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Understanding lateral hip pain — causes, diagnosis, and evidence-based treatment options
- Understanding Your Hip — Anatomy
The hip joint is one of the largest and most stable joints in the body. It is a ball-and-socket joint formed by the femoral head (ball) sitting within the acetabulum (socket) of the pelvis. While most people are familiar with the hip joint itself, the outer aspect of the hip — the lateral hip — is equally important and is the area affected in Greater Trochanteric Pain Syndrome.
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Gluteus medius — the primary hip abductor muscle that lifts your leg sideways and stabilises the pelvis during walking
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Gluteus minimus — a deeper muscle that assists with hip abduction and internal rotation
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Trochanteric bursa — a fluid-filled sac that reduces friction between the gluteal tendons and the iliotibial band (ITB)
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Iliotibial band (ITB) — a thick band of connective tissue running from the pelvis down the outside of the thigh to the knee
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Greater Trochanteric Pain Syndrome (GTPS) is an umbrella term for conditions causing pain on the outer side of the hip, over or around the greater trochanter. It affects approximately 1.8 per 1,000 adults per year in primary care and is 2–3 times more common in women, typically presenting between the ages of 40 and 60.
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Most common (60–70%)
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15–20%
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10–15%
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5–10%
Previously, lateral hip pain was often labelled simply as ‘trochanteric bursitis.’ However, research using MRI and ultrasound has shown that isolated bursitis is actually quite rare — in most cases, the primary problem is gluteal tendinopathy (degeneration of the tendons), with bursitis being a secondary finding.
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Women aged 40–60 most commonly affected (2–3× more common than in men)
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??????? ???????? ??? ??????? (USS) is the first-line imaging modality — it can visualise tendon thickening, tears, bursal fluid, and guide injections in real-time. MRI ?? ????? ??? ?? ??????? ??????? ?????? ??? ???? ????? ???????? ????? ????? ????. X-rays ????? ??? ???????? ?? ??????? ?????? ???? ????? ?? ?????. ??????? ??????? ??? ?????? ?????? (GTPS) ???? ????? ?? ???? ????? ???????. ????? ????? ???? ?????? ???? ???????? ?????? ?????.
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1. ????? ??????
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Symptom reduction within 2–4 weeks
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Gluteal strengthening (isometric → isotonic → functional), ITB stretching, core stability
60–70% improvement at 12 weeks
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Significant pain relief for 3–12 months
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Extracorporeal shockwave therapy (ESWT) — 3–5 sessions
68–79% success rate at 12 months
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75% pain relief at 4 weeks; effects may diminish by 3–6 months (Mellor et al., 2018)
???????? ?????? ???????? ??????? (PRP)
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Figure 3: USS-guided injection technique — real-time ultrasound ensures precise needle placement at the gluteal tendon insertion
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Avoid high-impact activity for 48 hours. You may experience temporary soreness at the injection site. Pain relief typically begins within 3–7 days for corticosteroid, and 4–6 weeks for PRP as healing occurs.
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????????: Typically 3–5 sessions at weekly intervals. Each session lasts 10–15 minutes. Evidence shows 68% success rate at 4 months (Rompe et al., 2009) and 79% success at 12 months (Furia et al., 2009), with outcomes superior to corticosteroid injection at long-term follow-up.
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Weeks 0–2
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Weeks 2–6
Side-lying isometric abduction (hold 30–45 sec × 5 reps, 3×/day), standing wall press (hip abduction against wall), bridging with band, core activation exercises
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Weeks 6–12
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Single-leg balance and proprioception, lateral band walks, step-downs, sport-specific drills, gradual return to impact activities (walking → jogging → running)
Figure 4: Key rehabilitation exercises for GTPS — isometric holds, side-lying abduction, clamshells, bridging, standing abduction, and single-leg balance
- Living with GTPS — Practical Advice
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With appropriate treatment, most patients see significant improvement within 3–6 months. However, some cases can take up to 12 months for full resolution. Early intervention and adherence to rehabilitation give the best outcomes.
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The vast majority of GTPS cases (over 95%) resolve with non-operative treatment. Surgery is only considered after at least 6–12 months of failed conservative management.
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Yes — but you need to modify your activities. Low-impact exercise (swimming, cycling, walking within pain limits) is encouraged. Avoid running, jumping, and activities that aggravate your symptoms until your physiotherapist advises progression.
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??? ???????? ????? ??????? (GTPS) ???? ??? ??????? ???????? ???????? (??????) ???????? ?? ????? ??????? ?? ?????? ????? ???? ?????? ??????? ??? ???? ????? ???? (?? ????? ???????). ??? ???? ???? ?? ?????? ???????? ????? ?????? ????? "????" ???????? ?????? ????? ????? ???????.
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Corticosteroid injections are typically limited to 2–3 per year to avoid tendon weakening. PRP injections do not carry this limitation and can be repeated if clinically indicated.
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- Warning Signs — When to Seek Urgent Help
??? ????? ?? ?? ??????? ????? ??????? ?????? (GTPS) ???? ???? ?????? ??? ??? ????? ???? ??? ??????? ?????? ??? ????? ??:
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- ????? ??????. ??????? ????????? ????? ??? ???????????????? ????? ?????? ??????? ???????: ????? ?????? ???????. BMJ. 2018?361:k1662.
- ?????????? ??????. ?????? ??? ???????? ?????? ???????? ??????? ?? ???? ?????? ????? ???????. ?????? ????????? ???? ???????. 2019;47(5):1130–1137.
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- ????? ?? ??? ??????. ???? ???? ?????? ???? ????? ????? ?????? ????? ??????? ????? ????????. ?????? ????????? ???? ???????. 2009;37(9):1806–1813.
- ???????? ?? ????? ?. ?????? ????? ??????? ???????: ??? ??????? ??????? ??????? ???????? ?? ????? ??????. ???? ?????? ??????? ??????? ?????? ??????. 2015;45(11):910–922.
- ????????? ??????. ????? ??????? ??????? ????? ???????? ??????? ?????? ????? ?????? ??????? ??? ?????? ??? ?? ????? ???????? ???????? ??? ?????? ??????. ???? ??? ??????. 2018;27(6):815–822.
- ??????? ?. ??????. ????? ??????? ??? ?????? ??????: ?????? ?????. ???????. 2024?16(7):e65279.
??? ????? ?? ?? ??????? ????? ??????? ?????? (GTPS) ???? ???? ?????? ??? ??? ????? ???? ??? ??????? ?????? ??? ????? ??:
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