In my clinical practice I noticed that we were treating many with lateral hip pain, most commonly post-menopausal women. These patients reported pain levels and impacts on their lives as marked as those with hip osteoarthritis. Their sleep and physical activity levels were substantially affected and together with the psychological distress caused by more severe presentations, the impact on general health and quality of life was marked. Long symptom duration, with delayed or mis-diagnosis was frequently reported, sometimes resulting in unnecessary interventions. Those identified as having a local soft tissue pathology had usually been diagnosed with trochanteric bursitis and given a corticosteroid injection (CSI) as the first line medical treatment and bursectomy for those with pain that did not settle. Previous failed physiotherapy had commonly included passive therapies such as therapeutic ultrasound to the ‘inflamed bursa’ and stretches for the iliotibial band or buttock.
When physiotherapy treatment for tendinopathy fails, have you ever thought ‘Where did I go wrong?’ Assuming you have applied contemporary evidence informed protocols that incorporate load management and appropriate exercise therapy (e.g. avoiding compressive loading for insertional tendinopathies), there are a number of factors that may influence your success, including patient beliefs and compliance, systemic illness and psychosocial issues. Have you ever considered though that prior medical treatment may have had you fighting an uphill battle from the start?