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Greater Trochanteric Pain Syndrome – A Common Form of Hip Pain

Greater trochanteric pain syndrome (GTPS) is one of the most common forms of hip pain in middle-aged adults. It’s also one of the most commonly missed or misdiagnosed forms of hip pain. You might have heard terms like “hip bursitis” or “sciatica”. Both of these terms are commonly (and incorrectly) used to describe GTPS. We’ll start by unpacking why GPTS is incorrectly diagnosed and what it is. Then, we’ll end by going through four exercises to help those dealing with GTPS.

Greater Trochanteric Pain Syndrome, Not Hip Bursitis

Hip bursitis is the most common incorrect diagnosis for greater trochanteric pain syndrome. The reason behind this is because GTPS used to be widely known in the medical world as bursitis. The original cause of pain was thought to be an inflamed bursa in the hip. This led doctors to suggest rest, cortisone injections, and ice.

However, this diagnosis is incredibly outdated. There has been an overwhelming amount of research showing that the bursa is not the problem. The problem is the muscles that attach to the greater trochanter, which is a bony projection on the outside of the hip. These muscles become deconditioned and are unable to tolerate the load that is being placed on them.

Unfortunately, despite the fact that the diagnosis is outdated, many doctors continue to misdiagnose (and thus incorrectly treat) individuals who have pain on the outside of their hip. This leads to unnecessary injections, imaging, and – ultimately – pain that does not typically resolve.

The best way to eliminate greater trochanteric pain syndrome is to load the tendons that are causing pain. This improves their tolerance to load, allowing you to gradually do more and more without pain. Eventually (and we say eventually because this is at least an 8-16 week recovery), things resolve and the pain goes away. It’s not an easy injury to recover from, but it’s definitely one that you can recover from – when you are treated appropriately.

Greater Trochanteric Pain Syndrome, Not Sciatica

Sciatica is commonly known as pain that starts in the buttocks and goes down the leg. However, GTPS can also do this. There are trigger points in the muscles that insert into the greater trochanter (gluteus medius, gluteus minimus) that can cause pain that is referred down the leg. Referred pain is when pain is experienced in a location that is different from the dysfunction. This is very typical in GTPS.

greater trochanteric pain - gluteus minimus
greater trochanteric hip pain

There are many tests physical therapists can do to differentiate if symptoms are coming from the sciatic nerve or muscles around the hip. There’s also one qualitative question that we typically ask clients – “If you had to draw the pain going down your leg, would you use a highlighter or a pen?” If the pain is truly coming from the sciatic nerve, the line would be thin, pin-point, and precise. When the pain comes from the muscles around the hip, while it is a thin line, it’s often a bit more fuzzy – like the width of a highlighter.

 

How do I know if I have GTPS?

As with any diagnosis, there is a range of symptoms that individuals who have greater trochanteric syndrome can experience. These symptoms tend to (but don’t need to) include –

  • Pain on the outside of the hip that may or may not go down the leg to the foot
  • Pain that worsens with standing, walking, stairs, or running
  • Pain that worsens when you lay on the painful hip
  • No specific incident that caused the discomfort to start
  • Tenderness when touching the muscles of the lower back, buttocks, and back of the leg 

Improving Greater Trochanteric Pain Syndrome

As we discussed before, the best way to improve greater trochanteric pain syndrome is by loading the tendons and muscles that attach to the greater trochanter. This is because the cause of the discomfort stems from muscles that are overloaded (not strong enough). The muscles that are involved (gluteus medius, gluteus minimus) are responsible for holding your body up while you walk. While these muscles are worked during group fitness classes, they are rarely truly strengthened. So, it’s not unusual for relatively active and healthy individuals to have greater trochanteric pain syndrome.

Below is the progression of exercises we use to strengthen the involved muscles in individuals who have GTPS. With strengthening during an injury, you want to keep discomfort to moderate or less during, immediately after, and a full 24 hours after performing the exercise. If discomfort goes above that or starts to collectively rise despite no increased discomfort during the exercise, it’s time to re-evaluate things.

This is a blog article that often helps individuals prescribe rehab exercises (and exercise in general) appropriately during an injury. However, if you are constantly pinging between too much and too little exercise, we suggest you seek help from an expert. This can help a small injury from progressing into a large injury that hangs around longer than you want it to.

 

Snow Angels

Side-lying Hip Abduction

Side Plank

Modified Side Plank with Hip Abduction

Wrapping It Up

To conclude, greater trochanteric pain syndrome is when the muscles on the outside of the hip are not strong enough to tolerate the load that is being placed on them. This causes pain on the outside of the hip that can travel down the leg. Because of this, GTPS is commonly misdiagnosed as bursitis or sciatica. Properly treating this form of hip pain involves gradually strengthening the muscles while resuming painful activities with graded exposure.

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