For Hip Pain, This Drug-Free Technique May Work as Well as Steroid Injections

Dry needling appears to have similar advantages to cortisone shots, without the side effects and long-term risks.

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If you're plagued by chronic hip pain, you're certainly not alone. An estimated 10% to 25% of the general population suffers from a type called greater trochanteric pain syndrome, or GTPS. Now new research suggests that dry needling—a technique that uses thin needles to stimulate muscle tissue—may work as well as steroid injections for treating GTPS, without the side effects and potential long-term risks.

The study, published in the Journal of Orthopaedic & Sports Physical Therapy, is the first to directly compare these two treatments for GTPS. Lead author Kindyle L. Brennan, PhD, an orthopedic therapist at Baylor Scott & White Health in Temple, Texas, says she uses dry needling often in her practice, especially when patients don't get relief from steroid injections.

While anyone can get GTPS, this type of outer-hip pain is more common in women and in people with low back pain, osteoarthritis, iliotibial band tenderness, and obesity. GTPS used to be considered a type of bursitis, or an inflammation of the bursa—the fluid-filled sac that reduces friction between tissues in the hip joint. (The condition was formerly called trochanteric bursitis.)

But doctors now know that GTPS sometimes has nothing to do with the bursa, or even with inflammation, says Brennan. Often, it's caused by injuries to surrounding muscles and tendons.

That means that cortisone and other steroid injections, commonly used to treat pain by reducing inflammation, may not be the best option for many GTPS sufferers. Plus, Brennan adds, steroids carry risks of side effects and long-term damage to bones and joints—especially with repeated injections—and they're not recommended for people with certain medical conditions.

Dry needling, on the other hand, involves no chemicals and few side effects. Brennan says the technique looks a lot like acupuncture, but it works quite differently.

"It's not looking to align qi or energy flows," she says. "It's specifically targeting myofascial abnormalities and sensitive trigger points in the muscles." Needle penetration is deeper than it is with acupuncture, and patients often experience aching, cramping, or contraction-like sensations during a treatment.

For the new study, Brennan and her colleagues recruited 50 patients with painful hips, most of whom had been diagnosed with GTPS. For six weeks, half of the patients received cortisone injections and half received dry needling, while the researchers measured pain and function at the beginning, middle, and end of the study.

Overall, patients in both groups experienced similar improvements, including a decrease in pain and an improved ability to move and complete daily activities. In other words, dry needling appears to be a "noninferior treatment alternative with minimal side effects," the authors wrote in their paper.

Evidence for using dry needling instead of cortisone shots is still "in its infancy," the authors concluded, and larger, longer studies are needed to better understand how exactly the technique works and what patients it's best for. Still, Brennan recommends it—along with other forms of rehabilitation and physical therapy—for many of her patients.

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