Education and exercise proves better than steroid injections for tendinopathy

Physiotherapy-led education plus exercise has been shown to be better than corticosteroid injections or a ‘wait and see’ approach to gluteal tendinopathy.

An Australian study found the eight-week education and home exercise program, including advice on tendon care and load management plus targeted strengthening of the hip abductors, was the most effective strategy in both the short- and long-term.

The study randomised 189 patients with lateral hip pain and MRI evidence of gluteal tendinopathy to one of the three arms.

Using a validated global rating of change score, about 77% of patients in the education and exercise group reported an improvement in their condition at eight weeks compared to 58% of patients who received a corticosteroid injection and 29% of patients on wait and see.

By 52 weeks, the education and exercise group was still doing better than the other groups (78% improved versus 57% and 52% respectively).

Self-reported hip pain intensity was lowest in the education and exercise group at eight weeks and comparable to the injection group but less than the wait and see group at 52 weeks.

“Education plus exercise was better than corticosteroid injection use in functional outcomes, quality of life, and self efficacy measures, and also had less frequent pain and greater clinically important pain reduction,” the study investigators said.

Measures of muscle strength did not differ between the groups at eight weeks suggesting the education component of the intervention including avoidance of postures and movements that compress the tendon, might underpin the benefits.

Professor Bill Vicenzino, from the University of Queensland’s School of Health and Rehabilitation Sciences, told the limbic future studies were aimed at teasing out the relative contribution of education and exercise to patient outcomes.

He said it was quite probable that the education component was critical with exercise adding value to that.

“We are currently looking at how little assistance with a physiotherapist will get patients by. It depends on how severe the case is, how quickly the patient picks up on the advice and how diligent they are at doing the exercises.”

He said patients had to be fully informed of the risks and benefits of each approach.

“My advice is don’t just send patients off to the radiologist to get a steroid shot in; consider the patients being fully informed of where they might be in 12 months if they follow these three options and then have the dialogue with the patients regarding what’s best for them in the circumstances.”

“Even a wait and see approach over the long term could be of some use to some patients. If 30% of people say they are better at eight weeks then 50% at 12 months, how can we extract the best approach for people so we can find out which patients get by with one session of advice versus a few sessions of education and recommendations for exercise, versus the full package.”

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