Focused Shockwave Therapy for Trochanteric Pain Syndrome

October 23, 2020  |  By Elise Hamann

Focused Shock Wave Therapy for Trochanteric Pain SyndromeAre you treating patients with greater trochanteric pain syndrome (GTPS)? 

This painful condition, often found among runners and active patients, results from an injury of the soft tissue in the thigh/buttocks area. GTPS affects up to 5% of the population, with greatest frequency in women and those over age 40. 

Treatment protocol often consists of traditional methods including rest, ice, physical therapy (including stretches and stabilization exercises to strengthen core muscles) and anti-inflammatory medications. Additionally, localized steroid injections are sometimes used to provide short-term pain relief. And on rare occasions, surgery may be a consideration for recalcitrant cases.

Though a fairly common condition, the physiopathology of GTPS remains largely unknown, and there is no true consensus on optimal management. Recent clinical evidence, however, points to focused shockwave therapy (also known as ESWT), as an effective treatment option for greater trochanteric pain syndrome. Click here to read the full study.

How was the research conducted?

A multicenter, randomized controlled clinical study, recently published in the Journal of Bone and Joint Surgery, evaluated the effectiveness of treating GTPS with a combined protocol that included focused extracorporeal shockwave treatment (ESWT) and physical therapy. Ultrasound was used to identify the greater trochanter area of the gluteus tendons enthesis. At each session, 2,000 pulses were applied at a frequency of 5.0 Hz and an energy flux density (EFD) of 0.20 mJ/MM2.

Patients in the treatment group received three weekly treatment sessions and followed a daily home exercise program for 24 weeks. Those in the control group received a sham shockwave treatment along with the PT program. Patients were assessed at one, two, three and six months. 

How is ESWT treatment typically conducted?

Ultrasound gel is frequently applied because it provides optimum coupling with the device. Start with a low intensity level and increase it gradually, typically at each successive session. Communication with the patient is key to determining the best level. It’s best to avoid exceeding comfort levels as this may cause muscles to tense up. 

How is the treatment area typically localized for ESWT?

Some physicians rely on a combination of accurate history taking, palpitation of the affected area and localizing pain points through treatment and patient feedback.

Additionally, many medical professionals prefer to localize via ultrasound, which helps ensure an accurate diagnosis and is useful post-treatment to evaluate outcome. 

How effective is shockwave therapy for greater trochanteric pain syndrome?

Overall, the study showed focused shockwave to be a highly effective treatment modality. Using a 0-10 visual analogue scale (VAS) for pain, the success rate for the treatment group was 86.8% at the two-month follow-up, and it was maintained through the end of the study. This is promising news for patients with this condition, potentially providing renewed hope for both pain relief and a return to their active lifestyle.

What does the research mean for treating similar musculoskeletal conditions?

Focused shockwave therapy/ESWT is not only effective in treating GTPS; the technology is also being used to treat a wide variety of common conditions including tibialis posterior tendinopathy,upper and lower extremities, Achilles tendinopathy and neuropathy.

Related: What is focused vs radial shockwave therapy?
Learn more about the differences between EPAT, focused shockwave and other technologies in What is Shockwave? A Glossary of Terms. 

Based on the growing body of research, GTPS is one of many musculoskeletal injuries and conditions that can be effectively treated with focused shockwave therapy. Click here to read the full study.

You can learn more about the impact of focused shockwave on GTPS by reading the full research report. Or, would you like to learn more about EPAT/ESWT firsthand? Contact us today to set up a demo.

shock wave

Topics: ESWT