Effectiveness of Combined Dry Needling and Progressive Loading for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial: Combined Needling and Exercise for GTPS

Satish Kumar; Noel S  Chatla; Perkash  Lal; Aneela  Shoukat; Komal; Noor-ul-Ain  Sohail

Authors

Satish Kumar Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
Noel S Chatla Rehabilitation Specialists , Monroe, Michigan, United States of America
Perkash Lal Agha Khan University and Hospital, Karachi, Pakistan
Aneela Shoukat Iqra University, Islamabad, Pakistan
Komal Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan
Noor-ul-Ain Sohail Iqra University, Islamabad, Pakistan

Keywords:

Dry needling, Exercise therapy, Greater trochanteric pain syndrome, Hip pain, Rehabilitation

Abstract

Background: Greater Trochanteric Pain Syndrome (GTPS) is a prevalent condition affecting about 10-25% of the general population, presenting as chronic lateral hip pain, which can impair function and quality of life. There are many potential interventions for GTPS, but there is little evidence for the effectiveness of dry needling with progressive loading exercise. This study aimed to determine the effect of dry needling with progressive loading exercise compared to standard care for patients with GTPS.

Methods: In this assessor-blinded randomized controlled trial, conducted in Islamabad, Pakistan, 124 adults (30-65y) were recruited with a diagnosis of GTPS and were randomized to either receive dry needling with progressive loading exercise (intervention group, n=62) or standard care (control group, n=62), with 12 sessions over 6 weeks. The primary outcome was pain intensity measured with the Numerical Pain Rating Scale (NPRS), while the secondary outcomes were Hip Disability and Osteoarthritis Outcome Score (HOOS), pressure pain threshold (PPT), and Global Rating of Change (GROC). Assessments were conducted at baseline, 6 weeks, and 12 weeks.

Results: At 12-week follow-up, the intervention group showed a significantly greater reduction in pain intensity compared to the control group (between-group mean difference: -2.3 points, 95%CI [-2.8,-1.8], p<0.001). Greater improvements were also observed for all other HOOS subscales, augmented for Sport/Recreation Function (19.9 points) and Quality of Life (20.4 points). The intervention group self-reported larger success rates (GROC ≥+4) than the control group at 12-week follow-up (81.4% versus 43.1%, p<0.001).

Conclusion: Combined dry needling and progressive loading exercises are superior to the standard of care for reducing pain and improving function in individuals with GTPS, sustained at a 12-week follow-up.

DOI: https://doi.org/10.59564/amrj/03.02/005

Author Biographies

Satish Kumar, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan

Lecturer

Noel S Chatla, Rehabilitation Specialists , Monroe, Michigan, United States of America

Director of Physical Therapy

Perkash Lal, Agha Khan University and Hospital, Karachi, Pakistan

Senior Physiotherapist

Aneela Shoukat, Iqra University, Islamabad, Pakistan

Senior Lecturer

Komal, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan

Physiotherapist

Noor-ul-Ain Sohail, Iqra University, Islamabad, Pakistan

Lecturer

References

Speers CJB, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2020;70:523-524.

DOI: https://doi.org/10.3399/bjgp20X712737

French HP, Woodley SJ, Fearon A, O'Connor L, Grimaldi A. Physiotherapy management of greater trochanteric pain syndrome (GTPS): an international survey of current physiotherapy practice. Physiotherapy. 2019;105:119-128.

DOI: https://doi.org/10.1016/j.physio.2019.04.001

Grumet RC, Frank RM, Slabaugh MA, Virkus WW, Bush-Joseph CA, Nho SJ. Lateral hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2019;11:235-245.

DOI: https://doi.org/10.1177/1941738119805127

Lin CY, Fredericson M, Smuck M, Burnham K, Curtin H, Chou LH. Evidence-Guided Treatment for Tendinopathies of the Lower Limb: Updates in Patellar, Achilles, and Greater Trochanteric Pain Syndromes. PM R. 2021;13:1305-1315.

DOI: https://doi.org/10.1002/pmrj.12544

Reid D, Rankin G, Mathieson S, Misra G, Faria R, Oliveira A. Physiotherapy management of greater trochanteric pain syndrome (GTPS): an international survey of current practice. Physiotherapy. 2022;114:85-91.

DOI: https://doi.org/10.1016/j.physio.2021.11.004

Ganderton C, Bandong AN, Mme Yiasemides T, Xu Q, Semciw AI. How Does Hip Osteoarthritis Compare with Greater Trochanteric Pain Syndrome in Terms of Patient-Reported Outcomes of Pain and Disability? A Cross-sectional Study. Arthritis Care Res. 2022;74:794-801.

DOI: https://doi.org/10.1002/acr.24520

Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res. 2019;12:1899-1911.

DOI: https://doi.org/10.2147/JPR.S154728

Fernández-Rodríguez T, Fernández-Rolle Á, Truyols-Domínguez S, Benítez-Martínez JC, Casaña-Granell J. Prospective Randomized Trial of Electrolysis for Chronic Gluteal Tendinopathy: The Intratissue Percutaneous Electrolysis Technique (EPI®) Versus Intraarticular Cortisone Injection. J Pain Res. 2021;14:1343-1353.

DOI: https://doi.org/10.2147/JPR.S309048

Clifford C, Paul L, Syme G, Millar NL. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ Open Sport Exerc Med. 2019;5:e000558.

DOI: https://doi.org/10.1136/bmjsem-2019-000558

Ganderton C, Semciw A, Cook J, Pizzari T. The effect of posture on hip muscle strength and gluteal pressure pain in greater trochanteric pain syndrome. Clin Biomech. 2019;66:96-103.

DOI: https://doi.org/10.1016/j.clinbiomech.2019.02.004

Sharma S, Palanchoke J, Reed D, Haxby Abbott J. Translation, cross-cultural adaptation and psychometric properties of the Nepali versions of numerical pain rating scale and global rating of change. Health Qual Life Outcomes. 2019;15:236. DOI: https://doi.org/10.1186/s12955-017-0812-8

Corsini N, Camargo PR, Alaiti RK, Zanca GG, Avila MA, Fidelis-de-Paula-Gomes CA, et al. The Global Rating of Change Scales in patients with low back pain: a reliability study. Musculoskelet Sci Pract. 2020;50:102277.

DOI: https://doi.org/10.1016/j.msksp.2020.102277

Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med. 2015;45:1107-1119.

DOI: https://doi.org/10.1007/s40279-015-0336-5

Ganderton C, Semciw A, Cook J, Moreira E, Pizzari T. Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. J Womens Health. 2018;27:815-829.

DOI: https://doi.org/10.1089/jwh.2017.6729

Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662.

DOI: https://doi.org/10.1136/bmj.k1662

Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplasty. 2014;29:383-386.

DOI: https://doi.org/10.1016/j.arth.2013.04.016

Fearon AM, Ganderton C, Scarvell JM, Smith PN, Neeman T, Nash C, et al. Development and validation of a VISA tendinopathy questionnaire for greater trochanteric pain syndrome, the VISA-G. Man Ther. 2015;20:805-813.

DOI: https://doi.org/10.1016/j.math.2014.09.013

Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015;43:752-761.

DOI: https://doi.org/10.1177/0363546514531911