From the Guidelines
For gluteus medius tendinitis and trochanteric bursitis where Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are contraindicated, treatment should focus on non-NSAID approaches including acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) for pain management, as recommended by 1.
Treatment Options
- Physical therapy is essential, incorporating stretching exercises for the piriformis, gluteal muscles, and IT band, along with strengthening exercises for the hip abductors and core muscles.
- Apply ice for 15-20 minutes several times daily during acute phases, then transition to heat therapy for chronic symptoms, as cryotherapy provides acute relief of tendinopathy pain and its use is widely accepted 1.
- Activity modification is crucial—avoid activities that worsen pain and consider low-impact alternatives like swimming or cycling.
- Corticosteroid injections (typically methylprednisolone 40mg with lidocaine) can provide temporary relief for severe cases, though limited to 3-4 injections yearly, as locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief 1.
- Extracorporeal shockwave therapy may help stimulate healing in chronic cases, as it appears to be a safe, noninvasive, effective but expensive means of pain relief for a number of chronic tendinopathies 1.
- Topical analgesics containing capsaicin or menthol can provide localized relief without systemic effects.
Rationale
These approaches work by reducing inflammation, improving blood flow, strengthening supporting muscles, and breaking the pain cycle while avoiding the gastrointestinal, renal, and cardiovascular risks associated with NSAIDs. Relative rest and reduced activity prevent further damage and promote healing and pain relief, as recommended by 1. Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes, as noted in 1.
Key Considerations
- The treatment plan should be individualized based on the patient's specific needs and medical history.
- Regular follow-up appointments with a healthcare provider are necessary to monitor the patient's progress and adjust the treatment plan as needed.
- Patient education on proper stretching, strengthening, and activity modification techniques is crucial for successful management of gluteus medius tendinitis and trochanteric bursitis.
From the Research
Treatment Options for Gluteus Medius Tendinitis and Trochanteric Bursitis
When Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are contraindicated, the following treatment options can be considered:
- Corticosteroid injections: Studies have shown that corticosteroid injections can be effective in treating gluteal tendinopathy and trochanteric bursitis 2, 3, 4.
- Physical therapy: Physical therapy, including exercise and load management, can help manage the condition and reduce pain 5, 4.
- Shock wave therapy: Shock wave therapy is another treatment option that has been used to manage gluteal tendinopathy 4.
- Surgery: Surgery may be considered for recalcitrant cases where other treatments have failed 3, 4.
- Education and load management: Educating patients on the underlying pathomechanics of the condition and managing the load on the tendons through exercise and lifestyle modifications can also be beneficial 5, 4.
Non-Pharmacological Interventions
Non-pharmacological interventions, such as:
- Activity modifications: Modifying activities to reduce stress on the affected tendon and bursa.
- Exercise: Engaging in exercises that strengthen the surrounding muscles and improve hip biomechanics.
- Physical therapy: Using physical therapy to improve range of motion, strength, and function.
These interventions can be used in conjunction with other treatments to manage gluteus medius tendinitis and trochanteric bursitis when NSAIDs are contraindicated 6, 5, 4.