Dry needling and cortisone injections are equally effective for managing greater trochanteric pain syndrome (GTPS). A clinical trial comparing these treatments found both significantly reduced pain and improved function over six weeks. Here’s what you need to know:
- Dry Needling: Targets muscle trigger points using thin needles. Requires multiple sessions (average 5.4). Minimal side effects like soreness or bruising. Offers long-term improvement without systemic risks.
- Cortisone Injection: Delivers corticosteroids to reduce inflammation in a single session. Provides faster relief (most feel better within 3 days), but effects last 3–6 months. Risks include skin discoloration, fat atrophy, and potential tendon damage.
Both treatments are safe and effective, with dry needling offering a drug-free option and cortisone injections providing quicker short-term relief. The choice depends on patient preferences, safety concerns, and treatment goals.
Quick Comparison:
| Aspect | Dry Needling | Cortisone Injection |
|---|---|---|
| Mechanism | Targets trigger points | Reduces inflammation |
| Sessions Needed | 3–7 (average 5.4) | Single session |
| Relief Onset | Gradual improvement | >60% feel relief within 3 days |
| Relief Duration | Long-term improvement possible | 3–6 months |
| Side Effects | Mild soreness, bruising | Cortisone flare, skin changes |
| Suitability | Broader patient suitability | Limited for certain conditions |
Both options are valid, but dry needling may appeal to those seeking a non-drug approach, while cortisone injections suit those prioritizing faster results. Discuss with your healthcare provider to choose the best fit for your needs.
EXPLAIN PAPER EP. 6: Dry Needling versus Cortisone Injection
Dry Needling vs Cortisone Injection: Treatment Overview
When conservative treatments fail to address GTPS (greater trochanteric pain syndrome), two interventional options often come into play: dry needling and cortisone injections. Both aim to reduce hip pain and improve mobility, but they operate through different methods and protocols. Let’s break down how each works and what outcomes you can expect.
How Dry Needling Works
Dry needling focuses on releasing trigger points in the hip muscles. Thin filament needles are inserted directly into these points, targeting areas of muscular dysfunction and neuromyofascial pain. This process often triggers a local twitch response, which can improve blood circulation and muscle performance.
Patients with GTPS typically undergo between 3 and 7 sessions, with an average of about 5.4 treatments [3]. Research, such as a study by Brennan, Allen, and Maldonado, has shown that dry needling can provide pain relief comparable to cortisone injections but with fewer risks [4]. Additionally, it has been found to outperform placebo treatments and, in some cases, even corticosteroid injections [7].
Cortisone Injection: The Standard Approach
Cortisone injections have been a go-to treatment for GTPS for years. This method involves injecting corticosteroid medication directly into the inflamed area of the lateral hip, often targeting the bursa. Corticosteroids work by reducing inflammation, which can lead to pain relief and improved function [2].
Typically, only one injection is needed [3]. Over 60% of patients report improvement within three days, and nearly 94% experience pain relief within a week [5]. However, around 20% may encounter a temporary "cortisone flare" [5]. The relief from cortisone injections usually lasts three to six months, but recent studies suggest they don’t necessarily provide better pain relief or functional gains compared to dry needling [3].
Here’s a quick comparison of the two treatments:
| Treatment Aspect | Dry Needling | Cortisone Injection |
|---|---|---|
| Mechanism | Targets muscle trigger points | Reduces inflammation |
| Number of Sessions | 3–7 treatments (average ≈5.4) | Typically a single treatment |
| Onset of Relief | Gradual improvement over sessions | >60% feel better within 3 days |
| Duration of Relief | Can provide long-term improvement | Relief lasts 3–6 months |
| Common Side Effects | Mild post-treatment soreness | ≈20% experience a temporary flare |
Both treatments are effective for managing GTPS, and the decision often depends on the patient’s specific needs, symptoms, and treatment preferences.
Clinical Trial Results
A randomized clinical trial evaluated the effectiveness of dry needling compared to cortisone injections for treating greater trochanteric pain syndrome (GTPS). The study found that both treatments offered similar levels of relief [6].
