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.
How Do You Diagnose Arthritis In The Hip?
Hip osteoarthritis is a progressive degenerative condition that results in pain, joint weakness, instability and restrictions of movement that interfere with daily activities, such as walking, climbing stairs or driving.
Your physiotherapist can diagnose hip osteoarthritis clinically through your subjective reporting. Symptoms may develop suddenly or gradually progress over time. Common symptoms include:
- Hip joint pain or tenderness that comes and goes.
- Typically there will be sharper pains in the groin and sometimes an ache in the front of the thigh. Many people present with hip arthritis thinking that it is a knee problem.
- Hip stiffness, particularly in the mornings.
- Limping when walking
- Inability to stand on one leg without pain. For example, putting on underpants or clothes
- Hip joint movements are restricted, especially inward rotation and hip flexion.
- Weak hip muscles, especially during sit to stand, squatting and stair climbing.
This helps direct your PhysioWorks physiotherapist to perform physical tests to confirm the suspicion of osteoarthritis and to exclude other conditions that may present similarly:
Standard tests used to diagnose hip osteoarthritis include:
Range of Motion Testing
- Performed in all planes of motion of the hip, this is helpful to see how much range of motion is available and if this is sufficient to perform your daily activities. This will also include assessing whether your movement is limited by lack of range or your pain.
Muscle Strength Testing
- It is complementary to your range of motion testing to assess enough strength to support the painful joint.
- There is good evidence to show that strengthening the muscles around the hip can improve symptoms and reduce the disability associated with a painful hip. Knowing which direction to enhance it is a crucial element to the assessment.
- This is a crucial element to your assessment to identify your inability to perform daily activities due to your hip osteoarthritis and help guide your treatment.
Assessment of Adjacent Joints and Muscles
- To ensure that your symptoms are only coming from your hip, your physiotherapist may assess other joints such as your Lower Back and SIJ to ensure that they are not the cause or contributing to your symptoms.
If hip osteoarthritis is suspected from your assessment, your physiotherapist may also request a hip radiograph or X-Ray to confirm the diagnosis. In some cases, you may require further 3D imaging with CT or MRI to plan adjunct therapies or surgical replacement of the hip.
If you are concerned that your hip pain may be related to osteoarthritis, call PhysioWorks today. With same-day appointments, their expert staff can assess your hip pain and put a plan in place to help you get back to your best!
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.
Article by John Miller
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.