Written by: Dr Tom Eaton (Accredited Exercise Physiologist)
Greater Trochanteric Pain Syndrome (GTPS) is characterised by the onset of a painful aching sensation on the outside of the hip joint which may travel towards the knee (but not below), and is painful when pressing on the affected area. GTPS can occur as an acute injury (reactive), or gradually worsen over a long period (degenerative). GTPS is most common amongst women aged 40-60¹ (approximately 25% of women over 50 experience GTPS¹), and long distance runners² but can be present in anyone.
Common symptoms of GTPS include stiffness of the hip on waking, pain when sitting in or rising from a low chair, pain sitting in a crossed leg position, pain in side lying, pain with walking up hills or stairs, and night pain causing interrupted sleep².
The pain experienced in GTPS is often due to inflammation of the tendon of the gluteus medius muscle, which is the largest and thickest tendon in the body². This tendon is responsible for maintaining the stability of the pelvis during movement and load bearing during walking². In GTPS, tendon inflammation is typically a result of a number of factors, including a sudden increase in activity (e.g. new exercise program), a subsequent failure of the tendon to adapt to load, compression of the tendon from other structures around the hip, and age-related hormonal changes².
While manual therapy treatments such as dry needling may be effective at reducing pain caused by GTPS in the short term, the best approach for reducing pain and improving function in the long term is exercise therapy combined with modification of daily activities3,4. Some common modifications to daily activities include:
- Sleeping with a mattress cover or pillow between the knees to unload the affected hip
- Minimising sitting time (>60 mins)
- Avoid certain positions like low sitting, crossed legged sitting and single leg standing
- Using a hand rail for support when climbing stairs
- For runners, small changes in technique may be necessary to address the cause of pain
An effective exercise program to treat GTPS should focus on strengthening gluteus medius muscle, and other hip and lower limb muscles involved in walking and running5. Recent research suggests to begin with prolonged holds of sets of 10 seconds, gradually increasing to 45 seconds5. Common exercises in the initial phase include banded hip abduction in a high sitting position, glute bridging and squats5.
Functional exercises such as sit-to-stands and standing balance should also be included as part of a well rounded program5. In subsequent phases these exercises can be progressed towards barbell squats, dead-lifts and other lower body compound exercises. A key element of any GTPS program is to optimise and effectively manage the exercise and daily activity load. This process is different for each person, and your Exercise Physiologist can provide some guidance as to best manage your pain, exercise program and daily activities.
If you or anyone you know has been diagnosed with GTPS or is experiencing lateral hip pain, please make an appointment to consult with one of our team to discuss how we can best assist you.
1. Segal NA, Felson DT, Torner JC, et al, Multicenter Osteoarthritis Study Group. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 2007;88:988-92. doi:10.1016/j.apmr.2007.04.014
2. Grimaldi, A., Mellor, R., Hodges, P. et al. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med 45, 1107–1119 (2015). https://doi.org/10.1007/s40279-015-0336-5
3. Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med 2012;46:163-8. doi:10.1136/ bjsports-2011-090414
4. Mellor R, Grimaldi A, Wajswelner H, et al. Exercise and load modification versus corticosteroid injection versus ‘wait and see’ for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskelet Disord 2016;17:196. doi:10.1186/s12891-016-1043-6
5. Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial BMJ 2018; 361 :k1662 doi:10.1136/bmj.k1662