Greater Trochanteric Pain Syndrome (GTPS): Symptoms, Causes, Treatment & Exercises

Key Takeaways

• GTPS causes pain around the greater trochanter (outer hip area) often due to tendon injury or bursa inflammation, frequently affecting middle-aged women.

• Symptoms typically include lateral hip pain that may radiate down the thigh, tenderness to touch, and pain during activities like walking or climbing stairs.

• Conservative treatments including rest, targeted exercises, anti-inflammatory measures, and physical therapy resolve most cases without surgical intervention.

• A comprehensive rehabilitation programme focusing on hip strengthening, stretching, and low-impact activities works for recovery and preventing recurrence.

• At MSK Doctors, we use advanced AI movement analysis and personalised treatment plans delivered by orthopaedic consultants specialising in hip conditions for optimal GTPS outcomes.

Greater Trochanteric Pain Syndrome Overview

What is GTPS?

GTPS refers to a collection of disorders that cause pain in the area of the greater trochanter, the bony prominence at the top of the femur. This pain is usually due to inflammation of the bursae or injury to the tendons surrounding this area (image courtesy of Cleveland Clinic).

Commonly, GTPS is mistaken for hip joint issues or arthritis, but it specifically affects the soft tissues around the hip. Diagnosing GTPS typically involves a physical examination and consideration of the patient's medical history. In some cases, imaging tests like MRI or ultrasound may be necessary to rule out other conditions.

Prevalence and Demographics

GTPS is particularly prevalent among middle-aged women, though it can affect men and younger individuals as well. The condition is often under-diagnosed, leading to prolonged discomfort for many. 

It's estimated that GTPS affects approximately 10-25% of the population at some point in their lives, with a higher incidence in those who engage in repetitive hip movements or have underlying biomechanical issues.

Symptoms of GTPS

Common Pain Areas

The primary symptom of GTPS is pain located at the outer hip, specifically around the greater trochanter. This pain can extend down the side of the thigh and is often described as aching or burning. It's typically aggravated by activities that involve hip movement, such as walking, running, or climbing stairs.

Some individuals may experience pain while lying on the affected side, which can disrupt sleep and contribute to overall discomfort. This lateral hip pain is a common symptom of GTPS and should prompt further evaluation by a healthcare professional.

Movement-Related Aggravation

• Walking, especially on uneven surfaces

• Climbing stairs or inclines

• Prolonged standing or sitting

• Lying on the affected side

These activities can exacerbate the symptoms of GTPS, leading to increased pain and stiffness. 

Associated Symptoms

Similarly, tenderness to touch, swelling, and a reduced range of motion in the hip are key indicators prone to GTPS. This is likely caused by inflammation of the bursae or tendons in the hip area. These symptoms can impact daily activities and quality of life - address them promptly.

Causes of GTPS

Tendon Injury

One of the primary causes of GTPS is injury to the tendons that attach to the greater trochanter. These tendons can become inflamed or damaged due to repetitive stress, overuse, or biomechanical imbalances. Tendon injuries are common in athletes and individuals who engage in repetitive hip movements, such as runners or dancers.

Addressing tendon injuries early can prevent further damage and reduce the risk of chronic pain. This may involve rest, physical therapy, and exercises designed to strengthen and stabilise the hip.

Inflammation of Bursae

Another significant cause of GTPS is the inflammation of the bursae, which are small fluid-filled sacs that reduce friction between bones and soft tissues. When these bursae become inflamed, a condition known as bursitis occurs, leading to pain and swelling in the hip area.

Bursitis happens when you engage in repetitive motion or prolonged pressure on the hip, such as sitting for long periods or lying on one side. Managing bursitis involves reducing inflammation through rest, ice application, and anti-inflammatory medications.

Other Factors Contributing to GTPS

Several other factors can contribute to the development of GTPS, understanding these will prevent and manage the condition effectively. These factors include:

• Repetitive stress or overuse of the hip joint

• Biomechanical issues, such as leg length discrepancies or improper gait

• Muscle imbalances or weakness in the hip and surrounding areas

Treatment Options for GTPS

Conservative Approaches

Conservative treatment is often the first line of defense against GTPS and can be highly effective in alleviating symptoms. These approaches include:

• Rest and activity modification to reduce stress on the hip

• Physical therapy to strengthen and stabilise the hip muscles

• Application of ice or heat to manage pain and inflammation

Medications and Injections

In some cases, medications may be necessary to manage the pain and inflammation associated with GTPS. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are used to provide relief, while corticosteroid injections can offer more targeted treatment for severe inflammation.

Role of Surgery

While GTPS can be managed with conservative treatments, surgery may be considered in severe or persistent cases. Surgical options aim to address the underlying issues, such as tendon repair or bursectomy, to alleviate pain and improve hip function.

