R.M. Cowan1, C.L. Ganderton2, J. Cook1, A.I. Semciw3, D.M. Long4, T. Pizzari3
1La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Australia, 2Swinburne University of Technology, Department of Nursing and Allied Health, Melbourne, Australia, 3La Trobe University, School of Allied Health, Human Services and Sport, Melbourne, Australia, 4Deakin University, School of Medicine, Geelong, Australia
Background: Greater trochanteric pain syndrome (GTPS) is a debilitating, chronic condition, most prevalent in post-menopausal women. Physical function is impaired and quality of life severely impacted. A positive association between high oestrogen levels and tendon health may exist, and post-menopausal women have reduced oestrogen. Menopausal hormone therapy (MHT) may reduce the incidence of tendon abnormality, particularly when combined with exercise. This 2 x 2 factorial randomised controlled trial (GLoBE Hip Trial) was the first to investigate the role of MHT and exercise therapy for managing GTPS.
Purpose: This study aimed to determine the effect of MHT and exercise on tendon pain and function in post-menopausal women with GTPS.
Methods: Post-menopausal women (n=132; mean age 61.16±6.49 years and mean Body mass index (BMI) 28.58±5.43) with uni- or bi-lateral GTPS were randomised into either MHT (oestradiol 50mcg and norethisterone acetate (NETA) 140mcg) or placebo transdermal cream groups combined with either targeted exercise or sham exercise groups. All groups received education on avoiding gluteal tendon compression and underwent 12-weeks of intervention. Primary outcome; Victorian Institute of Sport – Gluteal tendon (VISA-G) and secondary outcomes were measured at baseline, 12 weeks and 52 weeks. Global Rating of Change (GRoC) was assessed at 12 and 52 weeks. A linear mixed effects model was used to compare groups at each time point and changes over time. Body mass index was included as a covariate.
Results: All participants improved over time, regardless of intervention. There was no difference between targeted exercise and sham exercise or MHT and placebo creams (raw unadjusted and including BMI as covariate) at each timepoint. VISA-G outcome was significantly associated with BMI (p=0.003) and there was a significant interaction effect between cream and BMI (p=0.03). The population was therefore stratified based on BMI levels (<25, <30, ≥30). The MHT groups (MHT with targeted exercise or MHT with sham exercise) had significantly better VISA-G and secondary measure scores compared to placebo cream groups (placebo cream with targeted exercise or placebo cream with sham exercise) at all timepoints when BMI<25. There was no difference between MHT and placebo groups at each timepoint for participants with BMI≥25. There was no difference between exercise groups at any timepoint measured by all outcomes, regardless of BMI.
Conclusion(s): Menopausal hormone therapy combined with any exercise and education resulted in reduced pain and increased function for post-menopausal women with GTPS when BMI<25. Exercise with education surrounding avoidance of gluteal tendon compression is beneficial for this population, regardless of BMI.
Implications: Menopausal hormone therapy may be an effective intervention for post-menopausal women with GTPS when BMI<25 and when prescribed in conjunction with exercise plus education. A minimal loading exercise strategy is just as effective as targeted loading exercise when prescribed with education surrounding avoidance of gluteal tendon compression. Results of this study suggest reduced effectiveness of transdermal MHT with increasing BMI. Current results may underestimate the effectiveness of MHT as a viable intervention for this population.
Funding, acknowledgements: All authors thank the Physiotherapy Research Foundation, Arthritis Australia and La Trobe University for their contributions to funding.
Keywords: Tendinopathy, Hormone, Exercise
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: La Trobe University
Committee: La Trobe University Human Ethics Committee
Ethics number: 14-055
All authors, affiliations and abstracts have been published as submitted.
