Greater trochanteric pain syndrome diagram

What is Greater Trochanteric Pain Syndrome?

Greater Trochanteric Pain Syndrome involves the tendons and bursae (small cushioning sacs between tendons and bones around joints) surrounding the greater trochanter (a part of the thigh bone 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. The injury does not have to be caused by a specific incident but can be caused by repetitive actions in everyday life.

What causes GTPS?

GTPS is most common in adult women. The exact cause is not fully understood. It often takes many months to resolve, typically 6 – 12 months, or longer in some cases. GTPS may 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.
  • Sporting injury.

What are the symptoms of GTPS?

Greater Trochanteric Pain Syndrome causes pain over the greater trochanter that may extend into the outside of the thigh/leg. This area can also be very tender to touch. Pain is usually comes and goes 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 GTPS diagnosed?

Your physiotherapist or healthcare practitioner will conduct a thorough examination to rule out other possible causes of your pain. Usually this condition can be diagnosed by clinical examination. Diagnostic tests including Ultrasound and MRI may sometimes be used if the clinical diagnosis is unclear.

Treatment

Adapting activities and lifestyle

  • Do less aggravating activities, such as running or excessive walking.
  • When you are standing still, avoid leaning on one hip. Keep your weight evenly spread through both feet.
  • Do not sleep on the aggravated side. If sleeping on the opposite hip, try placing a pillow between your knees to stop your painful leg crossing over.
  • Reduce sitting with your legs crossed.
  • Losing weight can help with the symptoms
  • Managing your pain is best achieved through 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, e.g crossing your legs, as mentioned above, or standing with your hip pushed out to the side
  • Heat and gentle massage to the gluteal muscles can reduce the tension.

Pain Relief

Medication (such as simple painkillers or anti-inflammatories) may be useful. A pharmacist or your GP can help advise you what to take if needed. You can find further information here on what medications you could take here:

https://www.nhs.uk/medicines/paracetamol-for-adults/how-and-when-to-take-paracetamol-for-adults/

https://www.nhs.uk/medicines/ibuprofen-for-adults/

Exercise and restoring normal movement and strength

As your pain and inflammation settles, you will need to restore your normal hip joint movement, muscle length, and strengthen your muscles to improve control, endurance, balance and gait (walking pattern).

Exercises that may help:

  • Lying face down, squeeze your buttocks strongly together. Hold for 10 secs.
  • Lie face down. Tighten your stomach muscles and your buttock muscles and keep your hips down. Lift one leg slightly off the floor. Hold for 5 secs.
  • Lying on your back with knees bent. Squeeze your buttocks together and lift your bottom off the floor. Return to starting position.

Return to function

The final stage of your rehabilitation is aimed at returning 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. There are some general principles to follow:

  • 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.
  • Continue with hip stabilisation exercises to prevent a recurrence.
  • It is important to look at your lifestyle and make changes to try to prevent reoccurrence. Weight loss and a general increase in activity if appropriate can both be helpful.

If these steps don’t help, a physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals. It can take weeks or months to fully rehabilitate GTPS.

Be patient and stick with your treatment. If you try to do too much too soon, it can lead to more pain and reduced function.

Steroid injections

Steroid and local anaesthetic injections around the affected area can relieve pain. These are not considered best practice. Although short term pain relief can be achieved the steroid can weaken the tendon and cause more difficulties in the longer term.

However, it may be necessary to use a steroid injection to achieve enough pain relief to allow rehabilitation that can give lasting symptom relief. Your healthcare practitioner will be able to discuss this with you in more detail if appropriate.

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