PCP MD here. Have had great success helping my patients through various types of pain thanks to what I’ve learned from all of you, can’t thank you enough. I’m wondering if either of you have seen any research or anecdotally helped anyone through pains that were worse with contact rather than movement? As an example, I struggle with patients with “greater trochanteric pain syndrome” whose hips hurt to touch and they can’t lay on that side. It doesn’t hurt as much to move, and I haven’t had as much success with any exercises as I do with pain that is more movement related. While I generally try to find movements and loads that are tolerable for a movement and slowly load the area, I’m not finding success doing this with contact related pain. are there any analogous methods you guys are aware of for contact related discomfort? Can I have them slowly put more direct pressure on the area over time and hope to desensitize the area, or is that crazy? thanks for any insight you have.
Welcome to the club. This is common presentation I see and anecdotally, the individual is a post menopausal female or >65 year old male, sedentary lifestyle with little to no muscle mass around this region. In some cases, the greater trochanter is quite prominent. The primary complaint is pain laying on the affected side (sometimes both sides), tender to touch, etc.
They present with what some may call a compressive tendinopathy. Anything “tendon” related I typically default to the work of Jill Cook. She discusses the presentation of gluteal tendinopathy (and others) in this article:
But the recent LEAP trial suggests some form of loading program is recommended.
From an “anecdotal cherry picking biased goal of getting patient buy-in perspective” I’ll use the idea of resistance training improving pain via numerous mechanisms https://www.sciencedirect.com/scienc…26590018304565
Personally, following any form of progressive loading program, lathered in re-assuring, threat reducing language is probably the key ingredient (like most clinical presentations
I’m sure Derek or Michael will have much wiser words of wisdom for you
