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Greater trochanteric pain syndrome (GTPS) is a condition that causes pain in the outer side of the hip although the pain may also travel down through the upper thigh. The pain may also be localised on the lateral side of the hip.
The greater trochanter is a bony prominence of the thigh bone (femur). It sits at the top of the bone and on the outside of the hip. If you experience pain in both hips then it’s called bilateral greater trochanteric pain syndrome
If you have this syndrome then you may find walking difficult. The pain is usually the result of an injury. It can also be caused by repetitive movements, such as when running. Joggers are often susceptible to GTPS pain. People who have had hip surgery may also be prone to this type of pain.
Greater trochanteric pain syndrome used to be called trochanteric bursitis, so you may still see this term used by medical professionals. It was thought the pain was the result of inflammation of the bursa, which is a small sac filled fluid that helps to smooth the movement between two surfaces. If the bursa in the hip joint becomes inflamed then this can lead to a related condition called hip bursitis.
The latest research suggests that most cases of greater trochanteric pain syndrome are the result of small tears or damage to nearby muscles or tendons, rather than an inflamed bursa or bursitis of the hip. Therefore, the preferred medical term for the condition is now greater trochanteric pain syndrome rather than trochanteric bursitis.
The greater trochanter is a bony prominence of the thigh bone (femur). It sits at the top of the bone and on the outside of the hip. If you experience pain in both hips then it’s called bilateral greater trochanteric pain syndrome
If you have this syndrome then you may find walking difficult. The pain is usually the result of an injury. It can also be caused by repetitive movements, such as when running. Joggers are often susceptible to GTPS pain. People who have had hip surgery may also be prone to this type of pain.
Greater trochanteric pain syndrome used to be called trochanteric bursitis, so you may still see this term used by medical professionals. It was thought the pain was the result of inflammation of the bursa, which is a small sac filled fluid that helps to smooth the movement between two surfaces. If the bursa in the hip joint becomes inflamed then this can lead to a related condition called hip bursitis.
The latest research suggests that most cases of greater trochanteric pain syndrome are the result of small tears or damage to nearby muscles or tendons, rather than an inflamed bursa or bursitis of the hip. Therefore, the preferred medical term for the condition is now greater trochanteric pain syndrome rather than trochanteric bursitis.
Greater trochanteric pain syndrome is usually caused by damage to the buttock muscle (gluteal) tendons. This gluteal tendon damage (gluteal tendinopathy) causes pain and weakening of the fibres of the strong band of tissue that 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 and is known as the trochanteric or hip bursa. This condition and greater trochanteric bursitis often co-exist, so they are grouped under greater trochanteric pain syndrome.
Normally there is a gradual onset of the syndrome. This is thought to be the result from excessive friction between the greater trochanter and the gluteal tendons or the iliotibial band (a long piece of connective tissue that runs down the outside of your leg from the hip to the knee).
The following factors are the main causes behind developing excessive friction:
- Direct trauma to the hips and the side of the pelvis.
- Weak hip abductor muscles.
- Sudden increase in activity levels, such as taking up cycling or running .
- Prolonged standing while at work.
- High body mass index (BMI).
Associated low back pain or arthritis of the lower limb can also result in weakness and fatigue to the hip muscles, which can lead to greater trochanteric pain syndrome.
Pain is generally felt directly over the greater trochanter in the outer hip region. However, some individuals may suffer from referred pain, which radiates down the outside of the thigh.
Symptoms are aggravated by any posture that places direct pressure over the trochanteric region or activities that require repeated flexion and extension of the hip joint.
There are several activities that can aggravate greater trochanteric pain syndrome, these include:
- Lying on the affected side
- Prolonged sitting (which can cause tension in the iliotibial band that overlies the bursa)
- Walking
- Cycling and running
Your doctor or physiotherapist will be able to diagnose greater trochanteric pain syndrome by conducting a physical examination and taking a history of your condition. The main feature of greater trochanteric pain syndrome is often tenderness when pressing directly over the trochanteric region.
Although trochanteric bursitis symptoms, hip bursitis symptoms and greater trochanteric pain syndrome symptoms are very similar, an experienced consultant will be able to determine the precise cause of the pain. X-rays and MRI scans are not routinely required to diagnose GTPS.
Following a diagnosis, the treatments offered will be tailored to match you levels of activity with the aim of reducing or managing pain and improve your range of motion. Surgery is rarely offered as a treatment for the condition, although it may be offered should the treatments listed below fail to control or reduce your pain. Your consultant will discuss the range of treatments available to you during your initial consultation.
In the majority of cases, greater trochanteric pain syndrome can be managed very effectively by following a regular exercise routine. Symptoms will normally settle following a period of activity modification and home exercises. The use of anti-inflammatory medications will help manage the pain that may be associated with exercising.
However, in persistent cases your clinician may consider a referral for physiotherapy. Your physical therapist will be able to help you with a list of exercises that will reduce pain, strengthening your muscles and improve your range of motion.
The exercises are split into two groups. The first group is aimed at modifying your activities that aggravate the condition. The second group are a range of exercises that have been developed specifically to strengthen your muscles, which should help to alleviate chronic pain.
Modifying aggravating activities
This does not mean that you will have to stop cycling or running. However, the trochanteric bursa and gluteal tendon may need four to six weeks of relative rest. This is to settle symptoms while you work on strengthening the hip abductor muscles (see exercise below).
Modifying your range of activities 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.
Greater trochanteric pain syndrome exercises
Regular trochanteric bursitis exercises can help to strengthen the hip abductor muscles and tendon:
Side lying abduction:
In each exercise, perform three to four sets of 10 reps each. This exercise should be performed three to four times a week.
Bridge from floor:
In each exercise, perform three to four sets of 10 reps each. This exercise should be performed three to four times a week.
Supine piriformis stretch
In each exercise, perform five stretches each for a 30-second hold. This exercise should be performed three to two times a 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 doctor or physiotherapist.
Corticosteroid injection therapy
If you have followed a course of appropriate exercises and modified your activities in an attempt to reduce the pain from the GTPS, but you have noticed little improvement in your condition then you may be offered a course of corticosteroid injections.
This is more likely if your primary symptoms are due to trochanteric bursa inflammation. Your consultant will discuss with you the use of trochanteric bursitis injections. These trochanteric bursa injections will bring down the inflammation and control the pain.
Corticosteroid injections are a simple and effective method as part of a trochanteric bursitis treatment course. You can read more about local steroid injections here.
