{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:22:14Z","timestamp":1770682934321,"version":"3.49.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2016,10,26]],"date-time":"2016-10-26T00:00:00Z","timestamp":1477440000000},"content-version":"vor","delay-in-days":128,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Veterans Health Administration"},{"DOI":"10.13039\/100006379","name":"Office of Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006379","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Objective. This article presents an evidence-based algorithm to assist primary care providers with the diagnosis and management of lateral hip and thigh pain in older adults. It is part of a series that focuses on coexisting pain patterns and contributors to chronic low back pain (CLBP) in the aging population. The objective of the series is to encourage clinicians to take a holistic approach when evaluating and treating CLBP in older adults.<\/jats:p>\n               <jats:p>Methods. A content expert panel and a primary care panel collaboratively used the modified Delphi approach to iteratively develop an evidence-based diagnostic and treatment algorithm. The panelists included physiatrists, geriatricians, internists, and physical therapists who treat both civilians and Veterans, and the algorithm was developed so that all required resources are available within the Veterans Health Administration system. An illustrative patient case was chosen from one of the author\u2019s clinical practices to demonstrate the reasoning behind principles presented in the algorithm.<\/jats:p>\n               <jats:p>Results. An algorithm was developed which logically outlines evidence-based diagnostic and therapeutic recommendations for lateral hip and thigh pain in older adults. A case is presented which highlights the potential complexities of identifying the true pain generator and the importance of implementing proper treatment.<\/jats:p>\n               <jats:p>Conclusions. Lateral hip and thigh pain in older adults can contribute to and coexist with CLBP. Distinguishing the true cause(s) of pain from potentially a myriad of asymptomatic degenerative changes can be challenging, but a systematic approach can assist in identifying and treating some of the most common causes.<\/jats:p>","DOI":"10.1093\/pm\/pnw111","type":"journal-article","created":{"date-parts":[[2016,6,23]],"date-time":"2016-06-23T17:00:42Z","timestamp":1466701242000},"page":"1249-1260","source":"Crossref","is-referenced-by-count":13,"title":["Deconstructing Chronic Low Back Pain in the Older Adult\u2014Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VIII: Lateral Hip and Thigh Pain"],"prefix":"10.1093","volume":"17","author":[{"given":"Monica","family":"Rho","sequence":"first","affiliation":[{"name":"*Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago\/McGaw Medical Center of Northwestern University, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandra","family":"Camacho-Soto","sequence":"first","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abby","family":"Cheng","sequence":"first","affiliation":[{"name":"*Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago\/McGaw Medical Center of Northwestern University, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Havran","sequence":"first","affiliation":[{"name":"Extended Care & Rehab, VA Central Iowa Health Care Systems, Des Moines, Iowa"},{"name":"Des Moines University, Des Moines, Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia E.","family":"Morone","sequence":"first","affiliation":[{"name":"Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Rodriguez","sequence":"first","affiliation":[{"name":"**Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Shega","sequence":"first","affiliation":[{"name":"VITAS Healthcare, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debra K.","family":"Weiner","sequence":"first","affiliation":[{"name":"Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"},{"name":"**Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"},{"name":"Department of Psychiatry"},{"name":"Department of Anesthesiology, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2016,6,20]]},"reference":[{"issue":"6","key":"2020060117500405300_pnw111-B1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/BF01628504","article-title":"The sensory innervation of the hip joint\u2013an anatomical study","volume":"19","author":"Birnbaum","year":"1997","journal-title":"Surg Radiol Anat"},{"issue":"3","key":"2020060117500405300_pnw111-B2","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1007\/s11999-008-0680-y","article-title":"Clinical