You may experience pain:
in the hip/thigh/buttock area.
when lying on your side or with direct pressure.
increasing with exercise (walking, standing or running).
sitting with your legs crossed.
when climbing stairs
when lifting legs in/out a car or bed
This is called Greater trochanteric pain syndrome (GTPS). It occurs when the tissues which lie over the outside of the hip bone (greater trochanter) become irritated.
The soft tissues that attach to the outside of the hip include tendons and bursa. It was (& still can be) routinely diagnosed as bursitis but recent research has found it is actually more commonly a tendon (of gluteus medius) that is the issue (Pianka et al. 2021). One study identified that only 20% of GTPS was due to a bursitis and that the remaining 80% was due to alterations in the glutes tendons (Sanmamed & Fernández, 2023).
This is important as it affects the treatments chosen. For example, injecting the bursa with steroid won’t work if it’s the tendon. Of course, there are other possible causes (e.g. hip joint, spine) for pain in this region which we always look to exclude first.
The Gluteus Medius has the thickest tendon in the whole body. It covers a large area of the Greater Trochanter, travelling deeper than what you see on anatomy images (see yellow outline in the image to the right). It's role is to stabilise the hip when walking/running, take the hip out to the side (abduction), helps turn the hip outward (external rotation) and even its anterior fibres assist turning the hip inward (internal rotation).
Overlying the deeper structures round the hip are; Gluteus Maximus, Tensor Fascia Lata and the Iliotibial Band (see left). Between these and the greater trochanter and the gluteus medius attachment lies the bursa (see below).
As you can see these structures are very closely located to one another and why bursitis has been thought to be the main cause of lateral hip pain. Of course, there can be occasions where both tendinopathy and bursitis are present.
How do we mange this condition?
Our team are highly qualified musculoskeletal specialists “body mechanics” and will be able to carefully assess you to identify the true source/s of your pain leading to efficient treatment. These treatments include:
Advice on how avoid irritating the injury. e.g. Avoid lying on or compressing it, remove deep squatting from activities where possible and avoiding crossing legs.
Soft tissue release of the muscle belly can offer some temporary relief by reducing the tension/compression over the greater trochanter enabling you to perform your exercises in more comfort.
Taping can offer some temporary pain relief, but does not work for everyone.
Acupuncture can be used to offer pain relief and encourage an optimal environment for healing around the tendon (or bursa)
Shockwave has been found to be highly effective at treating GTPS (He et al., 2023; Notarnicola et al., 2023; Desantis et al 2023; Heaver et al., 2023).
Exercise. The correct rehabilitation exercises are pivotal to recovering from GTPS (Notarnicola et al, 2023; Desantis et al 2023). The exercises prescribed will depend on how painful the GTPS is. We would typically start with a weighted exercise where the tendon/muscle does not move, also known as Isometric loading. This will help manage pain and promote healing within the tendon in the correct way. The exercises will then be progress as and when it is appropriate.
The ultimate way to manage GTPS (and any other injury for that fact!) is to combine treatments. Shockwave and exercise has been found to very effective in the rehabilitation of this condition (Notarnicola et al., 2023; Desantis et al 2023; Heaver et al., 2023).
If you are struggling with you think might be GTPS then do not delay in getting booked in as we can help! We endeavour to get you back to living a pain-free life and doing the things you love as soon as possible. Just take a look at our Trustpilot and Google reviews to see how we've helped our clients.
References.
Pianka MA, Serino J, DeFroda SF, Bodendorfer BM. Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology. SAGE Open Medicine. 2021;9. doi:10.1177/20503121211022582
Sanmamed, A. G., & Fernández, M. L. R. (2023). Greater trochanteric pain syndrome (GTPS): updated multifactorial approach. Campa d, 162.
He, Y., Lin, Y., He, X. et al. The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis. BMC Musculoskelet Disord 24, 423 (2023). https://doi.org/10.1186/s12891-023-06443-5
Notarnicola A, Ladisa I, Lanzilotta P, Bizzoca D, Covelli I, Bianchi FP, Maccagnano G, Farì G, Moretti B. Shock Waves and Therapeutic Exercise in Greater Trochanteric Pain Syndrome: A Prospective Randomized Clinical Trial with Cross-Over. Journal of Personalized Medicine. 2023; 13(6):976. https://doi.org/10.3390/jpm13060976
Disantis, A., Andrade, A, J., Baillou, A,. Bonin, N., Byrd, T., Campbell, A., Domb, B., Doyle, H., Enseki, K., Getz, B., Gosling, L., Grant, L., Ilizaliturri Jr. V.M., , Kohlrieser, D., Laskovski, J., Lifshitz, L., McGovern, R., Monnington, K., O’Donnell, J., Takla, A., Tyler, T., Voight, M., Wuerz, T., Martin, R. L., The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement, Journal of Hip Preservation Surgery, Volume 10, Issue 1, January 2023, Pages 48–56, https://doi.org/10.1093/jhps/hnac050
Heaver C, Pinches M, Kuiper JH, et al. Greater trochanteric pain syndrome: focused shockwave therapy versus an ultrasound guided injection: a randomised control trial. HIP International. 2023;33(3):490-499. doi:10.1177/11207000211060396