FACULTY OF HEALTH SCIENCES School of Allied Health Department of Physiotherapy Appendix E Information and Exercise Booklet Project: Does oestrogen, exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial. UHEC: 14-055 CP 1
Greater Trochanteric Pain Syndrome (GTPS) Greater trochanteric pain syndrome (gluteal tendinopathy) is a common condition that causes pain on the outside of your upper thigh. It is thought to be due to tears or injury to the tendons and/or inflammation of the fluid-filled sac (bursa) in your hip. It can be a severely debilitating condition that results in limited activity, employment and capacity to exercise. Signs and symptoms Pain at the side of your hip Difficulty going up and down stairs Difficulty/inability to sleep on your side Discomfort with any activity that involves standing on one leg Risk Factors for developing GTPS PAIN Female Middle-aged Increased adiposity/weight Back pain Reduced angle of your hip joint to your thigh bone How common is GTPS? 1.8 patients per 1000 per year 23.5% in women at risk of knee osteoarthritis 54% in recipients of kidney transplants It is often misdiagnosed so it is likely to be more common than reported. 2
Tips for reducing your hip pain: General information: General Information - Stay active within your pain limits - Continue to complete your exercises as prescribed. Contact your physiotherapist if your symptoms increase or you have any questions. - You can continue your normal pain medication regime - You may apply an ice pack to the area at any time during the 12 week exercise intervention. Daily activities - Avoid going up or down stairs; use a lift where possible. Posture - Standing - DO stand evenly on both legs; DO NOT stand pigeon-toed or favour one leg by hanging on one hip. 3
General Information Posture Sitting - DO sit with your feet shoulder width apart and ensure that your hips are ALWAYS higher than your knees when sitting in a chair. Sitting on a towel or cushion can be helpful to bring your hips higher than your knees. - Avoid sitting in low sofas and car seats, which generally slope backwards. - DO NOT cross your legs at the knees when sitting. - DO NOT sit with the feet wide apart and knees together. 4
Sleeping: General Information - DO sleep on your back with a pillow under your knees - Try to avoid sleeping on your side, however, if you are unable to sleep in any other position, try: o Sleeping on an eggshell mattress overlay on your bed o Positioning pillow/s between your knees and ankles so that your legs are approximately shoulder width apart. 5
Exercise Protocol Instructions: Only complete the exercises that are prescribed to you by your physiotherapist. STAGE 1 Gluteal strengthening exercises Hip Hitch Instructions: Commence standing with your feet shoulder width apart and your back flush against the wall. You can place your arms on the wall for extra support. Keeping your unaffected leg straight and in line with your affected leg, lift your unaffected hip off the ground by 1cm by allowing your hip to hitch upwards. Therefore, your entire body weight is through your affected leg., holds (seconds) 1cm 6
Gluteal strengthening exercises Exercise Protocol Hip Hitch progression Progression: Stand behind and hold onto the back of a chair. Take weight through your arms for support and complete the hip hitch exercise as above., holds (seconds) 1cm 7
Exercise Protocol STAGE 1 Quadriceps strengthening exercises Wall Squat (1/4) Instructions: Commence standing with your back up against a wall with your feet shoulder width apart. Walk your feet forwards so that you are leaning against the wall, squat down (1/4 distance) so that your shin is vertical with the wall and so that your knees are not over your toes and then return to your starting position. 8
Exercise Protocol STAGE 1 Quadriceps strengthening exercises Progression: Wall Squat (1/2) Commence standing with your back up against a wall with your feet shoulder width apart. Walk your feet forwards so that you are leaning against the wall, squat down (1/2 distance) so that your shin is vertical with the wall and so that your knees are not over your toes and then return to your starting position. 9
Exercise Protocol STAGE 1 Calf strengthening exercises Calf Raises Instructions: Stand behind and hold onto the back of a chair. Take weight through your arms for support and complete a calf raise by rising up onto the ball for your foot (over a 2 second period), and then lowering back down (over a 2 second period). 10
