Article by Z. Russell, J. Clarey
What is Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome, or in short GTPS, involves the tendons and bursae (small cushioning sacs between tendons and bones
around joints) surrounding the greater trochanter (a part of the femur and the most prominent part on the side of your hip). An injury to these structures
causes pain on the outside of your buttock and thigh. This is known as Greater Trochanteric Pain Syndrome.
Greater Trochanteric Pain Syndrome is a combination of both gluteal (buttock) tendon injuries (tendinopathy)
and bursitis (inflammation of the bursa) surrounding the hip joint. The main tendons involved are
that of the gluteus medius and gluteus minimus muscles. The most common bursits associated with GTPS and lateral hip pain is Trochanteric Bursitis.
Tendinopathy (tendon pathology) describes the changes that can occur in the tendon as a result of loads being applied to the tendon. In some cases, the load can exceed what the tendon is capable of tolerating and a person may suffer from pain, what is now known as tendinopathy. Tendinopathy is the correct term for patients who develop tendon pain, however, many people still refer to this condition as tendinitis or tendinosis, however, these terms are no longer used to describe this condition. The most common hip tendinopathy is gluteal tendinopathy.
An overlying tissue, known as the iliotibial band (ITB), can add stress to the area as this runs directly over the greater trochanter producing friction
around the area. ITB Syndrome mainly affects the knee end of the ITB, but this
also commonly predisposes you to GTPS.
What Causes a Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome can be caused by direct trauma from a fall onto your side, prolonged pressure to the hip area, repetitive movements
(walking/running), commencing unaccustomed vigorous exercise, weight-bearing on the one leg for long periods, hip instability or the result of a sporting
What are the Symptoms of Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome causes pain over the greater trochanter that may extend into the lateral thigh/leg. It is characterised by the ‘jump’
sign where palpation of the greater trochanter causes the person to nearly jump off the bed.
- Pain is usually episodic and will worsen over time with continued aggravation.
- Pain is worse when lying on the affected side especially at night.
- Pain following weight-bearing activities - walking, running.
- There may be hip muscle weakness.
How is Greater Trochanteric Pain Syndrome Diagnosed?
Your physiotherapist will conduct a thorough examination to rule out other possible causes of your pain. Diagnostic tests including ultrasound and MRI
can be performed to confirm the diagnosis if required.
Common GTPS Related Injuries
What is Greater Trochanteric Pain Syndrome Treatment?
Treatment is targeted at managing pain, improving hip strength and control and a progressive return to sport.
PHASE I - Pain Relief & Protection
- Managing your pain. Pain is the main reason that you seek treatment for GTPS. In truth, it was actually the final symptom that you developed and should
be the first symptom to improve.
- Managing your pain is best achieved through ice therapy, relative rest and techniques or exercises that unload the injured structures.
- Eliminating the compressive Load is vital to the recovery of GTPS - Avoid positions that lengthen the affected hip including crossing
your legs, ‘popping’ your hip out in standing, lying on either side, walking on cambered surfaces and in the initial stages stretching the muscles
on the outside of the hip.
- Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, unloading
taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.
- If the pain does not resolve some cases may respond to a local corticosteroid injection. However your Physiotherapist will liaise with you and your general practitioner to help ascertain if this is the best management for you.
PHASE II - Restoring Normal ROM, Strength
- As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal hip joint range of motion, muscle length
and resting tension, muscle strengthening and endurance, proprioception, balance and gait (walking pattern).
- Hip researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of muscle firing patterns in normal pain-free
hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
- PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients to regain normal hip muscle control. Please ask your physio for
- Treat comorbidities- osteoarthritis, labral tears can frequently coexist.
PHASE III - Restoring Full Function
The final stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their hips that will determine
what specific treatment goals you need to achieve. For some people, it may be simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.
How to Return to Sport after Greater Trochanteric Pain Syndrome
- As soon as you are cleared by your physiotherapist you can return to your activity - but take it easy for a while.
- Don't start at the same level as before your injury. Build back to your previous level slowly, and stop if it hurts.
- Warm up before you exercise.
- After the activity, apply ice to prevent pain and swelling.
- Continue your hip stabilisation exercises to prevent a recurrence.
If these steps don't help, you may require a re-visit to your physiotherapist. It can take weeks or months to fully rehabilitate GTPS.
Be patient, and stick with your treatment. If you start using the injured hip too soon, it can lead to more damage and further time delays.
If you have any concerns please seek the advice of your physiotherapist.
Common GTPS Treatments
Early Injury Treatment
Avoid the HARM Factors
What to do after a Muscle Strain or Ligament Sprain?
Acupuncture and Dry Needling
Sub-Acute Soft Tissue Injury Treatment
Closed Kinetic Chain Exercises
Active Foot Posture Correction Exercises
Balance Enhancement Exercises
Proprioception & Balance Exercises
Agility & Sport-Specific Exercises
Real Time Ultrasound Physiotherapy
Soft Tissue Massage
Brace or Support
Electrotherapy & Local Modalities
Joint Mobilisation Techniques
Supportive Taping & Strapping
Helpful Gluteal Tendinopathy Products
Related Hip Injuries
Hip Joint Pain
Lateral Hip Pain
Adductor-related Groin Pain
Pubic-related Groin Pain
Inguinal-related Groin Pain
- Inguinal hernia
- Sportsman's hernia
Iliopsoas-related Groin Pain
Other Muscle-related Pain
FAQ's about Gluteal Tendinopathy
Common Physiotherapy Treatment Techniques
What is Pain?
Physiotherapy & Exercise
Massage Styles and their Benefits
How Does Kinesiology Tape Reduce Swelling?
What Causes Post-Exercise Muscular Pain?
Heat Packs. Why does heat feel so good?
How Do You Improve Your Balance?
Post-Run Soreness: Should You Be Concerned?
Running Recovery: 6 Helpful Tips
Sports Injury? What to do? When?
What are Growing Pains?
What are the Common Massage Therapy Techniques?
What are the Early Warning Signs of an Injury?
What Can You Do To Help Arthritis?
What is a TENS Machine?
What is Chronic Pain?
What is Musculoskeletal Physiotherapy?
What is Nerve Pain?
What is Sports Physiotherapy?
What is the Correct Way to Sit?
What to expect when you visit PhysioWorks?
What's the Benefit of Stretching Exercises?
What's Your Core Stability Score?
Why do your Joints Click?
Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker