Greater Trochanteric Pain Syndrome
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.
The Greater Trochanter
The greater trochanter is the bony prominence you can feel on the outer side of your hip. It is the attachment point for several important muscles and tendons that control hip movement and stability:
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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
Figure 1: Lateral view of the hip showing the greater trochanter, gluteal muscles, trochanteric bursa, and iliotibial band (ITB)
What is Greater Trochanteric Pain Syndrome?
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.
Condition
Description
Frequency
Gluteal tendinopathy
Degenerative changes in the gluteus medius and/or minimus tendons where they attach to the greater trochanter
Most common (60–70%)
Trochanteric bursitis
Inflammation of the trochanteric bursa between the gluteal tendons and the ITB
15–20%
Gluteal tendon tears
Partial or complete tears of the gluteus medius or minimus tendons
10–15%
External snapping hip
The ITB snapping over the greater trochanter during movement
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.
Figure 2: Comparison of healthy gluteal tendon (left) versus tendinopathy with degeneration and secondary bursitis (right)
Causes and Risk Factors
Category
Risk Factors
Biomechanical
Weak hip abductors, leg length discrepancy, wide pelvis (female anatomy), altered gait pattern, ITB tightness
Activity-related
Sudden increase in walking/running, prolonged standing, repetitive stair climbing, high-impact exercise
Postural
Habitual leg crossing, sleeping on affected side, standing with hip hitched, sitting on low chairs
Medical
Obesity (BMI > 25), lower back pain, osteoarthritis, previous hip surgery, hormonal changes (menopause)
Age & Gender
Women aged 40–60 most commonly affected (2–3× more common than in men)
Signs and Symptoms
The hallmark symptom of GTPS is pain on the outer side of the hip. This pain typically:
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Is localised over the bony prominence on the outside of your hip
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Worsens when lying on the affected side at night
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Increases with walking, climbing stairs, or prolonged standing
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May radiate down the outer thigh (but not below the knee)
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Is aggravated by crossing your legs or sitting in low chairs
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May cause a limp during prolonged walking
Severity
Typical Presentation
Mild
Pain only with specific activities (e.g., long walks, lying on side). Normal daily function.
Moderate
Pain with most weight-bearing activities. Disturbed sleep. Difficulty with stairs and prolonged standing.
Severe
Constant pain at rest and with activity. Significant sleep disturbance. Limp present. Unable to lie on either side.
Diagnosis
GTPS is primarily diagnosed through clinical examination. Mr Dehne will assess your hip using specific tests:
Test
What It Assesses
Palpation over greater trochanter
Direct tenderness at the tendon insertion
Resisted hip abduction
Pain/weakness suggesting gluteal tendinopathy
Single leg stance (30 seconds)
Pelvic drop indicating gluteal weakness
FABER test
Differentiates hip joint pathology from lateral pain
Trendelenburg test
Assesses gluteus medius function
Modified Ober's test
ITB tightness contributing to compression
Imaging
Ultrasound (USS) is the first-line imaging modality — it can visualise tendon thickening, tears, bursal fluid, and guide injections in real-time. MRI may be requested for complex cases to assess the extent of tendon damage and rule out other pathology. X-rays are useful to exclude hip joint arthritis or calcification.GTPS is primarily diagnosed through clinical examination. Mr Dehne will assess your hip using specific tests:
Treatment Options
Treatment follows a stepwise approach, starting with conservative measures and progressing if symptoms persist:
Stage
Treatment
Expected Outcome
1. Activity Modification
Avoid aggravating positions, sleep modifications, load management
Symptom reduction within 2–4 weeks
2. Physiotherapy
Gluteal strengthening (isometric → isotonic → functional), ITB stretching, core stability
60–70% improvement at 12 weeks
3. USS-Guided Injection
Corticosteroid or PRP injection under ultrasound guidance
Significant pain relief for 3–12 months
4. Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) — 3–5 sessions
68–79% success rate at 12 months
5. Surgery
Gluteal tendon repair, bursectomy, or ITB release (rare)
Reserved for refractory cases (< 5% of patients)
- USS-Guided Injection Therapy
Ultrasound-guided injections allow precise delivery of medication directly to the affected area. Mr Dehne performs all injections under real-time ultrasound guidance to ensure accuracy and safety.
Injection Type
Mechanism
Evidence
Corticosteroid
Reduces inflammation and pain rapidly. Best for acute flares and bursitis-predominant symptoms.
