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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, especially women between 40-60 years old. It’s also one of the most commonly 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 greater trochanteric pain syndrome.
In this blog post, we’ll start by unpacking why GTPS 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. This is because the original cause of pain was thought to be an inflamed bursa in the hip.
However, this diagnosis is incredibly outdated.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.
Unfortunately, despite the fact that the diagnosis is outdated, the majority of doctors continue to misdiagnose individuals who have pain on the outside of their hip. When pain is misdiagnosed, the wrong structure is treated and pain doesn’t resolve. For GTPS, this means that ice, rest, and cortisone injections are suggested when exercise, heat, and dry needling should be utilized instead.
Greater Trochanteric Pain Syndrome, Not Sciatica
Greater trochanteric pain syndrome is commonly misdiagnosed as sciatica because the pain is present in the same location. Why is that?
It’s simple. The muscles (gluteus minimus, gluteus medius, tensor fascia latae, and sometimes gluteus maximus) that are involved in GTPS are also involved in sciatica. Because the same structures are irritated (even though there is a different culprit irritating those structures), the pain is in the same location.
However, the key difference is that in sciatica the sciatic nerve is the primary cause of the pain whereas in GTPS, it is the muscles that are the main driver of symptoms. In both cases, the muscles are irritated, but it is for different reasons.
One other piece that can be confusing is this – why is the pain all the way down my leg if it’s just my hip muscles that are involved? This also has a simple explanation – referred pain. Referred pain is when pain is present in a different location than the cause of the symptoms.
The photos below illustrate this. The “x” in the photo is where the dysfunction is. And, the red color is where the pain shows up. This is common in muscles throughout the entire body. When muscles are irritated, they often cause pain in a location different from where the muscle actually is.
When we are trying to distinguish between sciatic pain and GTPS with a client, beyond the physical tests we complete, we often ask about the type of pain individuals are experiencing. Words like “sharp,” “buzzing,” “electric,” and “piercing” more often describe sciatica. Conversely, words like “achy,” “dull,” and “constant” are often associated with GTPS.
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 your hip
- A gradual onset of symptoms
- Tenderness when touching the muscles of the lower back, buttocks, back of the leg, and sometimes the calf
Improving Greater Trochanteric Pain Syndrome
It may seem counterintuitive, but the best way to improve greater trochanteric pain syndrome is by loading the tendons and muscles that attach to the greater trochanter. GTPS occurs because the muscles are not strong enough to tolerate the load that you are placing on them. The best way to improve their tolerance to load is to strengthen them.
However, it is important this is done gradually and systematically. We’ve seen individuals push too hard too soon, flare things ups, and set themselves back quite frequently. Throughout the process of healing, it’s important to remember that muscles take time to heal.
The changes experienced in the first 2-4 weeks are simply a result of muscles becoming more efficient. It takes 6-8 weeks of consistently loading muscles to experience any true structural changes within the muscle. With GTPS, it often takes individuals around 3 months (and sometimes up to 6) to truly get relief.
But I Work Out…Why am I Not Strong Enough?
Since we work primarily with people who regularly exercise, this is a common question we get. There’s also an easy (and unfortunate) answer.
The muscles that you utilize while exercising rarely include the muscles that are involved in GTPS. Most exercise is done in a forward/backward direction. It’s less common that side-to-side or rotational movements are performed. However, it is the side-to-side and rotational movements that are necessary to strengthen these muscles.
But you complete side-to-side and rotational movements while exercising, you say? Here’s the thing – you’re probably doing them wrong. I (Dr. Sarah) teach group fitness one afternoon per week and despite giving a lot of cues to not compensate when I incorporate rotational movements (and walking around and individually correcting people), about 90% of the class still does it wrong.
There’s a lot of reasons why this could be the case – it’s easier to compensate, people are unaware of what their body is doing, I need to improve my coaching, etc. But, the fact remains that these muscles rarely get strengthened. And, when they are strengthened, they usually are not strengthened enough.
Exercise Progression for Greater Trochanteric Pain Syndrome
Below is the progression of exercises we use to strengthen the involved muscles in individuals who have GTPS. Here’s some general rehab exercise guidelines to assist you –
- Start with less reps at a time (15-20 max), but complete more frequently (2-3x) throughout the day
- As symptoms improve, you can increase reps (30-40) at a time and decrease frequency (1x) throughout the day
- End-stage rehab looks like strength and conditioning programming – 2-3x/week, 3-4 sets, 6-20 reps (depending on whether you want to bias for strength or endurance)
- Pain shouldn’t be more than moderate and it should resolve within 15 minutes of completing the exercise
- Pain also shouldn’t increase as you complete the exercise additional times throughout the day or week
Side-lying Hip Abduction
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. Properly treating this form of hip pain involves gradually strengthening the muscles while resuming painful activities with graded exposure.
If you’re experiencing greater trochanteric pain syndrome and struggling to find relief, we recommend reaching out for a free consultation. There’s no obligation to work with us, no fine print, and no strings attached. We simply want you to be able to get back to doing what you love without discomfort and without getting lost in the medical system!