Greater Trochanteric Pain Syndrome (GTPS) is a clinical diagnosis for lateral hip pain affecting 1.8 patients per 1000 each year. It is an umbrella term which includes common conditions such as gluteal tendinopathy and trochanteric bursitis.It is most common in females between 40-60, and in those who are overweight. It presents as pain over the lateral (outer) aspect of the hip, that may radiate down the lateral thigh to the knee. Symptoms may include:
- Tenderness to palpate the lateral hip
- Pain lying on the affected side (or on the opposite side if the affected hip crosses the midline)
- Pain with prolonged sitting , or crossing legs while sitting
- Pain with weightbearing activities such as walking, climbing stairs, standing, and running
- Pain with resisted abduction, along with weak hip abductors
What causes GTPS?
The exact cause of GTPS is still unknown. There may be a couple of contributing factors including:
- Weakness of the hip abductor muscles can cause a lateral pelvic tilt which increases the compressive forces over the gluteal tendons and bursa
- Poor pelvic control in single leg stance, again increasing compression on the lateral hip
- Women are more prone to GTPS because of pelvic biomechanics, and hormonal effects especially during menopause. Females also have a smaller insertion of the GMed tendon causing reduced mechanical efficiency.
- Overuse/mechanical overload e.g. sudden increase in activity levels, returning to quickly to pre-injury activity levels, long distance running etc.
Can physiotherapy help?
Yes. Exercises and load modification are vital in the effective management of GTPS. Your physiotherapist will take a detailed history, and complete a full physical assessment to identify issues which may be contributing to your hip pain. They will provide an individualised programme to improve gluteal strength, and lumbopelvic control to optimise biomechanics and reduce compressive forces on the hip. Your physiotherapist will also guide you on how to modify your activities, keeping you as active as possible.
Shockwave therapy has also been shown to be effective in providing pain relief to those with GTPS. Click here to find more information about shockwave therapy.
Postural tips may also help to reduce compression on the lateral hip. These include:
- Do not stand unevenly on both legs, or favour one leg by ‘hanging on the hip’
- Do not carry baby on hip where possible.
- Sit with your feet shoulder width apart and ensure that your hips are
always higher than your knees when sitting in a chair. Avoid sitting in low sofas/car seats which generally slope backwards.
- Do not cross your legs at the knees when sitting.
- Sleep on your back with a pillow under your knees, or on the unaffected side with a pillow between your knees and ankles.
- Get dressed while seated to avoid standing on one leg.