Case Study of a Severe, Irritable Patient and When to Inject

This patient could walk only three to five minutes and had been told to stretch, walk through pain and do clams, side-lying abduction and single leg stance. Neil explains, citing Alison Grimaldi's 2025 masterclass, that stretching and clams add compression over the greater trochanter and are not supported for insertional tendinopathy. Low mood and poor self-efficacy also raise reported pain. The LEAP trial found education and graded exercise beat a steroid injection and wait-and-see at 8 and 52 weeks. Neil uses an injection only to calm tissue and open a short window for rehabilitation, and avoids repeat injections. She had an injection, used two elbow crutches and began isometrics over six weeks, based on the protocol by Rio and colleagues: about 70% effort, five 45-second holds. Pain fell from 9 to 5 out of 10 and walking time nearly doubled. Bridge progressions from the LEAP program followed, guided by a traffic light system, and by week 10 she managed a single leg bridge and was socializing again.