan needed before treating hip tendon pain?
Often, yes. Several conditions produce pain over the point of the hip and they take different paths, including bursitis, referred pain from the lower back and hip joint problems. A clinician who can examine you decides whether imaging is needed before anything is treated.
Get Started
Describe the problem and what has been tried.
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