Greater Trochanteric Pain Syndrome: Causes, Symptoms & Treatment

What is Greater Trochanteric Pain Syndrome or GTPS?

Greater Trochanteric Pain Syndrome or GTPS, is a term to describe pain at the outside aspect of the hip or thigh. The greater trochanter is a bony prominence of the femur that serves as an attachment point for powerful hip muscles including the hip abductors and rotators. This is also the location of a fluid filled sac called a bursa and a thick fibrous tissue called the IT band.

Greater Trochanteric Pain Syndrome or GTPS

Greater trochanteric pain syndrome can affect any of these soft tissue structures. Symptoms of greater trochanteric pain syndrome include tenderness to touch and difficulty sleeping on the affected side. Additionally, you may have pain with walking or weight bearing tasks. Pain may stay localized to the outside part of the upper thigh. It can also radiate to the outside aspect of the thigh to the knee.

Who is most Affected by Greater Trochanteric Pain Syndrome?

Greater trochanteric pain syndrome can affect both men and women of any age however it is seen more commonly in women between the ages of 40-60. This may be due to women having wider pelvis which places the outside of the hip further from a person’s center of mass. As result, this requires more muscle activation of the hip abductors and pelvic stabilizers.

What Causes It?

Greater Trochanter Pain Syndrome, or trochanteric pain syndrome, is a painful condition that affects the greater trochanter – the bony bump you can feel on the side of your hip. While the exact cause isn’t completely understood, several factors may play a role:

Muscle imbalances: Weak hip abductors and tight hip flexors can cause undue stress on the greater trochanter and surrounding tissues, leading to pain and inflammation.
Overuse or repetitive activities: Activities that involve repetitive hip movements, such as running or cycling, can strain the muscles and tendons around the greater trochanter. Over time, this repetitive stress can lead to the development of this syndrome.
Trauma or injury: A fall or sudden impact to the hip can cause damage to the muscles, tendons, or bursae around the greater trochanter, resulting in inflammation and pain.

It’s crucial to remember that although these factors are associated with this syndrome, it can also occur without any clear cause or trigger. If you have persistent hip pain or suspect you may have this syndrome, it’s recommended to consult with a healthcare professional for an accurate diagnosis and suitable treatment.

How does GTPS Occur?

Common activities that can provoke the onset of greater trochanteric pain syndrome include running, prolonged walking, sport overuse, or a traumatic event such as a fall. The lateral hip muscles, more specifically the glute medius and glute minimus, primarily act as pelvic and knee stabilizers. If these structures cannot withstand the load demanded by an activity, there can be a breakdown in muscle fibers leading to gluteal tendinopathy. The IT band assists with pelvic and knee stability too. When there is increased demand the IT band can excessively compress the trochanteric bursa or hip muscle tendons. This causes further impingement and irritation. Increased demand of the IT band happens with weakened hip abductors.

How is Greater Trochanteric Pain Syndrome Diagnosed?

Imaging such as X-Rays and MRI can help to rule out other pathologies such as hip arthritis, muscle tears, or fracture. Most cases of greater trochanteric pain syndrome can be diagnosed based on symptoms and physical exam by a physician or physical therapist. Physical exam can include palpation to the area, single leg stance, and passively moving the hip. Low back pathologies including radiculopathy should be considered, especially when experiencing pain that travels down the thigh and past the knee.

Therapist treating patient with greater trochanteric pain syndrome. JOI Rehab Greater Trochanteric Pain Syndrome

How is Greater Trochanteric Pain Syndrome Treated?

Greater trochanteric pain syndrome is a pain-limiting condition that can typically improve with activity modification. Additionally, a hip strengthening program can have positive effects. If you are experiencing greater trochanteric pain syndrome it may be helpful to avoid crossing your legs. Avoiding prolonged positioning where your leg is beyond midline can also relieve the symptoms of greater trochanteric pain syndrome. It can be helpful to sleep with a pillow between the knees at night.

Physical Therapy for GTPS

Gradual hip strengthening with emphasis on glute activation and pelvic stabilization can help to offload the IT band. This also promotes proper muscle facilitation. It may be beneficial to work with a physical therapist for body mechanic training. Especially, if there is a specific activity such as walking, squatting, or exercise that provokes your symptoms. In some cases, a physician may suggest use of a corticosteroid injection to decrease inflammation within the outside hip region.

3 Ways to Prevent Greater Trochanteric Pain Syndrome

Preventing greater trochanter pain syndrome is key to maintaining a healthy and active lifestyle. Here are some preventive measures you can incorporate into your routine to reduce the risk of experiencing this condition:

1. Proper warm-up and stretching: It’s important to warm up your muscles and joints before any physical activity. This increases blood flow and flexibility, reducing the chance of injury. Include dynamic stretches that target the hip and gluteal muscles to prepare them for the activity ahead.

2. Strengthening exercises: Weakness in the hip and gluteal muscles can contribute to this syndrome. Include exercises that target these muscles, such as hip abductions, clamshells, and bridges, to help improve their strength and stability. Consult with a healthcare professional or a physical therapist to learn proper technique and ensure you’re performing these exercises correctly.

3. Avoid overuse: Overusing the hip and gluteal muscles can lead to irritation and inflammation of the greater trochanter. Be mindful of your activity level and avoid excessive repetitive motions or high-impact activities that may strain these muscles. Allow yourself adequate rest and recovery time between workouts to allow your muscles to heal and prevent overuse injuries.

By incorporating these preventive measures into your routine, you can reduce the risk of developing greater trochanter pain syndrome. Always listen to your body, and if you experience any persistent pain or discomfort, consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

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