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What is it?

Greater Trochanteric Pain Syndrome (GTPS) is an inflammatory condition affecting the muscles, tendons, fascia, or bursae on the lateral hip. Typically, this occurs over a bony prominence called the Greater Trochanter at the top of the thigh bone (femur).

It is also known as lateral hip pain and trochanteric bursitis, but less reference is made to bursitis (inflammation of the bursae) as it plays a smaller role than previously thought.

It commonly presents as pain on the outer side of your upper thigh which can run down from the side of your leg into your knee.

(National institute for Health and Care Excellence (NICE) 2021)

Who is affected?

• GTPS is a common condition that affects more women than men, especially between the ages of 40-60 years old.

• It is often seen in combination with lower back pain and osteoarthritis.

What Causes Greater Trochanteric Pain Syndrome?

• Repetitive movements and loading, such as excessive running or walking.

• Deconditioned muscles around the hip and pelvis.

• Prolonged pressure on the outer thigh.

• A fall onto the side of your hip.

• Secondary conditions such as osteoarthritis, low back pain, leg length discrepancy.

Signs and Symptoms

• Pain (deep, aching, burning) on the outer surface of the hip that can radiate down the side of the thigh, that is usually aggravated by physical activity.

• Pain on the affected side at night (when lying on either side).

• Pain after prolonged sitting when standing from a low seat.

• Gradual onset. Or direct impact to the lateral hip at onset.

• Pain when sitting with legs crossed.

How is it diagnosed ?

The diagnosis is usually made based on your symptoms and on examination.

• Weakness in the hip when standing on one leg for longer than 30 seconds.

• Tenderness over the Greater Trochanter on the upper femur.

• Pain brought on by certain positions.

• Pain on resisted hip abduction.

(Grimaldi 2020)

Tests or further investigations are not normally needed. However, they may be necessary if the diagnosis is not clear.

How is Greater Trochanteric Pain Syndrome treated?

Fortunately, GTPS is a self-limiting condition. It is estimated that greater trochanteric pain syndrome resolves in over 90% of people with conservative measures (Reid, 2015). However, symptoms can take several weeks or months to settle. Persisting symptoms do not mean you are damaging your hip further.

It is treated by activity modification, pain relief, and physiotherapy in the first instance.

If symptoms fail to resolve, a steroid injection may be considered. This can be done in a primary care setting with sufficient training.

Activity modification

Try to limit activities that aggravate your hip pain (NICE, 2021)

• Avoid large hills or over-striding.

• Use a handrail if climbing stairs.

• Avoiding uneven terrain.

• Take shorter walks

Try to limit positions where you hip moves inwards.

• When lying on your side, place a pillow between your knees to keep your thighs parallel to each other.

• Lie on an extra duvet cover, to provide extra padding, if putting pressure on the affected side.

• Avoid sitting with your legs crossed, or with feet wide apart and knees together.

• Avoid low or saggy chairs.

 Pain relief 

1. Applying Ice (wrapped in a towel) for 10-20 minutes several times a day.

2. Simple pain killers advised by your GP like paracetamol or a non-steroidal anti-inflammatory. (NICE, 2021)

Physiotherapy

Your Physiotherapist will guide you on which exercises should be performed depending on your symptoms. The exercises aim to strengthen the muscles around the hip, which may be uncomfortable. The numbers of exercises to do are a guide, you will need to adjust this to your individual capabilities. Try get to the point of fatigue, where the muscles are feeling tired, but without aggravating your symptoms.

1. Stand with non-affected leg bent and knee pressing  the wall. Push into wall with knee hold for 5 to 10 seconds. Repeat this up to 10 times, twice daily. 

1. Place a dressing gown cord or resistance band placed around ankles. Push out against the band and hold for 5 to 10 seconds. Repeat this up to 10 times, twice daily. 

1. Lie on your back with your knees bent and feet flat on the floor/ bed. Lift your hips up from and squeeze your buttocks. Hold this position for 3-5 seconds. Repeat 10 times.

           You can progress this exercise by putting the foot of the unaffected side further forward than the painful side.

           Further progression, single leg bridge, you can do this by lifting on both legs and straightening the non-affected leg out or lift up on 1 leg.

1. From a seated position, push up through your legs into a standing position. Keep the movement slow and controlled. Repeat this 10 times.

            Then progress further by putting the foot of the unaffected side further forward than the painful side.

1. Start standing with your feet together. Then, leading with the affected side, step sideways and return to the starting position. Repeat this exercise 10 times.

           When able, try putting a resistance band around your ankles to progress this exercise further.

           In order to increase the challenge, try doing this exercise with a resistance band, with your knees slightly bent in a semi-squat position.

 Ongoing management

 As your symptoms are improving, you can gradually return to your usual activity, but take it easy for a while. Do not start at the same level as before your injury. Build back to your previous level slowly and seek guidance if it hurts. You may want to discuss this with your physiotherapist.

Continue your exercises given by the Physiotherapist and be aware that it may take 3-4 months, or longer, to fully recover.

Be patient and stick with your treatment. If you start using the affected muscles too soon, it can lead to further delay in your rehabilitation time.

If you have any concerns, please seek the advice of your Physiotherapist.