presentation of patients with symptomatic anterior hip impingement","volume":"467","author":"Clohisy","year":"2009","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"2020060117500405300_pnw111-B3","doi-asserted-by":"crossref","first-page":"E27","DOI":"10.1097\/BRS.0b013e31818b8882","article-title":"How often is low back pain not coming from the back?","volume":"34","author":"Sembrano","year":"2009","journal-title":"Spine"},{"issue":"3","key":"2020060117500405300_pnw111-B4","doi-asserted-by":"crossref","first-page":"403","DOI":"10.2106\/00004623-199072030-00013","article-title":"Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation","volume":"72","author":"Boden","year":"1990","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"2020060117500405300_pnw111-B5","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1002\/art.20213","article-title":"Progression of radiographic hip osteoarthritis over eight years in a community sample of elderly white women","volume":"50","author":"Lane","year":"2004","journal-title":"Arthritis Rheum"},{"issue":"5","key":"2020060117500405300_pnw111-B6","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1111\/pme.12759","article-title":"Introduction to special series: Deconstructing chronic low back pain in the older adult: Shifting the paradigm from the spine to the person","volume":"16","author":"Weiner","year":"2015","journal-title":"Pain Med"},{"issue":"1","key":"2020060117500405300_pnw111-B7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3109\/s10165-012-0638-5","article-title":"Distribution of hip pain in osteoarthritis patients secondary to developmental dysplasia of the hip","volume":"23","author":"Nakamura","year":"2013","journal-title":"Mod Rheumatol"},{"issue":"8","key":"2020060117500405300_pnw111-B8","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.apmr.2007.04.014","article-title":"Greater trochanteric pain syndrome: Epidemiology and associated factors","volume":"88","author":"Segal","year":"2007","journal-title":"Arch Phys Med Rehabil"},{"issue":"10","key":"2020060117500405300_pnw111-B9","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1016\/j.ejrad.2014.06.009","article-title":"Greater trochanter pain syndrome: A descriptive MR imaging study","volume":"83","author":"Klontzas","year":"2014","journal-title":"Eur J Radiol"},{"issue":"5","key":"2020060117500405300_pnw111-B10","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.2214\/AJR.12.10038","article-title":"Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis","volume":"201","author":"Long","year":"2013","journal-title":"AJR Am J Roentgenol"},{"issue":"1","key":"2020060117500405300_pnw111-B11","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-0033-1333913","article-title":"Greater trochanteric pain syndrome","volume":"17","author":"Klauser","year":"2013","journal-title":"Semin Musculoskelet Radiol"},{"issue":"4","key":"2020060117500405300_pnw111-B12","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1007\/s00586-015-4027-6","article-title":"Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls","volume":"25","author":"Cooper","year":"2016","journal-title":"Eur Spine J"},{"issue":"5","key":"2020060117500405300_pnw111-B13","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/rheumatology\/29.5.354","article-title":"A clinical epidemiological study in low back pain. Description of two clinical syndromes","volume":"29","author":"Collee","year":"1990","journal-title":"Br J Rheumatol"},{"key":"2020060117500405300_pnw111-B14","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/S1529-9430(02)00198-5","article-title":"Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists","volume":"4","author":"Tortolani","year":"2002","journal-title":"Spine"},{"issue":"3","key":"2020060117500405300_pnw111-B15","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.ptsp.2014.11.002","article-title":"Evaluation and management of greater trochanter pain syndrome","volume":"16","author":"Mulligan","year":"2015","journal-title":"Phys Ther Sport"},{"issue":"10","key":"2020060117500405300_pnw111-B16","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1177\/0363546509334374","article-title":"Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome","volume":"37","author":"Rompe","year":"2009","journal-title":"Am J Sports Med"},{"issue":"4","key":"2020060117500405300_pnw111-B17","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.semarthrit.2013.08.006","article-title":"The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon","volume":"43","author":"Dean","year":"2014","journal-title":"Semin Arthritis