Study Methods and Measurements
This prospective, randomized, and partially blinded trial involved 43 participants with GTPS (50 effected hips). They were randomly assigned to receive either dry needling or cortisone injections [6].
The treatment period lasted six weeks, with clinical outcomes assessed at four intervals: before treatment (baseline) and at 1, 3, and 6 weeks post-treatment initiation. This schedule allowed researchers to examine both short-term and sustained effects [6].
Key metrics included a numeric pain-rating scale (0–10), the Patient-Specific Functional Scale (PSFS), and data on pain medication use [6]. A noninferiority test was employed to determine if dry needling was at least as effective as cortisone injections, focusing on equivalency rather than superiority [6].
Trial Outcomes
The trial demonstrated that dry needling and cortisone injections were equally effective in reducing pain and improving function. By the 6-week mark, both groups showed significant improvements.
- Pain Scores: In the dry needling group, average pain scores dropped from 5.4 ± 1.8 at baseline to 2.8 ± 2.4 at 6 weeks. For the cortisone injection group, scores decreased from 6.1 ± 2.1 to 3.9 ± 3.7 during the same period [6].
- Functional Scores: The dry needling group saw PSFS scores improve from 3.9 ± 1.0 at baseline to 7.3 ± 2.3 at 6 weeks. The cortisone group’s scores increased from 3.4 ± 1.7 to 6.1 ± 3.0 [6].
| Outcome Measure | Treatment | Baseline | 1 Week | 3 Weeks | 6 Weeks |
|---|---|---|---|---|---|
| Pain Score | Dry Needling | 5.4 ± 1.8 | 3.6 ± 2.1 | 4.0 ± 2.2 | 2.8 ± 2.4 |
| Cortisone Injection | 6.1 ± 2.1 | 2.6 ± 2.7 | 2.7 ± 2.9 | 3.9 ± 3.7 | |
| PSFS Score | Dry Needling | 3.9 ± 1.0 | 5.2 ± 2.2 | 5.7 ± 2.0 | 7.3 ± 2.3 |
| Cortisone Injection | 3.4 ± 1.7 | 6.5 ± 2.8 | 6.5 ± 2.8 | 6.1 ± 3.0 |
Patients in the dry needling group averaged 5.4 sessions (ranging from 3 to 7), while those in the cortisone group received a single injection. Pain medication usage was similar between the groups by the 6-week mark [6].
There were no adverse side effects reported, and baseline characteristics were consistent across groups, ensuring that the results reflected treatment effects alone [6].
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Treatment Comparison: Effectiveness, Safety, and Cost
When deciding between dry needling and cortisone injections for treating GTPS, it’s important to weigh factors like effectiveness, safety, and cost.
Pain Relief and Duration of Results
A six-week trial revealed that both treatments provide comparable short-term pain relief. However, the long-term benefits remain uncertain[6]. These findings align with earlier research, highlighting the importance of making informed treatment choices based on individual needs.
Side Effects and Safety
Safety is another key consideration, and the two treatments differ in their risk profiles. Among 20,494 dry needling treatments, minor side effects occurred in 36.7% of cases, including bleeding (16%), bruising (7.7%), and pain during the procedure (5.9%). Major complications were extremely rare, occurring in less than 0.1% of cases[11].
Cortisone injections, on the other hand, come with a broader range of potential issues. Common side effects include pain and swelling at the injection site (sometimes referred to as a cortisone flare), skin discoloration (affecting 1.3% to 4% of patients), and fat atrophy (around 0.6% of cases)[10]. More serious complications can include elevated blood sugar levels, tendon injuries, cartilage damage, infections, and allergic reactions. As Kindyle L. Brennan, PT, PhD, OCS, COMT, noted:
The most obvious and direct implication of this study is the successful treatment of GTPS without the introduction of drugs to the system or the risk of serious side effects.[9]
Cortisone injections are generally not advised for patients with active infections, those taking blood thinners, or individuals with recent bone fractures[10]. Dry needling, with fewer absolute contraindications, offers broader suitability for a wider range of patients.
