Trochanteric pain syndrome

Greater trochanteric pain syndrome (GTPS) is a common cause of hip pain. It can make it difficult for you to walk or run.

This guide gives you information about the causes, symptoms, and treatment of greater trochanteric pain syndrome. We also introduce you to some exercises that can help you recover from GTPS and prevent it from happening again.

Pierre Schydlowsky Specialist MD in rheumatology


Content:

Do you have a constant ache or burning pain in your hip area? Are you walking with a limp? Does exercise make the pain worse? Is your pain more intense when you are lying on the affected side at night? If your answer is yes to any of these questions, you could be suffering from a condition called greater trochanteric pain syndrome (GTPS). It is a painful condition that affects the outer thigh and hip area.1

Looking for a solution to greater trochanteric pain syndrome? Try the Injurymap exercise app now.

Fortunately, GTPS responds well to conservative treatments, such as exercises. Surgery is rarely required to fix the problem.2 You can help reduce your symptoms of hip pain and inflammation with the proper physical therapy exercises. Exercises also help strengthen the hip muscles. Stronger hip muscles reduce your risk of suffering from greater trochanteric pain syndrome in the future.

With this informative guide, we will help you understand GTPS and how to treat it. Please keep in mind that this guide is for your information only. It should not replace formal medical care. You should get the opinion of a healthcare provider if your symptoms are severe and do not improve with home exercises.

What is greater trochanteric pain syndrome?

Greater trochanteric pain syndrome is a condition that affects the outer thigh and hip area. It happens when the tissues overlying the greater trochanter in the hip become irritated or inflamed.1 The greater trochanter is a bony prominence on the upper outer part of the femur (thigh bone). It is a protuberance on the thigh bone that is the attachment site for several large hip muscles.3 Overloading the hip can lead to a strain on the structures in this area, causing symptoms of greater trochanteric pain syndrome.

Trochanteric pain

Different types of tissues in the greater trochanter area can become irritated, leading to symptoms. These tissues include muscles, tendons, and bursae.1 A tendon is a band of connective tissue that attaches a muscle to a bone. A bursa is a fluid-filled sac near a joint. It prevents friction and allows smooth movement. Irritation of any of these structures can give rise to greater trochanteric pain syndrome.

There are approximately 20 bursae near the hip joint.2 The largest one is called the trochanteric bursa. It is located near the greater trochanter. An inflammation of this large bursa is called trochanteric bursitis. It is one of the causes of greater trochanteric pain syndrome.

Another possible cause of GTPS symptoms is gluteal tendinopathy (inflammation of a gluteal tendon).2 The gluteus muscles are your large buttock muscles that attach to the hip bones through tendons. When one of these tendons gets inflamed, it can lead to greater trochanteric pain syndrome. The inflammation usually happens as a result of excessive load on the tendon.5

Definition of greater trochanteric pain syndrome

The definition of greater trochanteric pain syndrome is hip pain due to irritation of structures near the greater trochanter.

Traditionally, greater trochanteric pain syndrome was thought to be due to inflammation of the greater trochanteric bursa.4 However, imaging studies, microscopic examination, and surgeries have shown otherwise. It is now known that the symptoms of GTPS can be caused by other conditions as well. This includes gluteal tendon inflammation. The tendon irritation can be present with or without the bursa inflammation.4

It is worth noting that a condition called iliotibial (IT) band syndrome can increase your risk of developing greater trochanteric pain syndrome. The IT band is a tough band of tissue that runs over the greater trochanter in the hip, all the way down to the calf area. IT band syndrome mainly affects the knee, but it can cause friction in the hip area, leading to GTPS.4

Symptoms of greater trochanteric pain syndrome

Greater trochanteric pain syndrome is characterized by a pain on the outer part of the thigh or hip. A characteristic feature of GTPS is the so called jump sign. When a doctor presses upon the greater trochanter area, a person with GTPS almost jumps off the table due to sudden, sharp pain. That’s why it’s called the “jump sign” in clinical diagnosis.4

The pain from GTPS can be a dull ache or a burning pain. The symptoms are more intense when you’re lying on the affected side at night. You may find that you are walking with a limp. Exercise and weight-bearing activities like walking and running often make the pain worse.1,4, GTPS pain can be episodic, i.e., it comes and goes and flares up from time to time. Without treatment, the symptoms can slowly worsen over time, leading to hip muscle weakness.

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Causes of greater trochanteric pain syndrome

Greater trochanteric pain syndrome is common among middle-aged women between the ages of 40 and 60. The reasons for this are not fully known.

The most common causes of GTPS are:1,4

  • Injury, such as a direct fall onto your side.
  • Prolonged pressure or overloading of the hip area, for example, from sleeping on that side or sitting in a bucket car seat.
  • Suddenly starting intense exercise (instead of gradually increasing your workout intensity).
  • Repetitive hip movements, for example, prolonged walking and running.
  • Running with a poor form, which can put excessive strain on the hip.
  • Bearing weight on one leg (instead of both legs) for long periods.
  • Weakness of the gluteus (buttock) muscles that support the hip joint.

Knowing the difference between greater trochanteric pain syndrome and other hip conditions

Several conditions have symptoms similar to those of greater trochanteric pain syndrome.

