What is it?
Greater Trochanteric Pain Syndrome (GTPS), is an injury involving the gluteal tendons and bursa surrounding the greater trochanter of the femur – the prominent bony part on the side of you hip. It is a combination of both gluteal tendinopathy and bursitis (inflammation of a bursa) surrounding the hip joint. The main tendons involved are that of the gluteus medius and gluteus minimus muscles. The most common bursitis associated with GTPS and lateral hip pain is trochanteric bursitis.
Tendinopathy describes the changes that can occur in the tendon as a result of loads to the tendon. In some cases, the load can exceed what the tendon is capable of tolerating, which can create pain, which is now known as tendinopathy. However, many people still refer to this condition as tendinitis or tendinosis.
An overlying tissue, known as the iliotibial band (ITB), can add stress to the area as this runs directly over the greater trochanter producing friction around the region. ITB syndrome mainly affects the ITB at the distal end near the knee, and can commonly occur alongside GTPS.
What causes GTPS?
Greater Trochanteric Pain Syndrome can be caused by direct trauma from a fall onto your side, prolonged pressure to the hip area, repetitive movements (walking/running), commencing unaccustomed vigorous exercise, weight-bearing on the one leg for long periods, hip instability or the result of a sporting injury among other things.
What are the symptoms of GTPS?
GTPS can present in a number of different ways, but commonly:
- Pain and swelling occurring over the greater trochanter.
- Pain that travels down the outside thigh and may continue down to the knee.
- Pain when sleeping on your side – especially the affected hip.
- Pain upon getting up from a deep chair or after prolonged sitting.
- Pain when climbing stairs.
- Pain when sitting with the legs crossed.
- Increased pain when running, walking, cycling or standing for long periods.
GTPS Treatment
PHASE I – Symptom Reduction
Your physiotherapist will likely implement a range of treatments in order to reduce your symptoms. This can include:
- Manual therapy techniques such as massage trigger point therapy and dry needling of the hip and thigh musculature. Gentle exercises such as stretching, heat packs, de-loading taping techniques.
- Activity modification and postural advice specific to GTPS which may include: avoid sleeping on the affected side, sit with knees below the level of the hip, minimise stair climbing, temporary reduction in exercise.
- A home exercise program will be implemented by your physio most likely focussing on reducing muscular tightness and improving gluteal tendon capacity.
PHASE II – Restoring Normal Movement and Strength
- You will gradually begin a supervised exercise program focussing on dynamic motor control and strength of the muscles supporting your hip, lower back and thigh – increasing the capacity or your hip to tolerate load. This can be in the form of clinical pilates and/or a gym based program.
- As the capacity of your musculature improves, your physio will progress your home exercise and supervised exercise programs into more functional positions/postures.
- Depending on your chosen work, sport or activities of daily living, your physio will aim to restore your function to safely allow you to return to your desired activities in line with your specific treatment goals.
PHASE III – Restoring Full Function & Preventing a Recurrence
- The last stage of your rehabilitation aims at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some people, it only is to walk around the block. Others, for example, may wish to run a marathon. Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.
- Unfortunately, GTPS has a tendency to return if participation to the treatment plan and rehabilitation is not sufficient. In addition to your gluteal muscle strength and endurance, your physiotherapist will assess your hip biomechanics and start correcting any issues that are identified.
- This fine-tuning of your hip stability and function by addressing any deficits in core strength and balance is important in the prevention of a recurrence. Your physio will guide you through self-management techniques to reduce and manage any future symptom increases.
If you are experiencing hip pain and would like to have a FREE assessment by a Physiotherapist or Exercise Physiologist, book in to Back in Motion Aspendale Gardens here.