75% pain relief at 4 weeks; effects may diminish by 3–6 months (Mellor et al., 2018)
PRP (Platelet-Rich Plasma)
Concentrated growth factors from your own blood to stimulate tendon healing. Better for chronic tendinopathy.
Superior long-term outcomes vs corticosteroid at 12 months (Fitzpatrick et al., 2019)
Figure 3: USS-guided injection technique — real-time ultrasound ensures precise needle placement at the gluteal tendon insertion
After your injection:
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.
Extracorporeal Shockwave Therapy (ESWT)
Shockwave therapy uses focused acoustic waves to stimulate healing in damaged tendons. It is a non-invasive treatment option with strong evidence for GTPS:
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Stimulates blood flow and neovascularisation in the damaged tendon
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Triggers release of growth factors to promote tissue repair
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Disrupts pain signalling and reduces chronic pain sensitisation
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Breaks down calcific deposits if present
Protocol: 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.
- Rehabilitation Programme
Structured rehabilitation is the cornerstone of GTPS treatment. The programme follows a progressive loading approach through four phases:
Phase 1: Pain Management & Load Reduction
Weeks 0–2
Isometric gluteal holds (pain-free), gentle hip flexor stretches, sleep position modification (pillow between knees), avoid aggravating activities (crossing legs, standing on one leg)
Phase 2: Isometric Strengthening
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
Phase 3: Isotonic Strengthening
Weeks 6–12
Side-lying hip abduction (progressive resistance), standing hip abduction with band, single-leg mini squats, step-ups (low step progressing to higher), clamshells with resistance band
Phase 4: Functional Rehabilitation
Weeks 12+
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
Activity
Advice
Sleeping
Sleep on your back or unaffected side with a pillow between your knees. Use a mattress topper for pressure relief.
Sitting
Avoid low chairs and crossing your legs. Use a cushion for hard seats. Stand up and move every 30 minutes.
Walking
Maintain a normal stride length. Use a walking stick in the opposite hand if needed. Build distance gradually.
Stairs
Lead with the unaffected leg going up, affected leg going down. Use the handrail for support.
Driving
Use a cushion if the seat is low. Avoid long journeys without breaks. Swing both legs out together when exiting.
Exercise
Swimming and cycling are excellent low-impact options. Avoid running and high-impact activities until Phase 4 of rehabilitation.
- Frequently Asked Questions
How long does GTPS take to resolve?
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.
Will I need surgery?
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.
Can I still exercise?
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.
Is GTPS the same as hip arthritis?
No. GTPS affects the tendons and bursa on the outside of the hip, while arthritis affects the hip joint itself (inside the groin). However, the two conditions can coexist, and Mr Dehne will differentiate between them during your assessment.
How many injections can I have?
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.
Why is it worse at night?
Lying on the affected side compresses the inflamed tendons and bursa against the bone. Even lying on the opposite side can stretch the ITB over the trochanter. Sleeping on your back with a pillow under your knees is usually most comfortable.
- Warning Signs — When to Seek Urgent Help
While GTPS is not a dangerous condition, seek medical attention if you experience:
- Sudden severe pain following a fall or trauma
- Inability to bear weight on the affected leg
- Redness, warmth, or swelling over the hip (possible infection)
- Fever or feeling generally unwell alongside hip pain
- Numbness or tingling extending below the knee
- Rapid unexplained weight loss with hip pain
- References
- Mellor R, et al. Education plus exercise versus corticosteroid injection for gluteal tendinopathy: a randomised clinical trial. BMJ. 2018;361:k1662.
- Fitzpatrick J, et al. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy. Am J Sports Med. 2019;47(5):1130–1137.
- Rompe JD, et al. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 2009;37(10):1981–1990.
- Furia JP, et al. Low-energy extracorporeal shock wave therapy for greater trochanteric pain syndrome. Am J Sports Med. 2009;37(9):1806–1813.
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910–922.
- Ganderton C, et al. Gluteal loading versus sham exercises to improve pain and dysfunction in postmenopausal women with greater trochanteric pain syndrome. J Women’s Health. 2018;27(6):815–822.
- Ladurner A, et al. Management of greater trochanteric pain syndrome: a narrative review. Cureus. 2024;16(7):e65279.
While GTPS is not a dangerous condition, seek medical attention if you experience:
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Get expert assessment and treatment for your lateral hip pain.
Your Consultant
Mr Kenan Dehne
Consultant Orthopaedic Surgeon
MD, MCh Orth, FEBOT Orth, FRCSEd Orth, CCST
Specialist in Knee & Hip Surgery
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