Similar conditions:6,7

  • Injuries or fractures of the femur (thigh bone)
  • Tear of the gluteus medius muscle
  • Hip fracture
  • Inflammation of the iliopsoas tendon
  • IT band syndrome
  • Lumbosacral radiculopathy (compression of the nerves in the lower back)
  • Piriformis syndrome (compression of the sciatic nerve by the piriformis muscle)
  • Osteoarthritis of the hip joint

If your symptoms of hip pain do not get better with home treatments, including physical therapy exercises, you should see a doctor. The doctor may order some tests and imaging studies to figure out exactly what’s going on with your hip.

How long does it take for greater trochanteric pain syndrome to heal?

Everyone’s body is different and heals differently from greater trochanteric pain syndrome. In general, it can take 6 to 9 months of focused rehab exercises to return to pain-free normal activities.1 It is quite common to have periodic GTPS flare-ups. If this happens, you may need to cut back on your exercises until the pain reduces.1 If your symptoms of greater trochanteric pain syndrome are not better after 1-2 months of rehab exercises, your doctor may recommend other treatments, such as steroid injections.

Can you recover completely from greater trochanteric pain syndrome?

Yes, you can recover completely from GTPS. Nonsurgical treatments are very effective in treating greater trochanteric pain syndrome. More than 90 percent of people with GTPS can successfully manage their symptoms with conservative treatments like exercise.8 Rehab exercises can provide significant pain relief and functional improvement.

Treatment for greater trochanteric pain syndrome

The most common cause of greater trochanteric pain syndrome is frequent stress and heavy loading of the structures in the hip. Exercises to strengthen the hip area can help speed up your return to pain-free activities. Here are some exercises you can do during your rehabilitation. Remember, loading the hip is necessary to aid recovery. But it is important to gradually increase the intensity of your exercises. This will help avoid overloading the hip and making your symptoms worse.1

Exercises for greater trochanteric pain syndrome

  1. Glute exercise for pelvis stability
    10 reps x 3 sets

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    Glute Exercise

    • Lie on one side.
    • Bend the lower leg to stay stable.
    • Use your arms as support.
    • The upper leg should be straightened out and a little backward in the hip.
    • Turn your toes downwards, and with your heel at the top position slowly lift the leg as far as possible.
    • Your foot should be kept slightly behind the back of the other legs foot.
    • Perform 3 sets of 10 repetitions with each leg.
  2. Side plank V
    5 reps

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    Side Plank

    • Lie on one side.
    • Support yourself with one forearm on the ground and the bottom foot on the floor and the other foot placed on top.
    • Lift your body up so it is aligned with your legs.
    • Pull the pelvis up and tighten your abdominal muscles and hold the position for 5 seconds.
    • Repeat the exercise 5 times to each side.
  3. Squat with ball
    10 reps x 3 sets

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    Squat with Ball

    • Stand up in front of a chair without touching it.
    • Stand on both legs with your feet slightly apart.
    • Your toes should point straight ahead.
    • Place a football or similar ball between your knees.
    • Squeeze the ball while slowly bending your knees, such that you just touch the chair without sitting.
    • Then slowly go back up.
    • Perform 3 sets of 10 repetitions.

Other treatment options for greater trochanteric pain syndrome

Lifestyle Changes: For the short-term, you may need to make some changes to improve your symptoms of GTPS. For example, you can try reducing activities such as running and excessive walking. You should avoid leaning on one hip. Always make sure you bear weight on both legs equally. If the pain is worse at night, you can avoid sleeping on the affected side. Try placing a pillow between the knees. This will help prevent you from crossing the painful leg over.1 Diet and exercise to lose weight may also help with symptom control.

Medications: Over-the-counter pain killers can provide short-term relief of GTPS pain. If the pain does not get better, a local injection of steroid medication may be recommended.

Surgery: Surgical interventions are rarely needed to treat greater trochanteric pain syndrome. Your doctor may, however, recommend surgery if you have a tendon rupture (separation) or persistent pain after 6-9 months of conservative treatment.

Managing hip pain from greater trochanteric pain syndrome

If you are struggling with hip pain, know that you are not alone. Greater trochanteric pain syndrome is a common cause of hip pain that affects both athletes and non-athletes. The good news is that GTPS can be managed with home remedies, mainly physical therapy exercises. Stretching exercises can help reduce muscle tension and improve flexibility and balance. Strengthening exercises can improve hip strength and restore normal range of motion. With regular exercise, your endurance will improve. You will gradually be able to return to normal activities and sports without pain.

The Injurymap app demonstrates a range of exercises to strengthen the hip. You can do these exercises conveniently at home with little to no equipment. If you have symptoms of greater trochanteric pain syndrome, begin with stretching exercises in the early stages of your rehabilitation. In the later stages, you can shift your focus to strengthening exercises. Start by gently loading your hip. Then gradually increase the intensity of the exercises to make your hip stronger. Doing these exercises will speed up your recovery from GTPS. The exercises will also lower your risk of developing this painful hip condition in the future.

Hip pain from greater trochanteric pain syndrome should not prevent you from doing your normal activities, going for a run, or playing a sport. With the Injurymap app, it is easy to do hip exercises at home with the correct technique. The app demonstrates each exercise and all you have to do is follow along. Download the Injurymap app today and start your journey to recovery.

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About the author

Pierre Schydlowsky is a specialist MD and Ph.D. of rheumatology with a diploma in sports medicine. He has published multiple research papers on shoulder and ski injuries and is teaching various advanced courses in sports medicine at Danish Universities.