Gluteal tendinopathy presents similar symptoms to severe hip arthritis, affecting as much as 25% of all women over 50. Treatment options generally include physical therapy, corticosteroid injections, and rest. This study was just published a few days ago (The LEAP Trial), comparing these treatment recommendations.
Subjects: Individuals with lateral hip pain, presenting for at least three months, aged 35-70 years of age were included (median age= 54.8 years ± 8.8). Pain inclusion criteria required subjective reported pain of at least 4/10 for each participant. Gluteal tendinopathy was confirmed with MRI and clinical diagnosis. Patients with previous hip replacements, corticosteroid injections, and neurological dysfunction prior to this study were excluded.
Methods: A single blind experiment was used to explore the most effective modality of treatment for gluteal tendinopathy. Subjects were dividing into three groups:
- EDX (n=69): physiotherapy led education and exercise program for 14 sessions of 8 weeks
- CSI (n=66): one corticosteroid injection
- WS (n=69): wait and see approach
Primary outcomes included patient-reported global change in hip condition/success of program (11-point scale) and pain intensity throughout the last week of the program and after a 52-week follow up (0-10 point scale).
Results: Success on the global rating of change at 8-weeks was greatest in EDX, followed by CSI. At 8-weeks, reported pain at rest on the numerical rating scale was mean score 1.5 (SD= 1.5) for EDX, 2.7 (SD= 2.4) for CSI, and 3.8 (SD= 2.0) for WS. EDX and CSI participants reported less pain than WS (mean difference −2.2 (95% confidence interval −2.89 to −1.54); −1.2 (−1.85 to −0.50); respectively), and EDX participants reported less pain than CSI (−1.04 (−1.72 to −0.37)). Success on the global rating of change was reported at 52 weeks by 51/65 EDX, 36/63 CSI, and 31/60 WS participants; EDX was better than CSI (20.4% (4.9% to 35.9%); 4.9 (2.8 to 20.6)) and WS (26.8% (11.3% to 42.3%); 3.7 (2.4 to 8.8)).
Take-home Points: Education plus exercise and corticosteroid resulted in enhanced patient outcomes and lower levels of pain after 8-weeks. Education plus exercise continues to outperform corticosteroid injections after 8 weeks in patient outcome, although after a 52-week follow-up pain intensity showed minimal differences.
Is there any utility in measuring the anthropometry/growth of youth athletes? It seems that the annual physical is most common place, recording the basics of height and weight. This was a quick read, a bit outside my normal literature yet it made me think a bit.
We could say that height and weight is a very basic but valid indicator of force production for youth populations. This helps differ biological and chronological ages. “Physiologically speaking, growth is a multi-factorial process but happens due to a combination of hyperplasia, hypertrophy, and accretion.” In basic terms…
- Hyperplasia refers to the growth of new cells
- Hypertrophy refers to the increase in cellular size
- Accretion is very similar to hypertrophy, but is respective to time (growth/maturation of cells)
Why is Monitoring Growth Important?
- Abnormal growth may be indicative of disease or a health condition
- Early detection of a disease or health condition may allow for advanced care/treatment
- A paper from the WHO correlated nutrition, BMI, breastfeeding, and parents refraining from smoking to allow for children to grow “normally” reaching genetic potentials
- Abnormal growth may be a result of genetic predisposition, malnutrition, illness, endocrine dysfunction, or injury
I must say- we should be careful to diagnose but rather make parents/medical staff aware of abnormal findings.
How to Monitor Growth
- Collecting weight and weight quarterly may be sufficient
- Maintain validity and reliability by standardizing the process each time
- Predicted adult height can be quite accurately predicted and may be worth considering
- “…Sherar et al. concluded that using other anthropometric data such as weight, height, and sitting height to predict adult stature is accurate within 5-8cm in boys and 3-8cm in girls for 95% of cases.” Equations below:
Issues with Monitoring Growth
- “During the decline from infancy to late adolescence, it is not unusual for a young child’s height to be in the 95th percentile one month and be in the 20th percentile the next.” So let’s relax
- Physicians often respond with “wait and see”, which is a bit more conservative than misdiagnosing
- PHV is non-uniform, so let’s not get crazy here
- There are gender differences with PHV worth comprehending
Take Home Points
- Monitoring is monitoring, not diagnosing
- Extra data can’t hurt anything, but your time taken from other things
- Identifying PHV may have training implications, but this could also be a bit of a reach
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