Ahead of print research article from JOSPT with Dry Needling being just effective Cortisone Injections for GTPS and a whole lot of cheaper. Great opportunity to educate the public on this, especially in direct access states to try get PT first for musculoskeletal ailments. One soap box I am going to get on is the need for standardization amongst dry needling continuing education. In most other treatments (manual therapy, ther ex, mobilizations etc) there are so many different and effective ways to do each technique. With dry needling I think we need standardization to distance ourselves from acupuncture and for safety concerns. Acupuncturists are trying to educate PT’s on Dry Needling and the gap between the professions become muddier. Please don’t do the cheapest dry needling course, check the reviews and talk to your peers.
Ahead of print article here: Dry Needling vs Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome A Non-Inferiority Randomized Clinical TrialStudy Design
Prospective, randomized, partially-blinded.
Greater trochanteric pain syndrome (GTPS) is the current terminology for what was once called greater trochanteric or sub-gluteal bursitis. Cortisone (corticosteroid) injections into the lateral hip is a traditionally accepted treatment for this condition. However, the effectiveness of injecting the bursa with steroids is increasingly being questioned, and an equally effective treatment with fewer adverse side-effects would be beneficial.
To investigate whether administration of dry needling (DN) is non-inferior to cortisone injections in reducing lateral hip pain and improving function in patients with GTPS.
Forty-three participants (50 hips observed), all with GTPS, were randomly assigned to a group receiving cortisone injections or DN. Treatments were administered over 6 weeks, and clinical outcomes were collected at 0, 1,3, and 6 weeks. The primary outcome measure was the numeric pain rating scale (0-10). The secondary outcome measure was the Patient Specific Function Scale (0-10). Medication intake for pain was collected as a tertiary outcome.
Baseline characteristics were similar in the groups. A non-inferiority test for repeated measures design on pain and averaged function scores at 6 weeks (with a non-inferiority margin of 1.5 for both outcomes), indicates non-inferiority of DN vs. cortisone injections (p-values of <0.01 for both). Medication usage (p-value=0.74) was not different between groups at the same time point.
Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN. Our data suggest that DN is a non-inferior treatment alternative to cortisone injections in this patient population.
Level of Evidence
Therapy, level 1b. Registered December 2, 2015 at www.clinicaltrials.gov (NCT02639039) J Orthop Sports Phys Ther, Epub 3 Mar 2017. doi:10.2519/jospt.2017.6994
Keyword: glucocorticoid injection, hip pain, methylprednisolone acetate, trigger point dry needling, trochanteric bursitis