A Comprehensive Guide to Greater Trochanteric Pain Syndrome (GTPS)
If you're dealing with a persistent, aching pain on the outside of your hip that worsens when you lie on your side, walk, or climb stairs, you may have a very common condition called Greater Trochanteric Pain Syndrome (GTPS), which is also known as trochanteric bursitis, gluteal tendonopathy or simply lateral hip pain. It's a condition which can significantly interfere with your daily life.
This guide will walk you through what GTPS is, its causes and symptoms, and most importantly, the effective, evidence-based strategies you can use to manage and treat it, from simple lifestyle changes to a comprehensive exercise programme and advanced medical interventions.
The information is also presented in video format below.
What is GTPS? It's Not What we used to Think
For many years, this type of hip pain was blamed on "trochanteric bursitis"—inflammation of a small fluid-filled sac (the bursa) on the outer hip. However, we now know from modern imaging studies like ultrasound and MRI that the bursa is rarely the main issue.
The true culprit in the vast majority of cases is a problem with the gluteal tendons, specifically the tendons of the gluteus medius and gluteus minimus muscles. These tendons act like strong ropes, attaching your powerful buttock muscles to the bony point on the outside of your hip (the greater trochanter). When these tendons are repeatedly overloaded, they can develop small, degenerative tears and fraying, much like a rope that has been strained too often. Therefore, GTPS is best understood as a gluteal tendinopathy—an overuse condition of the gluteal tendons.
Recognising the Symptoms
GTPS is characterised by pain felt on the outer side of the hip, directly over the bony bump of the greater trochanter. Key symptoms include:
- A deep, nagging ache on the outside of the hip.
- Pain that is significantly worse at night, especially when lying on the affected side.
- Pain that is triggered by activities like walking, climbing stairs, or standing up after being seated.
- Tenderness to the touch when pressing on the bony point of the outer hip.
- Pain that occasionally radiates down the side of the thigh but rarely travels past the knee.
While symptoms can sometimes begin after a fall or direct blow to the hip, they most often develop gradually over time with no obvious injury.
How is GTPS Diagnosed?
A diagnosis is typically made based on your symptoms and a physical examination. The classic sign is tenderness directly over the greater trochanter. While imaging like an ultrasound or MRI isn't always necessary, it can be used to confirm the diagnosis by assessing the condition of the gluteal tendons and ruling out other issues.
It's important to distinguish GTPS from other conditions with overlapping symptoms:
- Hip Arthritis: Pain from arthritis is usually felt deep in the groin or sometimes deep in the buttock, whereas GTPS pain is on the outer side of the hip.
- Sciatica: This typically involves lower back pain and pain that radiates below the knee into the calf or foot, often accompanied by pins and needles or numbness, which are not features of GTPS.
What Causes GTPS?
GTPS is fundamentally an overuse injury that occurs when the gluteal muscles and their tendons are not strong enough to handle the demands placed upon them.
While it can affect active people who increase their training too quickly, it is most often caused by a general weakness in the gluteal muscles. The primary risk factors are:
- A Sedentary Lifestyle: Prolonged sitting leads to weak and deconditioned gluteal muscles.
- Being Female: Women are more susceptible due to a wider pelvis, which places greater compressive forces on the gluteal tendons. Hormonal changes, particularly during and after menopause, can also affect tendon health.
- Being Overweight: Excess body weight significantly increases the load on the hip tendons with every step.
- A Sudden Increase in Activity: The classic story is someone who is generally sedentary but then undertakes a long charity walk or a new fitness class, overwhelming their unprepared tendons.
Your Treatment Plan: A Step-by-Step Guide to Recovery
The great news is that around 90% of people with GTPS can recover fully without injections or surgery. The key lies in a two-pronged approach: first, calming the irritated tendon down, and second, gradually building its strength and resilience.
Step 1: Reduce the Load and Settle the Pain
Before you can strengthen the tendon, you need to stop aggravating it. The goal is to reduce your pain to a manageable level (around a 5/10 or less).
- Avoid Crossing Your Legs: This position squashes the irritated tendon against the hip bone. Making a conscious effort to stop is a quick win.
- Adjust Your Sleeping Position: Avoid sleeping directly on the painful side. Sleep on your back or on your other side with a pillow placed firmly between your knees to prevent your top leg from falling across and compressing the tendon. A Contoured Knee Pillow can make this easier.
- Temporarily Reduce Activity: Cut back on long walks, running, or hill climbing until symptoms improve. This is a strategic rest, not complete bed rest.
