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Greater Trochanteric Pain Syndrome (GTPS)
Greater Trochanteric Pain Syndrome (GTPS) is a common condition whereby people experience persisting pain and often tenderness towards the outside of their hip. In the majority of cases, symptoms appear gradually over time. Alternatively, symptoms manifest after a specific activity or event.
The incidence of greater trochanteric pain is reported to be approximately 1.8 patients per 1000 per year with a higher prevalence in women. Patients with co-existing low back pain, osteoarthritis and obesity are more likely to suffer GTPS symptoms. The latter, obesity, is a recognised musculoskeletal health risk factor. To learn more about the interaction of obesity and musculoskeletal health, click here.
The primary cause of Greater Trochanteric Pain Syndrome is thought to be an insertional tendinopathy of the Gluteus medius and minimus muscles. The gluteal muscles are the bottom muscles and they form a tendon which then attaches or inserts to the thigh bone on the outside of the hip. A tendinopathy is a breakdown of collagen fibre within the tendon and is associated with a failed healing response to an overuse injury or sudden stress onto the tendon.
You may have heard the term ‘Trochanteric Bursitis’? This is a historical term commonly used to describe these symptoms. The trochanteric bursa or bursae (pleural, as there are more than one) are natural fluid filled sacks in our body that can be a source of pain. They sit between the bony prominences and the soft tissues of the lateral hip to act as biological cushions. The largest of these bursae is the subgluteus maximus bursa. This is found on the outside of your hip (over the bony area you can often feel with your hand). Although this is the largest bursa, there are many others in this region of variable size and location, all of which have the potential to cause various symptoms. This is one reason we now use the term greater trochanteric pain syndrome or ‘GTPS’. It captures the variability of presenting symptoms and acknowledges the myriad of other causes such as gluteal tendinopathy, muscle pain or tears and iliotibial band (ITB) pain. GTPS is a regional pain syndrome that often mimics pain generated from other sources, including degenerative joint conditions, i.e. osteoarthritis of the hip and spinal problems. Indeed, 20-35% of people with low back pain experience GTPS.
What are the symptoms of GTPS?
Symptoms of GTPS typically consist of persistent pain towards the lateral (outer) hip. Pain can radiate down the outside of the thigh to the knee but rarely below the knee. Classically, individuals with GTPS will have point tenderness over the lateral hip consistent with the site where they experience their pain. This may be over the bursae, gluteal tendons or associated soft tissue and is why people often struggle to lay comfortably on their side. In GTPS, it can be painful to push your leg out to the side against a resistance and climb stairs. In some people it can be much more intrusive and affect their ability to participate in sport, run or even walk. When examined, the hip joint and lower back can range from pain free to displaying a complex array of symptoms and clinical features.
How can GTPS be managed?
In the majority of people who experience GTPS their symptoms will be self-limiting. Conservative treatment strategies can help treat and ease the symptoms of GTPS. These can include physiotherapy, weight loss if your BMI is elevated (to check your BMI clinic here), use of appropriate pain relieving medications from your GP or pharmacist and activity modification. Physiotherapy helps to optimise the soft tissue health of your lateral hip, usually through a specific and personally tailored exercise program.
If you feel able, an excellent exercise to try with GTPS is the ‘clam’ as seen in this video:
If you feel you have mastered these exercises and they are helping, try these:
Still doing well? If you are feeling symptom relief and you are progressing, try this further progression:
Physiotherapists advise on activity modification strategies and help address any biomechanical issues. We provide guidance on optimising your overall musculoskeletal health and help manage any contributing factors such as issues with your back or hip joint.
In some cases, pain and symptoms may persist despite conservative management. In these circumstances, some individuals may benefit from a corticosteroid injection into the tissues of the lateral hip which is also provided within the MSK service.