| Safety Factor | Dry Needling | Cortisone Injection |
|---|---|---|
| Common Side Effects | Bleeding (16%), bruising (7.7%), pain (5.9%) | Pain and swelling, skin discoloration (1.3%–4%), fat atrophy (~0.6%) |
| Major Complications | Less than 0.1% occurrence | Tendon injury, cartilage loss, infection, allergic reaction |
| Systemic Effects | None reported | Elevated blood sugar |
| Contraindications | Minimal | Active infection, blood thinners, recent bone fractures |
Treatment Costs and Access
Cost and accessibility are crucial factors to consider. Cortisone injections are typically administered in a single office visit, making them convenient and cost-effective. They are widely covered by insurance in the United States and can be provided by various healthcare professionals, including primary care doctors, rheumatologists, and orthopedic surgeons[12].
Dry needling, in contrast, often requires multiple sessions, which can increase overall costs and time commitments. Insurance coverage for dry needling varies depending on the provider’s credentials, state regulations, and specific policies. Additionally, access to dry needling may be limited, especially in rural areas, as it requires practitioners with specialized training in trigger points and neuromuscular anatomy. This difference in availability can influence treatment decisions based on location and resources.
Dry Needling Treatment at Portland Chiropractic Group
Portland Chiropractic Group in Oklahoma City takes a patient-focused approach to treating greater trochanteric pain syndrome (GTPS) using dry needling. Guided by clinical research, the clinic tailors treatments to align with methods that solves the problem. Practitioners conduct thorough evaluations using orthopedics, neurological, and pain provocation patterns to uncover the underlying causes of discomfort.
"Dry Needling offers precise relief for musculoskeletal pain by targeting trigger points and releasing muscle tension. This therapy is effective for treating chronic pain, sports injuries, and movement dysfunctions." – Inner Gate Health & Wellness [14]
Since GTPS affects an estimated 10% to 25% of people [8], the clinic emphasizes creating customized care plans. By combining dry needling with other therapies, they aim to enhance results and promote faster recovery. This evidence-driven approach forms the foundation of their services.
Dry Needling Sessions and Pricing
Dry needling sessions at Portland Chiropractic Group are priced between $65 and $70 per session, with a promotional "Stagflation Special" rate of $55 available [15]. For those needing ongoing care, package options include:
- $204 for 4 sessions
- $840 for 20 sessions
All packages must be used within one year of purchase.
During a session, thin needles are inserted into, near, or around trigger points, tendons, fascia, bone, or nerve to alleviate pain and or improve mobility. These needles work without medication, targeting specific areas for pain control or limited mobility, by tapping into the bodies innate ability to heal itself [18]. Patients may experience mild soreness for 24 to 36 hours after treatment, as well as occasional bruising at needle sites. To support recovery, staying hydrated and gently active with the bodily area treated directly afterwards is recommended.
Combined Treatment Options
To provide comprehensive care, Portland Chiropractic Group integrates dry needling with other therapies. These include the Graston Technique, shockwave therapy, chiropractic adjustments, massage therapy, and sports rehabilitation. This holistic approach addresses GTPS from multiple angles, ensuring a well-rounded treatment plan.
Research suggests that dry needling delivers results comparable to corticosteroid injections for pain relief and improved function [8]. As highlighted in clinical studies:
"Patients can achieve similar outcomes from dry needling as from cortisone injections." [8]
With serious complications occurring in less than 0.1% of cases [13], the clinic prioritizes patient safety and collaboration. Treatment plans are developed with input from patients, considering their medical history, preferences, and goals. This ensures a personalized and effective care experience.
Treatment Decision Guide for Patients and Providers
Drawing from the clinical trial findings discussed earlier, this guide aims to help patients and providers make informed decisions about managing GTPS (greater trochanteric pain syndrome). Research shows that dry needling is just as effective as cortisone injections for treating GTPS, a condition that affects 10–25% of people [3]. This insight is particularly valuable given the potential risks tied to steroid injections.
