At Sport and Spinal Physiotherapy, when we tell someone they have Greater Trochanteric Pain Syndrome (or GTPS for short) we usually get a look back mixed between confusion and disappointment. People are often concerned with the term ‘syndrome’. They think we have just diagnosed them with a permanent injury, which it is not. And usually the term ‘Greater Trochanteric Pain’ is just as confusing or concerning. “What does that even mean?”.
Overall this term is used to describe lateral hip and gluteal pain which is caused by your gluteal tendons and bursa in that area. In essence, it’s a regional pain syndrome that can also be caused by other sources such as muscles, degeneration of the joint or referral from a spinal pathology (1). But let’s break it down…
Your greater trochanter is the boney landmark at the top of your femur (thigh bone) which you can feel on the side of your hips. Here you have your trochanteric bursa. Bursa’s are sacs filled with fluid that are located where tendons run over bones and fundamentally act as a cushion.
In this area you also have your gluteal tendons – notably gluteus medius and gluteus minimus. These run over the trochanteric bursas which attach your glute muscles to your hip.
The term syndrome is often misunderstood. However, it is generally used as an umbrella term to group similar symptoms together which occur concurrently.
What you usually come to a physio for. An injury, unpleasant feeling, annoyance or all of these.
To Put it All Together
Greater Trochanteric – relating to the greater trochanter (the hip).
Pain – an unpleasant feeling.
Syndrome – a group of symptoms.
So essentially it means: “an unpleasant feeling or pain in the area of your hip that has certain symptoms”.
Ok, so what is GTPS exactly?
GTPS is caused by an injury to either the bursa (fluid filled sacs between tendons and bones that act like cushions) or tendons around your hip. Or it can be an injury to both your bursa and tendons. Or it could also be caused by other structures in the area such as your ITB or hip joint. The main causes of lateral hip pain (or GTPS) are:
- Tendinopathy of the gluteal tendons.
- Tendinopathy refers to the breakdown of the cartilage within the tendon.
- The most common tendons involved are the gluteus minimus and gluteus medius.
- Bursitis refers to inflammation of the bursa.
- The most common bursa involved is the trochanteric bursa. This bursa sits on top of the boney part of your lateral hip.
Traditionally it was thought that these two injuries were a ‘team’. I.e. they always occurred concurrently. This can certainly be the case. However, it can often be one pathology or the other, which will help to target your rehabilitation. This will be discussed further below.
Who Gets GTPS?
Anyone can be diagnosed with GTPS and it is a reasonably common injury. However recent research has shown that it more commonly affects:
- Women between 40-60 years old
- People with knee OA
- Adults with ITB issues
- People with lower back pain
- Long distance runners
What are the Symptoms?
The main symptom of GTPS is pain on the side of your hip and thigh. Additionally, it can radiate down your thigh and into your buttock as well. It is often worsened with:
- Lying on the sore side
- Prolonged standing
- Running or walking long distances
- Sitting cross legged
- Repetitive motions
What causes GTPS?
Other than the known risk factors as listed above the development of GTPS is sometimes unknown. However some things that may lead to GTPS include:
- A traumatic fall onto your hip
- Repetitive movements such as walking or running
- Weight bearing more on one leg
- Prolonged period of pressure on the hip or greater trochanter
What should I do?
There are many things we can do for you at Sport and Spinal Physiotherapy. Five of the more important pieces of advice are outlined below:
1) Load Management
Unfortunately GTPS usually means we need to decrease load. But this DOES NOT mean stopping completely. It’s referred to as ‘relative rest’. Essentially, we determine the aggravating factors, possibly decrease of modify these without stopping you completely.
With the new world of smart watches it makes load management so much easier…
You notice that your pain is increased when you walk more than 10 000 steps in one day. Instead, you can trial walking 9,000 overall and monitor your pain.
You your pain is exacerbated after a 3km walk or run. Instead, you can trial a 2km walk or run and monitor your pain.
2) Activity Modification
There are a few position and activities that can be particularly aggravating for GTPS. You should try to avoid:
- Lying on the affected side
- Sitting cross legged
- Lazy standing (all your weight onto one leg)
- Lying on your non-affected side with a pillow between your knees.
- Sitting in a slightly higher position, legs uncrossed so your knees are slightly pointing down.
- Standing with equal weight on both side OR slight transfers of weight from side to side.
3) Ice and Heat
The age old question. Usually this is a personal preference.
During acute flare ups or the early stages of pain ice on the painful area may help to minimise pain. Aim for 15-20 minutes every 2-3 hours.
For chronic pain, heat may be beneficial. Especially over tight areas such as your ITB, quad or lower back. Aim for 5-10 minutes every 2-3 hours.
4) Use Non-steroidal Anti-Inflammatory Drugs
Non-steroidal anti-inflammatory drugs (NSAIDs) may be beneficial during GTPS as it can involve inflammatory components. A recent study found equal benefits in the use of a topical NSAID and oral NSAIDs.
*Disclaimer: please speak with your pharmacist or GP before beginning and dose of NSAIDs.
And most importantly…
5) Therapeutic Exercise
This can easily be guided by one of the physios at Sport and Spinal Physiotherapy. The aim is to improve mobility, flexibility and the strength of your hip. This allows for muscular balance and coordination, improved biomechanics and essentially less load through the area. Essentially, over time this improves your function and performance and above all, decreases your pain.
Currently load (or exercise) is considered the primary catalyst to improve tendon function and return it to health. This load usually needs to be individualised
This needs to be individualised for each individual!
Your physio will be able to guide you on your progressions. Below are three exercises (in order of progressions) that will load your glute tendons to begin the healing pathway:
1) Glute Bridge
This exercise can be performed with an additional TheraBand around your knees to further load your gluteus medius.
2) Squats with Theraband
3) Step Ups
The healing rate for everyone varies drastically but be prepared for a longer based rehab. Expect months rather than weeks for this to improve. If you think you might be suffering from GTPS give us a call on 62624464 and we can sort out an appointment for you!
(1) Greater Trochanteric Pain Syndrome. Available: https://cdn.journals.lww.com/anesthesia-analgesia/Fulltext/2009/05000/Greater_Trochanteric_Pain_Syndrome__A_Review_of.49.aspx 6/5/19
(2) Greater Trochanteric Pain Syndrome: a review of diagnosis and management in general practice. Available: https://bjgp.org/content/67/663/479. 7/5/19
(3) The management of greater trochanteric pain syndrome: A systemic literature review. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761624/. 8/5/19