Physiotherapy versus corticosteroid injection for chronic lateral hip pain: a randomized clinical trial.

Arm 1: Eight Week Physiotherapy Exercise Intervention. This group will receive detailed advice and education on tendon care (handouts, DVD and oral explanation by the treating physiotherapist), as well as a comprehensive exercise programme, to be performed both at home daily and in the form of individual supervised exercise sessions at the physiotherapy clinic. The exercises will include functional retraining, targeted strengthening for the hip and thigh muscles, as well as exercises using Pilates equipment (i.e. a Reformer). The participant will attend an initial 1 hour physiotherapy session in Week 1, where assessment, education and training of the exercises will occur. In Week 2, the participant will attend a half hour session to reinforce all information, assess progress and technique and continue exercise progressions. For the remaining 6 weeks, the participant will attend two half hour sessions per week at the physiotherapy clinic for re-assessment of responses and progress, and progression of the exercise programme as able. There will be 14 sessions in total. The prescribed home exercise programme will consist of no more than four exercises, in order to facilitate compliance, and will be performed daily, taking no more than 15 to 20 minutes. Response to the exercises will be re-assessed at each physiotherapy session in order to modify and progress the home exercises as appropriate to the individual. Arm 2: A single ultrasound guided Corticosteroid injection (Celestone (1 ml) or Kenacort (1 ml ), with Bupivacaine (2 ml)) around the tendons at the hip, performed under ultrasound guidance by an experienced sports physician or radiologist, as well as receiving basic advice on tendon care. Arm 3: Patients will attend a single half hour session with a trial physiotherapist of their choice, where they will be advised to adopt a wait and see policy in which they will be given advice on how to take care of their condition themselves and assurance that the condition will resolve over time. Taking over the counter pain relief medication will be permitted should the patient feel it is required.