"The potential detrimental side effects of steroid injection, particularly repeated injections, are of concern for patients and providers alike." – Kindyle L. Brennan, PT, PhD, Baylor Scott & White Health [16]
Women are at a much higher risk of developing GTPS, being four times more likely to experience it compared to men [1]. The condition commonly affects women between the ages of 40 and 60, and recovery tends to be slow, often taking 6–9 months [1]. These factors are critical when planning treatment and setting realistic expectations for recovery.
Choosing the Right Treatment
When deciding between dry needling and cortisone injections, it’s essential to consider their safety profiles. Dry needling targets soft tissue injuries and neuromyofascial pain with very few risks [3].
"The identification of a comparable treatment alternative with minimal side effects, such as dry needling, offers valuable clinical advantages." – Kindyle L. Brennan, PT, PhD, Baylor Scott & White Health [16]
Patient-specific factors play a key role in treatment decisions. For example, individuals with certain comorbidities may not experience the same level of pain relief from corticosteroid injections [17].
Long-term management strategies are another critical aspect. While cortisone injections are a passive treatment, exercise and education empower patients to take control of their condition. Studies have shown that exercise and education outperform both minimal treatment and corticosteroid injections in the short, medium, and long term [17].
At Portland Chiropractic Group, a comprehensive approach combines dry needling with therapies like the Graston Technique, shockwave therapy, functional training, and chiropractic adjustments. This tailored strategy considers each patient’s medical history, preferences, and goals, creating a personalized treatment plan.
Cost and session frequency are also important factors. For example, Portland Chiropractic Group offers dry needling sessions priced between $55 and $70, with package options available to make treatment more accessible.
What’s Next for GTPS Treatment
As research continues to shed light on effective treatments, there’s a growing emphasis on conservative, evidence-based approaches like dry needling that carry fewer risks.
Future studies will likely focus on refining treatment protocols and identifying which patients respond best to specific therapies. The six-week follow-up period in the current study [3] underscores the need for longer-term research to evaluate sustained benefits.
Combination therapies, integrating dry needling with exercise, manual therapy, and patient education, show promise for addressing both immediate pain relief and long-term functional improvement.
Healthcare providers are increasingly prioritizing patient-centered care, tailoring treatments to individual preferences and circumstances. This approach allows patients to avoid treatments like steroid injections if safety is a concern, while others may opt for options requiring fewer sessions.
With its growing evidence base, dry needling is emerging as a strong first-line treatment option, offering patients a safe and effective alternative to traditional methods.
FAQs
What are the long-term advantages of dry needling compared to cortisone injections for greater trochanteric pain syndrome?
Dry needling has been shown to provide pain relief that lasts longer and may improve mobility more effectively than cortisone injections. While cortisone injections often deliver faster short-term relief, they come with a higher risk of side effects. In contrast, dry needling tends to have fewer complications and offers more enduring benefits.
If you’re looking for a treatment option that prioritizes fewer risks and long-term results, dry needling might be worth considering. That said, the right choice ultimately depends on your specific health needs, so it’s essential to discuss options with your healthcare provider.
What are the safety differences between dry needling and cortisone injections, and what factors should patients consider when deciding on a treatment?
Dry needling is often viewed as a safer option, especially when performed by a trained professional. The risks, such as infection or tissue damage, are relatively low. On the other hand, cortisone injections come with potential downsides, including cartilage damage, weakened bones, and a higher risk of infection – concerns that grow with repeated use.
Choosing between these treatments depends on several factors: the safety of each method, the severity of the condition, and the patient’s medical history. A consultation with a qualified healthcare provider can guide patients toward the most suitable option for their specific situation.
What should be considered when choosing between dry needling and cortisone injections for treating greater trochanteric pain syndrome?
When choosing between dry needling and cortisone injections, several factors come into play, such as the intensity of your pain, how you’ve responded to treatments in the past, and what aligns best with your preferences. Dry needling might offer relief that lasts longer, while cortisone injections are known for providing quicker pain relief, though they can sometimes bring side effects.
Your healthcare provider will evaluate your overall health, treatment objectives, and any possible risks to help determine which option suits you best.
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