Greater trochanteric pain syndrome

What is greater trochanteric pain syndrome (GTPS)?

GTPS is an umbrella term for a collection of issues that cause pain on the outside of the hip. The primary source of pain is the tendons of the gluteal (bottom) muscles as they attach into the side of the hip. The tendon irritation can also occur with bursitis, inflammation of small sacs of fluid around the tendon, and small tears. It is one of the most common causes of pain on the outside of the hip.

What causes it?

Decreased hip and glute muscle strength is the primary cause of GTPS. Pain can occur after a bout of increased activity that you are unaccustomed to such as suddenly doing lots of gardening, decorating or starting a new exercise class. Sometimes the pain may gradually build up over time with no recognisable trigger. In the former the increase in activity causes the tendon to swell up and then become irritated, this ultimately leads to weakness of the muscle and tendon. If the symptoms came on gradually with no trigger this often means the muscle or tendon have been gradually getting weaker over time and that they have now began to find tasks difficult which results in pain.

Factors that contribute to getting GTPS:

• Being female: GTPS is four times more common in women than men
• Most common in middle aged women especially around menopause
• Reduced strength in the gluteal (bottom) muscles
• Often occurs after taking up a new activity or sudden burst of increased exercise “more than the norm”
• General reduced fitness
• Being overweight

How can I tell if I have GTPS?

• Pain is usually felt on the outside of hip & can radiate down the side of the thigh
• Often provoked by walking, standing, stairs, sitting and lying on the affected side
• Groin pain is more commonly caused by the hip joint and numbness or tingling sensations are more likely caused by the nerves in the lower back

How can GTPS be treated?

There are 4 strategies to treat GTPS.

Strength exercises

This is the main treatment for GTPS. The primary cause of the problem is weakness around the hip and gluteal muscles, therefore the main treatment is to build up the strength of these muscles.  This is the most effective option according to research, which shows symptoms improving by 75% at 8 weeks and is more effective than injection therapy.  The exercises need to be just right with regards to how much you do; too little will not be enough to increase your strength, too much will increase your pain. See the exercise plan for exercises and how to build these up.

General exercise

Moderate intensity exercise for examples fast walks, cycling, pilates or yoga class also help to strengthen the hip muscles and maintain your fitness levels. They also have the added benefit of endorphin release, the body’s natural painkiller.

Weight management

Having GTPS and being overweight is strongly linked.  Studies show a weight loss of 10% can provide a 50% reduction in symptoms.  To calculate your target weight loss figure, multiply your body weight by 0.10.  Excess body fat is also known to amplify inflammation around the body and so can cause an increase in pain – losing weight can help avoid this.

*Link to general health weight loss section*

Activity modification

As with your exercises; too much activity can irritate symptoms and too little can lead to deconditioning.  Feeling pain in the hip does not mean you are damaging the tissues, most pain that occurs after activity (without incident or trauma) is related to sensitivity of the muscles rather than damage. Try to take regular breaks and pace activities to avoid building up the sensitivity. Also try to avoid hitching your hip, crossing your legs or lying on that side in the short term until your muscles have started to strengthen as you complete your exercises.

What if this doesn’t help?

Surgery has not been shown to help this condition. Injections usually only provide short term relief and the use of injections would be carefully considered between you and your treating clinician, since steroid injections can have negative effects on tendon health.