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Subtitle
Should you stretch patients with GTPS?
What is GTPS?
Greater Trochanteric Pain Syndrome: A presentation of symptoms characterized by lateral hip pain localized around the greater trochanter of the femur.
To understand whether or not we should stretch, we must understand the pathophysiology of GTPS
What causes the pain?
The lateral hip pain is usually caused by irritation and degeneration of the tissues near the femur bone (gluteal tendinitis and/or trochanteric bursitis)
What causes the degeneration?
These tissues are irritated when the Iliotibial band undergoes tension compresses the tissues between the ITB and the greater trochanter
Rehab strategy
The rehab strategy is simple:
- Decrease TFL and ITB tension
- Less compression of gluteal tendons & bursa
- Less degeneration
- Less pain
- Happy patients
Why Stretching is common
Using this train of thought, many clinicians assume that prescribing stretches will result in decreased TFL-ITB tension
So… Should You stretch the ITB?
Deciding whether to stretch or not stretch the ITB will come down to whether the cost outweighs the benefits
Costs: Increased compressive load on the symptomatic tissues, increasing degeneration and irritation
Benefits: Long term decreases in compressive load on the tissues and improved biomechanics of functional activities
When should you stretch the ITB
- Direct relationship between tight TFL and dysfunction
- physical tissue limitations (PROM ≈ AROM)
When you should pursue alternative options
- Patients with neuromuscular tissue limitations
For patients with PROM > AROM, this is indicative of a neuromuscular ROM limitation. This patient could benefit from stretching, but there are other treatments which could work better and with less compression
Physical VS Neuromuscular Muscle Tightness
Physical:
- PROM ≈ AROM
- Passive muscle tension: physical resistance to stretch from the structures of the muscle or surrounding fascia1
Neuromuscular:
- PROM > AROM
- Active muscle tension: Tension created from dynamic muscle contration due to neuromuscular excitation1
Physical Stretching Exercises
- Wall ITB stretch
- Thomas Stretch
TFL Neuromuscular Releases
- Contract-relax
- Manual release
- Self-myofascial release
- Massage gun with stretching
References