A thorough evaluation by an orthopaedic specialist will determine the appropriateness of surgical intervention.

Exercises for GTPS

Hip Strengthening Exercises

Strengthening the hip muscles is vital for stabilising the joint and reducing stress on the tendons and bursae. Effective exercises include:

• Clamshells: Lying on your side with knees bent, raise the top knee while keeping feet together.

• Bridges: Lying on your back with knees bent, lift your hips towards the ceiling.

• Side leg raises: Lying on your side, lift the top leg straight up and down.

These exercises help build strength in the hip abductors and gluteal muscles, providing better support and reducing pain (image courtesy of Youtube). 

Stretching Techniques

Stretching helps maintain flexibility and prevent muscle tightness. Incorporate the following stretches into your routine:

• Hip flexor stretch: Kneel on one knee and push your hips forward.

• Iliotibial band stretch: Cross one leg over the other and lean to the side.

• Hamstring stretch: Sit with one leg extended and reach towards your toes.

Regular stretching can improve the range of motion in the hip and alleviate tension that contributes to GTPS.

Low-Impact Activities

Engaging in low-impact activities can help maintain fitness while reducing strain on the hip. Consider incorporating activities such as swimming, cycling, or walking into your exercise routine.

Reducing Inflammation

Reducing inflammation is a key component in managing GTPS effectively. One of the most accessible methods is applying ice packs to the affected area for 15-20 minutes several times a day. 

Another useful technique is incorporating anti-inflammatory foods into your diet. Foods rich in omega-3 fatty acids, such as salmon and walnuts, and those high in antioxidants, like berries and leafy greens, can help reduce inflammation naturally. Staying hydrated and avoiding inflammatory foods like processed sugars and excessive caffeine can also contribute to managing symptoms effectively.

Maintaining Mobility

Regular movement prevents stiffness and promotes circulation, aiding the healing process. Gentle exercises, such as walking or cycling, can be beneficial, provided they don't exacerbate symptoms. Listen to your body and avoid pushing through pain.

Incorporating flexibility exercises, such as yoga or tai chi, can also support joint mobility and reduce tension in the hip area. These activities promote balance and coordination, which prevents falls and further injury. Perform a warm-up before engaging in any exercise to prepare your muscles and joints for activity.

Long-Term Management Tips

Long-term management of GTPS involves a combination of lifestyle changes and ongoing exercises. Regular physical therapy sessions can help maintain strength and flexibility in the hip region, reducing the risk of future flare-ups. Maintain a healthy weight to minimise stress on the hips.

Adjust your environment to support your recovery consider using ergonomic furniture and supportive footwear to reduce strain on the hips during daily activities. Engaging in activities that promote mental well-being, such as meditation or hobbies, can also support long-term recovery by reducing stress and promoting overall health.

Specialised GTPS Care: The MSK Doctors Advantage

At MSK Doctors, we understand the complex nature of GTPS and offer targeted treatments based on the latest evidence and innovative techniques. 

Our approach begins with accurate diagnosis using advanced imaging and our advanced MAI-Motion AI movement analysis platform, enabling us to identify the precise cause of your hip pain.

Our specialist orthopaedic consultants provide immediate access to expert treatment without GP referrals. We recognise that GTPS requires individualised management, which is why we develop personalised treatment programmes that address your specific symptoms, functional needs, and lifestyle goals.

Our comprehensive care extends beyond symptom relief to focus on long-term resolution and prevention. Through targeted injections, specialised physical therapy methods, and intensive regenerative treatments, we've helped countless patients overcome GTPS. 

You can trust us to provide the exceptional care your hip deserves. Book your consultation with MSK Doctors today and allow yourself to move freely and confidently once again.

Frequently Asked Questions (FAQ)

What are the first steps to take if I suspect GTPS?

If you suspect you have GTPS, the first step is to consult a healthcare professional for an accurate diagnosis. They will perform a physical examination and may recommend imaging tests to confirm the condition. 

Are there any specific exercises I should avoid?

Yes, certain exercises may aggravate GTPS symptoms and should be avoided. High-impact activities, such as running or jumping, can place excessive stress on the hip and worsen pain. 

What are the signs that I need medical intervention?

If you experience persistent pain that does not improve with conservative treatment, or if your symptoms worsen, it may be time to seek medical intervention. Signs that warrant further evaluation include severe pain, swelling, or difficulty performing daily activities. 

How long does it typically take to recover from GTPS?

Recovery time for GTPS varies depending on the severity of the condition and the effectiveness of the treatment plan. With appropriate conservative treatment, many individuals experience improvement within 6-12 weeks. 

How can MSK Doctors help in managing GTPS?

At MSK Doctors, we offer a comprehensive approach to managing GTPS, combining clinical expertise with personalised care.