Greater Trochanteric Pain Syndrome

What is Greater Trochanteric Pain Syndrome (AKA Lateral Hip Pain)?

Greater Trochanteric Pain Syndrome (GTPS) is a common condition that causes pain on the outside of your hip, also known as lateral hip pain.

In the past, this pain was often associated with a condition known as “trochanteric bursitis.” We now know that this pain is usually associated with the tendons of the gluteal muscles (especially gluteus medius and minimus) becoming irritated or overloaded. The small fluid-filled sac (known as the bursa) in this area can still play a role, but it’s often a secondary issue.

Who commonly experiences GTPS?

GTPS can affect anyone, but is more common in:

• Those in their 40s-60s and particularly of female gender

• Those who spend long periods sitting, walking on uneven surfaces, or standing on one leg

• Individuals with weaker hip muscles

• Those of a higher BMI, as this can increase the load on the muscles and tendons.

What can cause GTPS?

GTPS often develops gradually rather than from one specific injury. 

Common causes may include:

1. Overload of the Gluteal Tendons: The gluteus medius and minimus muscles help keep the pelvis stable when you walk. When these tendons are overworked, weakened, or irritated, they can become painful.

2. Compression of the Tendons: Certain positions such as crossing your legs, sitting in a low chair, or lying on the painful side, can put increased load on the tendons and can trigger pain.

3. Weak Hip Muscles: If the hip muscles aren’t strong enough, they can struggle to control daily movements. This can then increase strain on the tendons over time, contributing to pain.

4. Bursitis (Less Common): The bursa can still become irritated, but this is usually because the tendons are already overloaded.

5. Other Contributing Factors:

Other conditions can also contribute to GTPS by altering how you move and the load that is put through these tendons. Examples can include lower back pain, osteoarthritis, conditions that alter how you walk and general deconditioning can also play a role.

Signs and symptoms

Common symptoms associated with GTPS can include:

• Pain on the outside of the hip, sometimes spreading down the outer thigh

• Pain when lying on the painful side, especially at night

• Pain with walking, standing on one leg, climbing stairs, or getting out of a car

• Tenderness to touch over the bony area on the hip

• Pain when crossing your legs or sitting for a long period of time

• A gradual onset of discomfort that becomes worse overtime, 

Treatment and management

There are many different conservative modalities of treatment that can be used in the treatment of GTPS.

Hands-on Treatment: An osteopath may use hands-on techniques to reduce pain, improve movement, and provide rehabilitation exercises to strengthen the muscles around the hip.

Rehab exercises: A structured strengthening program is one of the most effective treatments. The main goals are to:

• Strengthen the gluteal muscles

• Reduce irritation of the tendons

• Improve the way your hip and pelvis move.

This is usually introduced gradually so the hip can tolerate more load over time.

Load Management: Your practitioner can help you identify movements, postures, or habits that aggravate the hip or produce excess load. They can then provide you with strategies on how to adjust these to reduce any overload of the tissues and therefore pain. 

Other Options:

Some other forms of treatment may include:

• Shockwave therapy may help for persistent cases.

• Cortisone injections may give short-term relief, especially if the bursa is inflamed

• Surgery is generally rare and only considered if all conservative treatments have failed.

Self management strategies

A few practical steps you may wish to start with include:

1. Modify Painful Activities

• Try to decrease lying on the sore hip. Try lying on the opposite side with a pillow between your knees.

• Reduce crossing of your legs.

• Limit sitting in low or soft chairs.

• Reduce long walks, hill walking, or stairs during painful flare-ups.

2. Gentle Strengthening Exercises: Your osteopath can prescribe exercises to gradually strengthen your hip muscles. Early exercises might include:

• Isometric hip holds (gentle muscle activation without movement)

• Side-lying leg lifts

• Standing band exercises

• Step-up variations when pain improves.

The important thing is slow, progressive loading. We don’t want to push through sharp pain, especially in the initial stages of rehab.

3. Avoid Stretching into Pain:

Deep stretching of the outer hip (like pulling your knee across your body) can increase tendon compression and may make symptoms worse.

4. Heat or Ice for Comfort:

Use whichever feels better for you! Both can help to reduce pain.

5. Keep Moving:

Complete rest is not helpful. Gentle, regular movement helps maintain tendon health and reduces stiffness.

6. Address Contributing Factors:

Improving posture, movement patterns, lower back mobility, and reducing body weight (if relevant and contributing) can all support long-term recovery.

GTPS is a common and highly manageable cause of outer-hip pain. With the right combination of hands-on care, targeted strengthening, and small changes to daily habits, most people see improvements in their pain. 

If you’re unsure whether your hip pain is related to GTPS or want help with a personalised rehab plan, book an appointment below.

Book Online Here

Note this is generalised advice for educational purposes only. We recommend booking in for an osteopathy appointment for personalised advice for you.

References

1. Pumarejo Gomez, L., Li,D., & Childress JM. (2024). Greater trochanteric pain syndrome (greater trochanteric bursitis. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557433/

2. Kemp w, & Crossley K, & Agricola R, & Schache A, & Pritchard M (2017). Hip pain. Brukner P, & Khan K(Eds.), Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e. McGraw-Hill Education. https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=1970&sectionid=168693766

3. Sopher, R. & Waters, A. (2020). Greater trochanteric pain syndrome clinical practice guideline. The Ohio State University. Wexner Medical Centre. https://medicine.osu.edu/-/media/files/wexnermedical/patient-care/healthcare-services/sports-medicine/education/gtps.pdf?la=en&hash=7D4D0BB44EB508656AD8A11373ADE15FBBB8D7BD 

4. Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: Integrating pathomechanics and clinical features in tts management. Journal of Orthopaedic & Sports Physical Therapy, 45(11). https://www.jospt.org/doi/abs/10.2519/jospt.2015.5829