Greater Trochanteric Pain Syndrome
Greater Trochanteric Pain Syndrome (GTPS)
Greater Trochanteric Pain Syndrome (GTPS) is a common cause of pain on the outside of the hip. It affects the tendons and bursae (small fluid-filled sacs that cushion bones and tendons) around the greater trochanter – the bony prominence on the outside of your thigh.
Although symptoms can begin after a fall or sporting injury, they often develop gradually through repetitive everyday activities.
What is Greater Trochanteric Pain Syndrome?
GTPS occurs when the tendons and bursae surrounding the greater trochanter become irritated or overloaded.
This irritation causes pain over the outside of the hip, which may spread into the buttock or outer thigh.
Unlike many injuries, GTPS does not always result from a single incident and frequently develops over time through repeated loading of the hip.
Common Causes
GTPS may develop due to:
- A fall directly onto the side of the hip
- Prolonged pressure on the hip
- Repetitive walking or running
- Starting a new or more intense exercise programme
- Standing on one leg for prolonged periods
- Hip instability
- Sporting injuries
Common Symptoms
Symptoms commonly include:
- Pain on the outside of the hip
- Pain extending into the outer thigh
- Tenderness over the side of the hip
- Pain when lying on the affected side, especially at night
- Pain during walking or running
- Hip weakness
- Symptoms that gradually worsen if the hip continues to be overloaded
How is GTPS Diagnosed?
A physiotherapist or clinician will assess your symptoms and examine your hip to rule out other causes of pain.
Most cases can be diagnosed through a clinical examination alone.
Occasionally, imaging such as:
- Ultrasound
- MRI scan
may be requested if further diagnostic clarification is required.
Treatment Options
Most people improve with conservative treatment.
The main aims are to reduce pain, decrease irritation around the tendons and gradually rebuild hip strength.
Pain Management
Managing pain is the first step in recovery.
Helpful strategies include:
- Relative rest
- Reducing activities that aggravate symptoms
- Avoiding positions that compress the outside of the hip
- Using simple pain relief medication if appropriate
- Applying heat to reduce muscle tension
- Gentle massage of the gluteal muscles
During the early stages, try to avoid:
- Crossing your legs
- Standing with your weight pushed onto one hip
- Lying directly on the affected side
- Walking on sloping or cambered surfaces
- Stretching the muscles on the outside of the hip when painful
Steroid Injections
A corticosteroid injection around the affected tissues may provide short-term pain relief.
However, injections are not considered first-line treatment because repeated steroid injections may weaken the tendon over time.
Your clinician will discuss the benefits and risks if this option is appropriate for you.
Restoring Strength and Movement
As pain settles, rehabilitation focuses on:
- Improving hip movement
- Restoring muscle strength
- Improving balance
- Improving walking pattern (gait)
- Building endurance
- Returning to normal daily activities
A structured home exercise programme is one of the most important parts of recovery.
Key Rehabilitation Exercises
Complete these exercises slowly and within a comfortable range.
Exercise 1 – Glute Squeeze
Lie on your stomach.
Squeeze your buttock muscles together firmly.
Hold: 10 seconds
Repeat: 10 times
Exercise 2 – Prone Hip Extension
Lie on your stomach.
- Tighten your stomach muscles.
- Tighten your buttock muscles.
- Keep your hips on the floor.
- Lift one leg a short distance from the floor.
Hold: 5 seconds
Repeat: 10 times
Exercise 3 – Bridge
Lie on your back with your knees bent and feet flat on the floor.
Squeeze your buttocks and slowly lift your hips until your body forms a straight line from your shoulders to your knees.
Lower back down slowly.
Repeat: 10 repetitions
Returning to Normal Activities
As your symptoms improve:
- Increase activity gradually.
- Do not immediately return to your previous activity level.
- Warm up before exercise.
- Continue your hip strengthening exercises.
- Consider lifestyle changes such as increasing general activity or weight management if appropriate.
Recovery often takes several weeks or months.
Trying to do too much too soon may increase pain and delay recovery.
When Should You Seek Further Advice?
Arrange a review with your physiotherapist or healthcare professional if:
- Pain continues despite following your rehabilitation programme.
- Symptoms are worsening.
- Walking becomes increasingly difficult.
- Night pain is persistent.
- You are unable to return to normal daily activities.
Your rehabilitation programme may need to be adjusted to help you continue progressing.
Key Points
- GTPS is a common cause of pain on the outside of the hip.
- Most people improve with conservative treatment and physiotherapy.
- Avoid positions that place prolonged pressure on the outside of the hip during the early stages of recovery.
- Strengthening the hip muscles is an essential part of long-term recovery.
- Recovery may take several weeks or months, but gradual rehabilitation provides the best long-term outcomes.
