Greater Trochanteric Pain Syndrome

zoe russell physio

Article by Z. RussellJ. 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

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 injury.

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.

Physiotherapy

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 their advice.
  • 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.

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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
  • Core Exercises
  • Closed Kinetic Chain Exercises
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Orthotics
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Brace or Support
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Gluteal Tendinopathy Products

    Hip Injuries

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    Related Hip Injuries

    General Information

    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

    • Hip Flexor Strain

    Other Muscle-related Pain

    Systemic Diseases

    Referred Sources

    Hip Surgery


    FAQ's about Gluteal Tendinopathy

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • 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
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    Last updated 18-Jan-2018 02:50 PM

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