If you have been diagnosed with hip bursitis or tendinitis you may want to consider other options before committing to steroid injections. A new wave of research is suggesting that application of Dry Needling (DN) acupuncture, as an alternative to steroid injection for treatment of hip pain and functional limitations, is safe and just as effective1!

What is bursitis?

Bursitis refers to inflammation of the bursa. A bursa is a fluid filled sac that provides cushioning between tendons and/or bones around your joints2.

Although it is a common diagnosis, hip bursitis is an often-inaccurate term used in the medical field. The majority of cases described as hip bursitis actually have no inflammation in the bursa!  Muscle tears, tendon strains and trigger points can all cause pain in this area1.

The most common risk factor for pain in the outer hip area is overuse injuries (also referred to as repetitive stress injuries). Running and standing for long periods of time are common causes.

What are the symptoms of hip bursitis and tendonitis? 

This condition is characterized by tenderness to touch over the bony prominence on the outer aspect of the hip1. In more acute stages, pain is often described as localized and sharp. However, more chronic conditions can be felt as dull and achy.

You might also experience pain with certain movements or positions.  Your hips may hurt when you are standing and bearing weight. This pain can be more noticeable as you shift your weight to stand on the affected leg. This pain may occur when you are walking, climbing up/down the stairs, running, prolonged standing and cycling. You may also experience pain when there is simply too much pressure on your hips, like when are trying to sleep on the affected side.

How common is hip bursitis/tendinitis?

It is estimated that 10% to 25% of us will experience chronic hip pain within our lifetime1. You are more at risk for pain in this region if you have any of these issues:

  • low back pain
  • osteoarthritis
  • IT (iliotibial) band tenderness
  • excess body weight

What is Greater Trochanteric Pain Syndrome?

The term bursitis is often used as a catch-all term for pain felt in the outer aspect of the hip and thigh. We now know that pain in this body area can be caused by a number of issues. Bursitis, gluteal muscle tears, tendinopathy and trigger points in any of the muscles crossing the hip can all be a source of this discomfort1.

As we gain a deeper understanding of sensation and causes of pain, the complexity of understanding the source of the problem is leading us to prefer the term Greater Trochanteric Pain Syndrome (GTPS) over bursitis. This change reflects the fact that the bursa is not always the main source of the hip pain. It also helps us to consider more comprehensive solutions as it encompasses a wider variety of causes.

Is steroid injection beneficial?

YES! Therapeutic steroids – sometimes referred to as corticosteroids or cortisone – are helpful in treatment of a number of different conditions3 (such as hip bursitis). Therapeutic steroids are similar to the hormones your body releases to fight illnesses, injuries and help reduce inflammation in your body. Your physician or specialist will inject a small amount of steroid to control pain and inflammation in a bursa, joint, tendon or muscle. A local anesthetic is also commonly injected at the same time.

Are there any side effects to steroid injections?

Although rare, there are a number of adverse effects associated with steroid injections that should be considered. Side effects of steroid injections can include4:

  • mild allergic reactions
  • temporary increase in pain
  • swelling
  • blood sugar increase

More severe side effects may include weakening of tendons and ligaments with multiple injections in one area over a short period of time. Achieving  minimal relief after two injections is generally considered as a contraindication to having more injections4.

Are there any alternatives to steroid injection?  

Recognizing that hip bursitis is not the only cause of hip pain, other treatment options are being considered as alternatives to cortisone injections. Massage, stretching and appropriately selected exercises can all be helpful. A recent study1 shows that Dry Needling – also known as intramuscular stimulation (IMS) – is just as effective as steroid injection for treatment of GTPS (including bursitis and tendinitis)!

Dry Needling acupuncture can help!  

Dry needling (DN) is the Western approach to acupuncture. In this technique thin needles are used to stimulate local trigger points in muscles. DN treatment reduces muscular and myofascial pain, releases trigger points, and helps restore movement. (To learn more about Dry Needling technique and how it works, click here).

The key to an effective treatment is about appropriate diagnosis! By completing a detailed assessment, your physiotherapist will identify trigger points and muscles that carry excessive tone (i.e. are too tense). Once the right trigger points are identified, fine sterile needles are inserted through the skin to release these knot-like thickenings in the muscles and fascia. Muscles around the side and back of buttock region, muscles of your thighs and muscles of the lower back often respond well to dry needling for treatment of GTPS1.

When should you consider Dry Needling acupuncture for your hip pain?

Dry needling is a safe and effective alternative to corticosteroid injections for treatment of many types of hip pain.  It can be selected as an alternative when cortisone injections should not be used – such as drug allergies. Or if you prefer this type of approach, dry needling can be an appropriate substitute.

Dry Needling can benefit you if:

  • Hip pain is making your day-to-day function more difficult.
  • A steroid injection resulted in minimal or no relief.

Contact us if you are interested in learning more about alternative options to injections or would like to book a treatment for your hip pain.  Speak with Milad Bazaz-Jazayeri, Registered Physical Therapist –  mbazaz@orthophysio.com – to learn more about treatment options that fit your needs best.

 

 

 

 

References:

  1. Kindyle , Brennan , Allen Bryce, and Munoz Maldonado Yolanda. “Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial.” (journal of orthopaedic & sports physical therapy) 47 (April 2017): 232-239.
  2. American Academy of Orthopaedic Surgeons. Hip Bursitis. March 2014. http://orthoinfo.aaos.org/topic.cfm?topic=a00409.
  3. Labrosse, Julie, et al. “Effectiveness of Ultrasound-Guided Corticosteroid Injection for the Treatment of Gluteus Medius Tendinopathy.” American Journal of Roentgenology 194, no. 1 (January 2010): 202-206.
  4. Cardone, Dennis, Alfred Tallia, and Robert Wood Johnson. “Joint and Soft Tissue Injection.” American Family Physician 66, no. 2 (July 2002): 283-289.