Study On The Effect Of Muscle Energy Technology And Extracorporeal Shock Wave In The Treatment Of Gluteal Tendinopathy

Background In recent years,more and more patients have been referred to doctors for hip Pain.With the development of medical science,hip and/or hip pain can be found to be due to Greater Trochanteric Pain Syndrome(GTPS),of which gluteal tendinopathy has the highest incidence.The pathogenesis of this syndrome is not clear,the treatment is not targeted,the curative effect is not ideal,so it is of great significance to analyze its etiology and study the treatment methods.Background: In recent years,more and more patients have been referred to doctors for hip Pain.With the development of medical science,hip and/or hip pain can be found to be due to GTPS,of which gluteal tendinopathy has the highest incidence.The pathogenesis of this syndrome is not clear,the treatment is not targeted,the curative effect is not ideal,so it is of great significance to analyze its etiology and study the treatment methods.Objective This study is divided into two parts,the first part is to analyze the etiology and general characteristics of GTPS.The second part is to explore the short-term efficacy of Muscle Energy Technology(MET)and extracorporeal shock wave therapy(ESWT)in the treatment of gluteal tendinopathy,in order to provide the best treatment for the clinical treatment of gluteal tendinopathy.Methods From October 2021 to November 2022,100 patients diagnosed with GTPS by imaging and clinical diagnosis of GTPS in the Department of Orthopedics and Rehabilitation Medicine of the General Hospital of the People’s Liberation Army of Chinese People’s Republic of China were preliminarily analyzed,and 50 normal subjects were collected for comparison with GTPS patients and analyzed the differences in their general characteristics.In addition,40 patients diagnosed with clinical manifestations of gluteal tendinopathy were collected,and randomly divided into MET group and ESWT group according to the coin toss method,with 20 patients in each group,and all patients strictly met the inclusion criteria and exclusion criteria.The MET group was treated with post-isometric relaxation(PIR)technique,and the treatment was maintained for 15 seconds to rest and relax for 5 s,this action was repeated 10 times,and the patient was treated once a day for 5 days a week(2 days in the hospital by a therapist,and the patient’s family was instructed to train the patient at home for 3 days)for a total of two weeks.The ESWT group adopts the extracorporeal shock wave therapy instrument produced by Xiangyu Medical Company,the equipment model XY-K-SHOCK MASTER-500,sets the treatment parameters: 0.03-0.2mJ/mm2,1500～2000 pulse number,1.5-2.0Pa treatment pressure,8-15 Hz frequency,220 V voltage,uses the body surface pain point positioning method to select the pain point,each time selects 1-2 obvious tender points of the hip and/or hip for shock wave treatment,and the treatment was performed twice a week with a minimum interval of 48 hours for a total of two weeks.Both groups were given a home-based exercise training instruction programme in addition to the above treatment.The indexes and efficacy of each group were evaluated before treatment and two weeks after treatment.The main evaluation indicators of efficacy observation are: VAS,mHHS,HOS-ADL/HOS-SSS,LEFS.Secondary measures were: muscle strength,trunk endurance(plank time test and glute-bridge time test),ROM,HADS,and PSQI.Results(1)Preliminary analysis of the etiology of GTPS patients showed that78 cases(78%)of gluteal tendinopathy,42 cases(42%)of greater trochanteric bursitis,and 2 cases(2%)of iliotibial band thickening were reported by imaging examination(including simple disease and combined diagnosis).Physical examination results were positive for tenderness and percussion pain in the greater trochanteric area in 100 patients,SLS in 100 patients,tenderness and percussion pain in iliac attachment point of gluteus medius in 78 patients,4-line test in 29 patients,hip joint resistance abduction test in 15 patients,and Trendelenburg sign in 8 patients.The statistical results of causes of hip pain in GTPS patients showed that there were 29 patients with hip pain without obvious inducement,45 patients with sports training injury,23 patients with standing for a long time,9patients with fall injury,and 4 patients with other causes of injury.②The analysis of general characteristics of GTPS patients showed that VAS score,mHHS score,LEFS score,HOS-ADL score,HOS-SSS score and HADS-A score in GTPS group were significantly worse than those in normal control group(p<0.001).Hds-d score,PSQI score and hip bridge time were significantly different from those in normal control group(p<0.05),but there was no significant difference in plank time between the two groups(p>0.05).Comparison of the mean values of bilateral hip ROM and perihip muscle strength between GTPS group and normal group showed that adductor,abductor,internal rotation,external rotation,extensor,adductor and external rotation ROM were significantly lower than normal group(p<0.001).The strength of hip flexor,the strength of hip flexor hip extension,hip flexor ROM,abductor ROM and internal rotation ROM were significantly lower than those in normal group(p<0.05).The pain score of GTPS patients was significantly negatively correlated with gluteal bridge time,healthy side internal rotation muscle strength,healthy side external rotation muscle strength and LEFS score(p<0.05),and significantly negatively correlated with mHHS score and HOS-ADL(p< 0.001).(2)After two weeks of treatment,①intra-group comparison: ESWT and MET could reduce the VAS score and HOS-ADL score in patients with gluteal tendinopathy,and the difference was statistically significant(p< 0.05);the MET group significantly improved the mHHS score,LEFS score,hip extension ROM,abduction ROM,internal rotation ROM,hip flexion,hip extension,hip extensor muscle strength,and HADS-A score,all of which were statistically significant(p<0.05).②Intergroup comparison: the MET group improved pain VAS score,mHHS score and hip extension ROM better than ESWT group,and the differences were statistically significant(p<0.05);there was no significant difference between the two methods in improving LEFS score,HOS-ADL score,HOS-SSS score,muscle strength around hip joint,plank support time,gluteal bridge time,HADS-A score,HADS-D score,and PSQI score in patients with gluteal tendinopathy(p>0.05).Conclusion(1)GTPS involves a variety of etiology,sports injury is more common,the etiology diagnosis mainly depends on imaging;Patients with GTPS have obvious pain,and perihip muscle strength,trunk endurance,hip ROM,function,quality of life and emotional sleep quality are significantly worse.Pain in patients with GTPS is related to trunk endurance,part of lower limb muscle strength,activities of daily living and lower limb function.(2)Short-term treatment of MET can effectively improve the pain and dysfunction of gluteus tendinopathy patients,and short-term treatment of ESWT can effectively improve some dysfunction of gluteus tendinopathy patients;The short-term effect of MET on pain and dysfunction in gluteal tendinopathy patients was better than ESWT.