Brian T. Swanson
Background and Purpose: Greater trochanteric pain syndrome (GTPS) is a multifactorial cause of lateral hip pain, affecting between 1.8 and 5.6 patients per 1000 per year. The prevalence of GTPS is more common in patients with coexisting low back pain. Though discectomy is effective in the treatment of prolapsed lumbar intervertebral discs, it does not correct concurrent hip pathology. As GTPS in the setting of discectomy rehabilitation lacks defined treatment guidelines, the purpose of this case report is to display physical therapy (PT) treatment of GTPS in conjunction with simultaneous rehab from lumbar microdiscectomy.
Case Description: A 56-year-old male was referred to PT for treatment of lateral hip pain two weeks after successful lumbar microdiscectomy of L4/L5. He reported hip and back stiffness with sleeping and prolonged sitting. He experienced a steady decrease in tolerance for sitting (15 - 20 minutes maximum) and recreational activity (bicycling 20 minutes per day), despite a significant daily walking routine (15,000 steps per day). An exercise program was created that centered around lumbar stabilization and gluteal recruitment, while maintaining a neutral lumbar spine.
Outcomes: Hip range of motion was improved to within normal limits in all planes. Improvements in core stability and reduction of hip pain were achieved. These manifested in increased tolerance for sitting (2 hours) and recreational activity (bicycling 20 miles). However, reports of hip stiffness with inactivity remained at discharge.
Discussion: The concurrent treatment of GTPS and rehab post lumbar discectomy requires a balance of intervention selection. Care must be taken to avoid exacerbating symptoms of one site while treating the other. Further research is needed to develop clinical guidelines in the treatment of GTPS and rehab from discectomy.
Jeffrey, Sean, "Therapeutic Exercise In The Treatment Of Greater Trochanteric Pain Syndrome S/P Lumbar Discectomy: A Case Report" (2016). Case Report Papers. 57.