Rheum"},{"key":"2020060117500405300_pnw111-B18","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/01.blo.0000118184.83983.65","article-title":"Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis","volume":"421","author":"Wong","year":"2004","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"2020060117500405300_pnw111-B19","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1002\/jor.20030","article-title":"Glucocorticoids inhibit tenocyte proliferation and Tendon progenitor cell recruitment","volume":"24","author":"Scutt","year":"2006","journal-title":"J Orthop Res"},{"issue":"6","key":"2020060117500405300_pnw111-B20","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1080\/17453670610046118","article-title":"Glucocorticoids suppress proteoglycan production by human tenocytes","volume":"76","author":"Wong","year":"2005","journal-title":"Acta Orthop"},{"issue":"2","key":"2020060117500405300_pnw111-B21","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/00042752-200603000-00011","article-title":"Musculoskeletal injury in the masters runners","volume":"16","author":"McKean","year":"2006","journal-title":"Clin J Sport Med"},{"issue":"3","key":"2020060117500405300_pnw111-B22","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/00042752-200605000-00013","article-title":"Practical management of iliotibial band friction syndrome in runners","volume":"16","author":"Fredericson","year":"2006","journal-title":"Clin J Sport Med"},{"issue":"5","key":"2020060117500405300_pnw111-B23","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1249\/JSR.0b013e31822d403f","article-title":"Running injuries\u2014Changing trends and demographics","volume":"10","author":"Fields","year":"2011","journal-title":"Curr Sports Med Rep"},{"issue":"4","key":"2020060117500405300_pnw111-B24","doi-asserted-by":"crossref","first-page":"344","DOI":"10.4085\/1062-6050-45.4.344","article-title":"Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility","volume":"45","author":"Ferber","year":"2010","journal-title":"J Athl Train"},{"issue":"6","key":"2020060117500405300_pnw111-B25","doi-asserted-by":"crossref","first-page":"326","DOI":"10.2519\/jospt.2003.33.6.326","article-title":"Use of an inclinometer to measure flexibility of the iliotibial band using the Ober test and the modified Ober test: Differences in magnitude and reliability of measurements","volume":"33","author":"Reese","year":"2003","journal-title":"J Orthop Sports Phys Ther"},{"issue":"10","key":"2020060117500405300_pnw111-B26","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1016\/j.apmr.2006.06.007","article-title":"Assessment of stretching of the iliotibial tract with Ober and modified Ober tests: An ultrasonographic study","volume":"87","author":"Wang","year":"2006","journal-title":"Arch Phys Med Rehabil"},{"issue":"3","key":"2020060117500405300_pnw111-B27","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/00042752-200007000-00004","article-title":"Hip abductor weakness in distance runners with iliotibial band syndrome","volume":"10","author":"Fredericson","year":"2000","journal-title":"Clin J Sport Med"},{"issue":"5","key":"2020060117500405300_pnw111-B28","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1111\/pme.12757","article-title":"Deconstructing chronic low back pain in the older adult\u2013step by step evidence and expert-based recommendations for evaluation and treatment: Part I: Hip osteoarthritis","volume":"16","author":"Weiner","year":"2015","journal-title":"Pain Med"},{"issue":"15","key":"2020060117500405300_pnw111-B29","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1097\/BRS.0b013e31828f463e","article-title":"Comparison of radicular symptoms caused by lumbar disc herniation and lumbar spinal stenosis in the elderly","volume":"38","author":"Rainville","year":"2013","journal-title":"Spine"},{"key":"2020060117500405300_pnw111-B30","volume-title":"Netter\u2019s Orthopaedic Clinical Examination: An Evidence-Based Approach","author":"Cleland","year":"2011","edition":"2nd edition."