Greater Trochanteric Pain Syndrome
Greater Trochanteric Pain Syndrome
What is Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome, or in short GTPS, involves the tendons and bursae (tiny cushioning sacs between tendons and bones around joints) surrounding the greater trochanter (a part of the femur the most prominent element on the side of your hip). An injury to these structures causes pain on the outside of your buttock and thigh. This pain is known as Greater Trochanteric Pain Syndrome.
Greater Trochanteric Pain Syndrome is a combination of both gluteal (buttock) tendon injuries (hip tendinopathy) and hip 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 bursitis associated with GTPS and lateral hip pain is Trochanteric Bursitis.
Tendinopathy (tendon pathology) describes the changes that can occur in the tendon due to loads to the tendon. In some cases, the load can exceed what the tendon can tolerate, and a person may suffer from pain, which 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.
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 region. 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 result from 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. We characterise GTPS 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
Please consult your trusted physiotherapist to assess the origin of your hip pain.
Greater Trochanteric Pain Syndrome Treatment?
Treatment targets pain management, improving hip strength and control and a progressive return to sport.
PHASE I – Pain Relief & Protection
- You are managing your pain. Pain is the main reason that you seek treatment for GTPS. In truth, it was 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 bone.
- 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 mobility aid (e.g. 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 settle, your physiotherapist will turn their attention to restoring your normal hip joint range of motion, muscle length and resting muscle tension. Muscle strengthening and endurance, proprioception, balance and gait (walking pattern) retraining will follow.
- Hip researchers have discovered the importance of your hip muscle recruitment patterns with a standard order of muscle firing patterns in healthy, 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 in regaining standard 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 aims 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 only 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 your physiotherapist clears you, 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 rehabilitate GTPS fully.
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.
For specific advice regarding your lateral hip pain, please consult your physiotherapist.
Common Causes of Hip & Groin Pain
Hip Joint Pain
- Hip Arthritis - Hip Osteoarthritis
- Hip Labral Tear
- Hip Pointer
- Femoroacetabular Impingement - FAI
- Perthes Disease
- Slipped Femoral Capital Epiphysis
- Stress Fracture
- Avascular Necrosis of the Femoral Head
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
- Piriformis Syndrome
- Muscle Pain -Muscle Strain
- Poor Hip Core
- DOMS -Delayed Onset Muscle Soreness
- Core Stability Deficiency
Hip Pain Treatment
A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.
Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence, or improve your athletic performance.
The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.
However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.
You should consult a healthcare practitioner who has a particular interest in hip pain and injury management to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all impact, especially at the high athletic performance end. A quality practitioner will educate you on your condition and combine it with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.
Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.
For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapists experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.
Hip Pain Treatment Options
Your hip physiotherapist may consider an extensive range of treatment options, including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and hip joint control exercises as they deem appropriate for your specific functional and sporting needs. Please consult with them for advice.
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.