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Greater Trochanteric Pain Syndrome (GTPS) is lateral hip pain which can also radiate into the buttock, groin, ITB area, quads or hamstrings. The pain can be quite severe and interrupt sleep. Classically it is made worse by walking up and down stairs, sitting crossed legged or high impact activities such as running. During Lockdown we have seen an increase in this type of condition which is often associated with the all or nothing culture of sitting and working at home in front of the PC then engaging in a sudden increase of exercise that the body is not use to. 
Physiologically GTPS is caused by increased load on the Gluteus Medius, Gluteus Minimus and deeper rotator muscles of the buttock which insert into the greater trochanter located near the top of the thigh bone. Undue stress can be placed on these tendons creating reactivity in the tendon which causes pain or in more advanced cases a tendinopathy that is associated with a structural change in the tendon that can produce pain, weakness, inflammation and even stiffness. Telling signs are excessive pain when palpating the tendon insertion, difficulty standing on one leg, pain going up or down stairs and a reduction in gluteal strength. 
It can be more prevalent in perimenopausal women where there appears to be a link with hormonal changes. Smoking and diabetes also have detrimental effects on tendons. 
For treatment to be successful it is important to isolate the cause of tendon overload, which is often an imbalance between the strength / control functions of the lower limb musculature. In the past, we often suggested rest in combination with soft tissue techniques however recent research would suggest that this is not always a successful intervention. Current research and opinion is that it is preferable to avoid aggravating movements or positions that cause excessive pain whilst strengthening the gluteal muscles in a controlled manner to improve tendon strength and movement control so that a return to the patients activity of choice is facilitated. 
Exercises typically begin in stationary positions to activate the gluteal muscles with reduced load and then are progressed to more dynamic positions as pain allows. When strength and control improves exercises are prescribed to become more sport or function specific. 
In runners or sports that involve running dynamic pelvic control, stride length and lower limb positioning can also be assessed via slow motion video analysis and tips on running cues that off load the tendon can be given. 
There are alternative causes of lateral hip pain which need to be excluded to get accurate diagnosis and treatment to resolve symptoms. The lumbar spine can refer pain to this area and the Sciatic Nerve can be a source of pain as it glides along its course from the lumbar spine though the complex deep gluteal musculature. It is important to consider the hip joint as degenerative changes can also mimic some of the symptoms associated with lateral hip pain or GTPS. 
Ninety percent of people with symptoms of GTPS recover with conservative treatment. Once you have an understanding of the cause of your symptoms, management and resolution is much easier. 
If you feel you are experiencing symptoms that may be related to GTPS and would like further advice please feel free to contact us or book an appointment. 
Tagged as: Lateral thigh pain
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