Greater trochanteric pain syndrome

GTPS describes pain in the outer aspect (lateral) of the hip.

It is usually caused by damage to the gluteal (buttock muscle) tendons. This gluteal tendon damage (tendinopathy) causes pain and weakening of the fibres of the strong band of tissue which attaches the gluteal muscles to bone of the outer hip. It is sometimes associated with inflammation in the fluid filled sac which lies on the outside of the hip, known as the trochanteric bursa.  These conditions often co-exist and are termed greater trochanteric pain syndrome (GTPS).

Normally there is a gradual onset, thought to result from excessive friction between the greater trochanter (bony prominence on the outside of the hip) and the gluteal tendons or iliotibial band.

The following factors may predispose to developing excessive friction:

  • Direct trauma to the side of the pelvis
  • Weak hip abductor muscles
  • Sudden increase in activity levels such as cycling or running
  • Prolonged standing
  • High body mass index (BMI)
  • Associated low back pain or arthritis of the lower limb resulting in weakness and fatigue to the hip muscles

Pain is felt directly over the greater trochanter in the outer hip region. Some individuals may suffer from referred pain radiating down the outside of the thigh.

Symptoms are aggravated by any posture placing direct pressure over the trochanteric region or activities requiring repeated flexion and extension of the hip joint.

Aggravating activities can include:

  • Lying on the affected side
  • Prolonged sitting (which can tension the iliotibial band over the bursa)
  • Walking
  • Cycling and running

GTPS can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature is often tenderness when palpating directly over the trochanteric region.

X-rays and scans are not routinely required.

In the majority of cases, GTPS can be managed very effectively by following a regular exercise routine:

Modifying aggravating activities

This does not mean that you will have to stop cycling, running etc. However, the trochanteric bursa and gluteal tendon may need 4-6 weeks of relative rest initially to settle symptoms while you work on strengthening the hip abductor muscles (see below).

Activity modification is the key to relief of symptoms. It is essential to remove causative factors for the tendon to heal. This may take several weeks. Examples are reducing time walking or standing, appropriate footwear and weight reduction.

Exercises

Regular exercises to strengthen the hip abductor muscles and tendon:

3-4 sets of 10 reps, 3-4x per week

3-4 sets of 10 reps, 3-4x per week

5×30 second holds, 2x per day

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.

Physiotherapy; Symptoms will normally settle following a period of activity modification and home exercises. However, in persistent cases your clinician may consider a referral for physiotherapy.

Corticosteroid injection therapy

For individuals who have trialed a course of appropriate exercises and modified activities, corticosteroid injections can be offered for individuals whose primary symptoms are due to trochanteric bursa inflammation. You can read more about local corticosteroid injections here.

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