Femoro Acetabular Impingement, Hip Pain, Iliopsoas Syndrome, Groin Pain
Conditions
Keywords
Percutaneous needle electrolysis, Therapeutic exercise, Anterior hip pain, Iliopsoas, Hip function, Range of motion, Pain intensity, Ultrasound-guided therapy, Conservative treatment, Ultrasound-Guided Percutaneous Needle Electrolysis
Brief summary
Hip pain in the front of the hip is common and can make daily activities and sports difficult. One frequent cause is femoroacetabular impingement, also known as hip impingement. This clinical trial is studying whether adding ultrasound-guided percutaneous electrolysis - a minimally invasive physiotherapy technique that uses a fine needle and a small electrical current - to a program of specific exercises works better than doing the exercises alone. Participants will be randomly assigned to one of two groups: * One group will receive two sessions of percutaneous electrolysis plus a home exercise program. * The other group will follow the same home exercise program without percutaneous electrolysis. The study will last five weeks. Researchers will measure pain, hip movement, and hip function at the beginning, after one week, and after four weeks. They will also record any side effects. The main goal is to find out if adding percutaneous electrolysis helps reduce hip pain and improve function more than exercise alone. This pilot study will help determine if this technique could be a safe and effective non-surgical treatment option for people with pain in the front of the hip.
Detailed description
Femoroacetabular impingement is a common cause of anterior hip pain in young and middle-aged adults. This condition involves abnormal mechanical contact between the proximal femur and the acetabular rim, which can lead to labral damage, cartilage injury, and pain. Soft tissue structures, particularly the iliopsoas tendon and its relationship with the anterior capsulolabral complex, frequently contribute to the symptoms. Ultrasound-guided percutaneous electrolysis is a minimally invasive technique used in physiotherapy. It involves the application of a controlled galvanic current through a fine needle inserted under ultrasound guidance into targeted soft tissues, with the aim of reducing pain and promoting tissue repair. This randomized pilot clinical trial will compare the effectiveness and safety of ultrasound-guided percutaneous electrolysis combined with a therapeutic exercise program versus the same therapeutic exercise program alone in participants with anterior hip pain compatible with femoroacetabular impingement. Eligible participants will be randomly allocated to one of two parallel groups. Both groups will follow a standardized home-based exercise program focused on hip mobility, gluteal strengthening, core stability, and controlled hip flexor activation. The experimental group will additionally receive two sessions of ultrasound-guided percutaneous electrolysis, performed one week apart. Primary and secondary outcomes will include pain intensity during provocative tests, hip range of motion to the first onset of pain, and self-reported hip function. All outcome assessments will be conducted by a blinded evaluator at baseline, one week, and four weeks after the first intervention session. Adverse events will be systematically recorded. The results of this pilot study will provide preliminary evidence regarding the potential additive benefit of percutaneous electrolysis to exercise therapy and will inform the design and sample size calculation of future larger-scale randomized controlled trials
Interventions
OTHERUltrasound-guided percutaneous needle electrolysis
Ultrasound-guided percutaneous needle electrolysis will be applied to the iliopsoas region targeting hyperechoic fibrotic tissue near the anterior hip joint. The procedure will be performed using a sterile needle under real-time ultrasound guidance with a long-axis in-plane approach from lateral to medial. Electrical current will be delivered with parameters of 2.5 mA for 3 seconds, with a total of 3 applications per session. Two sessions will be performed, one at baseline and one after 7 days. The intervention will be carried out by a physiotherapist with specific training in invasive techniques.
BEHAVIORALTherapeutic exercise program
Participants will perform a home-based therapeutic exercise program focused on lumbopelvic stability, hip strength, and controlled mobility. Exercises include glute bridge, bird dog, isometric hip flexion, and controlled hip flexion mobility. The program consists of 3 sets of 10 repetitions per exercise, performed 3 to 4 times per week over a 4-week period. Exercises will be performed within pain-free ranges and adjusted according to individual tolerance. Initial instruction will be provided by a physiotherapist, with follow-up supervision at one week and four weeks.
Sponsors
CEU San Pablo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Anterior hip pain (inguinal region) lasting more than 3 months * Numeric Rating Scale (NRS) pain score ≥ 4/10 during at least one provocative test * Positive result in at least one of the following clinical tests: Straight Leg Raise (SLR), Flexion-Adduction-Internal Rotation (FADIR), or Hip-External Rotation-Flexion-Ceiling (HEC) * Ultrasound findings compatible with pseudofibrotic tissue near the iliopsoas tendon at the anterosuperior acetabular recess * Age between 18 and 55 years * Able to provide written informed consent
Exclusion criteria
* Previous hip surgery * Moderate or severe hip osteoarthritis (diagnosed radiographically) * Neurological pathology affecting the lower limb * Dominant lumbar spine pathology * Active rheumatic or systemic inflammatory diseases * Any contraindication to percutaneous electrolysis * Belonephobia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Numeric Rating Scale (NRS) pain score during provocative hip tests | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Average pain intensity measured with the Numeric Rating Scale (NRS 0-10, where 0 = no pain and 10 = worst pain imaginable) during three standardized provocative tests: Straight Leg Raise (SLR), Flexion-Adduction-Internal Rotation (FADIR), and Hip-External Rotation-Flexion-Ceiling (HEC). The mean of the three scores is calculated to obtain a global measure of provoked anterior hip pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Rating Scale (NRS) pain during SLR test | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Pain intensity measured with the Numeric Rating Scale (NRS 0-10) during the Straight Leg Raise (SLR) test. |
| Numeric Rating Scale (NRS) pain during FADIR test | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Pain intensity measured with the Numeric Rating Scale (NRS 0-10) during the Flexion-Adduction-Internal Rotation (FADIR) test. |
| Numeric Rating Scale (NRS) pain during HEC test | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Pain intensity measured with the Numeric Rating Scale (NRS 0-10) during the Hip-External Rotation-Flexion-Ceiling (HEC) test. |
| Hip flexion range of motion to first onset of pain (P1) | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Passive hip flexion range of motion measured with a clinical goniometer until the first onset of pain (P1). |
| Hip external rotation range of motion to first onset of pain (P1) | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Passive hip external rotation range of motion measured with a clinical goniometer until the first onset of pain (P1). |
| Hip internal rotation range of motion to first onset of pain (P1) | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Passive hip internal rotation range of motion measured with a clinical goniometer until the first onset of pain (P1). |
| Hip function and quality of life (Hip Outcome Tool-12, iHOT-12Sv) | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Self-reported hip function and quality of life were assessed using the validated Spanish version of the International Hip Outcome Tool-12 (iHOT-12Sv). The iHOT-12 is a patient-reported outcome measure consisting of 12 items, each scored on a visual analog scale ranging from 1 to 100, where higher scores indicate better hip function and fewer symptoms. The overall score is calculated as the mean of the 12 items, resulting in a total score ranging from 0 to 100. |
| Adverse events | Baseline (T0), 7 days (T1), and 4 weeks after T1 (T2) | Incidence and type of adverse events. |
Countries
Spain
Contacts
CONTACTGuillermo Gallardo López
PRINCIPAL_INVESTIGATORGuillermo Gallardo Lopez
CEU SP University
Outcome results
None listed