Exercise Protocol STAGE 2 Gluteal strengthening exercises Hip Hitch with toe taps onto 7.5cm step Instructions: Using your arms for balance, complete the hip hitch exercise as in stage 1. Once in a hip hitch position, tap your toes back and forth from the 7.5cm step positioned in front of you (approximately 10cm in front of your starting position) to the floor. Maintain the hip hitch throughout. 1cm 11
Exercise Protocol STAGE 2 Gluteal strengthening exercises Progression: Hip Hitch with toe taps onto 10cm step Instructions: : Using your arms for balance, complete the hip hitch as in stage 1 and tap your toes onto a 10cm step positioned in front of you (approximately 10cm in front of your starting position). 12
Exercise Protocol STAGE 2 Quadriceps strengthening exercises Sit to stand (standard high chair) Instructions: Sit in a standard chair with your legs shoulder width apart. Shuffle forwards towards the front of the chair so that your bottom remains on the chair but your thighs are positioned off the chair. Cross your hands over your chest, and move from a sitting to standing position. Once standing, return to sitting. Progression: Sit to stand (standard - low chair) Instructions: Sit in a lower chair (determined by your physiotherapist) and repeat as above. 13
Exercise Protocol STAGE 2 Calf strengthening exercises Calf raise with toe rise Instructions: Complete a calf raise as above as in stage 1. Sustain the calf raise (keeping your heel off the ground) whilst completing a toe raise (lifting the toes of one leg up into the air, then returning your toes to the ground). Alternate this procedure with your opposite leg whilst maintaining your heel off the ground in a calf raise position. 14
Exercise Protocol STAGE 3 Gluteal strengthening exercises Hip Hitch with hip swing forwards and backwards Instructions: Stand behind and hold onto the back of a chair. Take weight through your arms for support and complete the hip hitch exercise as in stage 1. Once in a hip hitch position, keeping your knee straight swing your leg forwards and backwards (10 ). 15
Exercise Protocol STAGE 3 Quadriceps strengthening exercises Sit to stand, biasing affected leg Instructions: Sit in a standard chair (seat height of approximately 46cm) with your legs shoulder width apart. Shuffle forwards towards the front of the chair so that your bottom remains on the chair but your thighs are positioned off the chair. Position your affected leg so that your foot is situated closer to the chair (further back than the unaffected leg). Cross your hands over your chest, and move from a sitting to standing position. Once standing, return to sitting. 16
STAGE 3 Exercise Protocol Calf strengthening exercises Single leg calf raise Instructions: Using your arms for balance, stand on one leg and complete a calf raise as in stage 1. Repeat exercise on the opposite leg. 17
Advanced Exercises Gluteal Strengthening Single leg wall squat Instructions: Commence standing with your back up against a wall with your feet shoulder width apart. Walk your feet forwards so that you are leaning against the wall and straighten your unaffected leg out in front of your body, keeping both knees at the same height. Squat down so that your shin is approximately vertical with the wall, making sure your knees do not go over your toes and then return to your starting position. ¼ Squat: ½ Squat: 18
Advanced Exercises Quadriceps Strengthening Step up Instructions: Commence standing in front of a standard height step. Step up onto the step leading with your affected leg and then step back down to the starting position leading with your unaffected leg. Use a rail or wall to hold onto for balance. 19
Advanced Exercises Calf Strengthening Single leg calf raise Instructions: Repeat stage three with increased repetitions 20
Contact Details and Study information Your Trial Physiotherapist: ATTACH BUSINESS CARD WITH CONTACT DETAILS HERE Questions If you have any questions regarding your exercise program please contact your allocated Physiotherapist. You may also contact the chief investigator on this trial Ms Charlotte Ganderton via phone (03) 9479 1389 or email C.Ganderton@latrobe.edu.au at any time during or after the trial. 21