- Walk Mindfully: Try to avoid limping, as this can lead to further weakness. If pain forces you to limp, use a walking stick or cane in the opposite hand to offload the hip.
- Use Ice or Heat: An ice pack on the painful spot for 20 minutes can help reduce pain. A heat pack on your buttock muscles can help ease muscle tension, especially after exercise.
Step 2: The Gluteal Strengthening Programme
This is the single most important part of your recovery. A consistent and progressive exercise programme will increase your tendon's capacity to handle load, making it resilient to future flare-ups. Perform these exercises for 15-20 minutes daily, progressing slowly as your pain allows.
You can see the full programme being demonstrated in the video below.
Basic Strengthening Exercises
- The Clamshell: Lie on your good side with your painful hip uppermost, knees bent, and ankles together. Keeping your pelvis still, slowly lift your top knee away from your bottom knee. Hold for 3 seconds. Aim for 15-20 repetitions. To progress, add a Resistance Band around your knees.
- Standing Hip Abduction (Isometric): Stand side-on to a wall, about a foot away. Push the ankle of your affected leg into the wall and hold the contraction for 5 seconds. Repeat 10 times.
- Side Plank: Lie on your side, supporting your body on your elbow and forearm, keeping a straight line from your head to your feet. Hold for 15-30 seconds. Repeat 2-3 times on each side.
Functional Strengthening Exercises
- The Bridge: Lie on your back with your knees bent. Slowly lift your pelvis off the floor, squeezing your glutes. Hold for 5 seconds. Aim for 15-20 reps. To progress, perform a slow "stepping" motion while holding the bridge, keeping your pelvis level.
- The Squat: This is a vital exercise. Stand with your feet shoulder-width apart and perform a shallow squat, keeping your back straight and feet flat. Use a chair for support if needed. Start with 2 sets of 10 and build up. Progress by adding a resistance band around your knees, keeping tension on it throughout the movement.
- Standing Hip Abduction (with band): With a Resistance Band around your ankles or knees, stand on your good leg and move your affected leg out to the side against the resistance. Perform in a slow, controlled manner for 10-15 reps.
Dynamic and Balance Exercises
- Single Leg Balance: This is another crucial exercise. Simply practice balancing on your affected leg, using a wall for support initially. Aim to hold for 30 seconds. To progress, perform a slow "hip hinge," leaning your torso forward while balancing, even reaching to touch the floor if you can.
- Step-Ups: Use a bottom stair. Step up and down slowly and with control, first leading with one leg for 15 reps, then the other. You can also perform side step-ups.
Long-Term Prevention: Weight Management and Your Workstation
- Weight Loss: If you are overweight, even a small reduction in body weight can dramatically decrease the strain on your gluteal tendons. This is often the critical factor for patients who fail to improve.
Rethink Your Desk: If you have a desk job, prolonged sitting is your enemy. Consider a standing desk converter or a full riser desk. Gradually increasing the time you spend standing at work can strengthen your leg muscles, improve your overall health, and reduce your risk of recurrence.
Riser Desk
When to Seek Further Help: Interventional Treatments
If you have diligently followed the self-help and exercise plan for 3-6 months with little improvement, you are in the unlucky 10%. At this point, it is reasonable to discuss further options with a healthcare professional.
- Corticosteroid Injection: An injection can provide powerful short-term pain relief. Its main benefit is to reduce pain enough to allow you to engage more effectively with your exercise programme. It is not a long-term cure, and repeated injections may weaken the tendon.
- Shockwave Therapy: This non-invasive treatment uses high-energy sound waves to stimulate a healing response in the tendon. It typically involves a course of 3-6 weekly sessions.
- Needle Fenestration/PRP Injections: These procedures involve using a needle (with or without injecting your own concentrated blood platelets, or PRP) to create micro-trauma in the tendon, aiming to trigger a new healing process. They are always performed under ultrasound guidance.
- Radiofrequency Ablation: A newer pain management technique where a specialised needle is used to heat and "burn away" the small sensory nerves that transmit pain signals from the tendon.
- Surgery: Surgery is a last resort and is not routinely performed for GTPS. The evidence for its effectiveness is limited, and most hip surgeons are reluctant to offer it.
Conclusion: Patience and Persistence Are Key
Greater Trochanteric Pain Syndrome can be a frustrating and painful condition, but it is highly treatable. Recovery is not instant; it requires a commitment to changing your habits and consistently performing your exercises. By reducing the aggravating loads and systematically rebuilding the strength of your gluteal tendons, you can get back to walking, sleeping, and living your life without that nagging pain in your hip.
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This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.