},{"issue":"2","key":"2020060117500405300_pnw111-B31","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/RHU.0b013e31816b2f99","article-title":"The sensitivity and specificity of the slump and the straight leg raising tests in patients with lumbar disc herniation","volume":"14","author":"Majlesi","year":"2008","journal-title":"J Clin Rheumatol"},{"issue":"1","key":"2020060117500405300_pnw111-B32","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/BRS.0b013e3181c953cc","article-title":"The accuracy of the physical examination for the diagnosis of midlumbar and low lumbar nerve root impingement","volume":"36","author":"Suri","year":"2011","journal-title":"Spine"},{"key":"2020060117500405300_pnw111-B33","first-page":"298","article-title":"Changes in nerve root motion and intraradicular blood flow during intraoperative femoral nerve stretch test","volume":"99(suppl 3)","author":"Kobayashi","year":"2003","journal-title":"J Neurosurg"},{"issue":"1","key":"2020060117500405300_pnw111-B34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1302\/0301-620X.71B1.2915013","article-title":"Ipsilateral sciatica on femoral nerve stretch test is pathognomonic of an L4\/5 disc protrusion","volume":"71","author":"Christodoulides","year":"1989","journal-title":"J Bone Joint Surg Br"},{"issue":"4","key":"2020060117500405300_pnw111-B35","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1055\/s-0034-1387807","article-title":"Optimal duration of conservative management prior to surgery for cervical and lumbar radiculopathy: A literature review","volume":"4","author":"Alentado","year":"2014","journal-title":"Global Spine J"},{"issue":"4","key":"2020060117500405300_pnw111-B36","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/00007632-198904000-00018","article-title":"Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study","volume":"14","author":"Saal","year":"1989","journal-title":"Spine"},{"issue":"4","key":"2020060117500405300_pnw111-B37","first-page":"432.","article-title":"Physical medicine and rehabilitation: Lumbar stabilizing exercises for the nonoperative treatment of disc lesions","volume":"153","author":"Saal","year":"1990","journal-title":"West J Med"},{"key":"2020060117500405300_pnw111-B38","volume-title":"The Lumbar Spine: Mechanical Diagnosis and Therapy","author":"McKenzie","year":"1981"},{"issue":"2","key":"2020060117500405300_pnw111-B39","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/S1529-9430(02)00565-X","article-title":"The role of repeated end-range\/pain response assessment in the management of symptomatic lumbar discs","volume":"3","author":"Wetzel","year":"2003","journal-title":"Spine J"},{"issue":"19","key":"2020060117500405300_pnw111-B40","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1001\/jama.2015.4468","article-title":"Oral steroids for acute radiculopathy due to a herniated lumbar disk: A randomized clinical trial","volume":"313","author":"Goldberg","year":"2015","journal-title":"JAMA"},{"issue":"7","key":"2020060117500405300_pnw111-B41","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.spinee.2009.03.005","article-title":"Spinal stenosis prevalence and association with symptoms: The Framingham Study","volume":"9","author":"Kalichman","year":"2009","journal-title":"Spine J"},{"issue":"21","key":"2020060117500405300_pnw111-B42","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1097\/00007632-199611010-00002","article-title":"Anatomic changes of the spinal canal and intervertebral foramen associated with flexion-extension movement","volume":"21","author":"Inufusa","year":"1996","journal-title":"Spine"},{"issue":"6","key":"2020060117500405300_pnw111-B43","first-page":"883","article-title":"Meralgia paresthetica: A review of the literature","volume":"8","author":"Cheatham","year":"2013","journal-title":"Int J Sports Phys Ther"},{"issue":"7","key":"2020060117500405300_pnw111-B44","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1016\/j.clinph.2013.02.003","article-title":"Sonographic and electrophysiologic findings in patients with meralgia paresthetica","volume":"124","author":"Suh","year":"2013","journal-title":"Clin Neurophysiol"},{"key":"2020060117500405300_pnw111-B45","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.clineuro.2015.04.007","article-title":"Comparison of effectiveness of different surgical treatments for meralgia paresthetica: Results of a prospective observational study and protocol for a randomized controlled trial","volume":"134","author":"de Ruiter","year":"2015","journal-title":"Clin Neurol Neurosurg"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/17\/7\/1249\/2223284","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/17\/7\/1249\/2223284","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T21:50:40Z","timestamp":1591048240000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/17\/7\/1249\/2223284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,20]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2016,6,20]]},"published-print":{"date-parts":[[2016,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnw111","relation":{},"ISSN":["1526-4637","1526-2375"],"issn-type":[{"value":"1526-4637","type":"electronic"},{"value":"1526-2375","type":"print"}],"subject":[],"published-other":{"date-parts":[[2016,7]]},"published":{"date-parts":[[2016,6,20]]}}}