Tronchanteric Pain Syndrome

Greater trochanteric pain syndrome (GTPS) is a condition characterised by pain and tenderness on the outer side of the hip, near the greater trochanter of the femur bone. It often occurs due to degeneration, inflammation or irritation of the tendons, muscles, or bursa surrounding the greater trochanter.

The symptoms of greater trochanteric pain syndrome can vary from person to person but commonly include the following:

• Pain in the hip, thigh, or buttock area.
• Increased pain when lying on the affected side or with direct pressure on the hip.
• Exacerbation of pain during activities such as walking, standing, or running.
• Tenderness to touch in the hip region.
• Discomfort when sitting with legs crossed.
• Pain when standing on the affected leg is often described as “hanging on the hip.”
• Difficulty climbing stairs.
• Pain when lifting legs in or out of a car or bed.
•  
• These symptoms can significantly impact daily activities and may vary in intensity depending on the individual and the underlying cause of the syndrome.

Greater trochanter pain syndrome encompasses various conditions that lead to pain in the same area. The underlying causes may include:

• Injury to the gluteal tendons.
• Inflammation of the hip bursae (bursitis).
• External coxa saltans (snapping hip syndrome).
•  

This syndrome can develop due to:

• Repetitive activities cause friction between the femur and the IT band.
• Excessive exercise intensity or volume.
• Sedentary lifestyle.
• High body fat percentage.
• Scoliosis.
• Leg length discrepancy.

Diagnosing greater trochanter pain syndrome typically involves a combination of clinical tests rather than relying on a single diagnostic procedure. Some commonly used tests include:

• Single leg stance test: This test involves standing on one leg for 30 seconds and observing if pain occurs within that time frame, which can   indicate greater trochanter pain syndrome.
•  
• Resisted hip rotation and abduction: These tests assess the strength and function of the hip muscles and tendons, with resisted lateral rotation showing high sensitivity and specificity.
•  
• Specialised manoeuvres like FADER, OBER, and FABER aim to increase tension on the gluteal tendons, helping to identify greater trochanter pain syndrome.
•  
• Observation of daily activities: Assessing activities like putting on socks and shoes can provide insights into functional limitations associated with greater trochanter pain syndrome.

• Direct palpation of the greater trochanter: Palpating the greater trochanter for tenderness, known as the “jump sign,” can help diagnose greater trochanter pain syndrome.

• Trendelenburg sign: This test evaluates hip muscle weakness, which may be present in patients with greater trochanter pain syndrome and indicates a potential gluteus medius tear.
•  
• Specialised tests for external coxa saltans: Tests like FABER, Ober, Hula-Hoop, and active hip flexion followed by passive extension and abduction can help diagnose this condition when suspected.

Imaging is recommended under the following circumstances:

• When gluteal tears are suspected, Ultrasound or MRI may be utilised to confirm the diagnosis if clinical suspicion arises.
•  
• When conservative treatment has proven ineffective: When conservative approaches fail to alleviate symptoms, imaging may be warranted to further evaluate the underlying cause.
•  
• When the diagnosis remains unclear: If clinical assessments yield inconclusive results, imaging studies such as ultrasound or MRI can provide additional information to clarify the diagnosis.

Treatment options for greater trochanteric pain syndrome include:

• Laser Therapy
• Shockwave Therapy
• Neuromuscular Release
• Acupuncture and Dry Needling
• Custom Orthotics
• Functional Exercise
• Joint Mobilisation
• PHF Stretching
• Spinal Manipulation
• Cupping
• Percussion Massage
• Core Isolation Training
• Traction
• Mobiliser Machines
• Scar Tissue Stretches and Guasha

These approaches aim to alleviate pain, reduce inflammation, improve muscle function, and restore mobility in the affected area. Treatment plans may vary depending on the individual’s specific needs and response to therapy. It’s important to consult one of our practitioners to determine the most appropriate treatment approach for each greater trochanteric pain syndrome case.

Rest may be recommended initially after developing greater trochanteric pain syndrome to allow for tissue healing. However, prolonged rest is not typically advised. It’s essential to gradually reintroduce movement and strength-building exercises to support tissue healing and promote recovery. Returning to normal activities gradually is critical for achieving good short- and long-term outcomes. While exercise may initially exacerbate symptoms, listening to your body and gradually increasing activity levels can lead to improvements over time. Regular practice of exercises designed to improve movement in the leg can help alleviate symptoms and restore function. It’s essential to monitor pain levels and progress, adjusting the intensity and frequency of exercises to avoid exacerbating symptoms.

We assess your symptoms, movement and activity demands before discussing a management plan. Shockwave therapy is not a necessary part of every plan; any recommendation should consider suitability, alternatives and condition-specific evidence.

While medications may be prescribed to manage pain associated with greater trochanteric pain syndrome (GTPS), it’s important to note that they are typically used as part of a comprehensive treatment plan and are not considered the sole solution. Additionally, medications alone may not address the underlying causes of greater trochanteric pain syndrome. 

We discuss options and likely timeframes after assessment.

Greater trochanteric pain syndrome frequently recurs despite conservative treatment approaches. Patients commonly report temporary relief from pain with medication. However, addressing the underlying cause can significantly diminish the likelihood of recurrence. Targeting the root cause of the syndrome, such as biomechanical issues or muscular imbalances, can substantially reduce the risk of repeated episodes.

The primary and most efficient lifestyle modifications for addressing greater trochanter pain syndrome include the following measures:

• Maintain a balanced level of physical activity both at work and at home.
• Adjust your daily activities to avoid repetitive or aggravating movements.
• Engage in exercises designed to strengthen the muscles surrounding your hip.
• Maintain a healthy body weight to alleviate excess stress on the affected area.
• Effectively manage any other existing health conditions you may have.

Factors that increase the risk of developing greater trochanteric pain syndrome include being female, obesity, experiencing knee pain, tenderness in the iliotibial band, and low back pain. Notably, greater trochanter pain syndrome usually doesn’t cause redness, severe swelling, fever, or malaise. If you experience these symptoms, it may indicate the presence of an infection or another underlying condition that requires medical attention.