Greater trochanteric pain syndrome

Greater trochanteric pain syndrome (GTPS) is a common and painful condition of the outer side of the hip and thigh. You may also hear it called lateral hip pain or trochanteric bursitis. It happens when the tissues lying over the outside of the hip bone (the greater trochanter) become irritated.

The soft tissues that attach to the outside of the hip include tendons and bursa. When these are overloaded, they are the main source of the pain in GTPS.

The condition is more common in females and in people aged between 40 and 60 years old, but it can affect any age.

Greater trochanteric pain syndrome (GTPS) doesn't look the same in everyone. You may have some of these symptoms or all of them:

• pain in the hip, thigh or buttock area
• worse pain when lying on your side or with direct pressure
• pain that increases with exercise, such as long periods of walking, standing or running
• tenderness to touch
• pain when sitting with your legs crossed
• pain when standing on the affected leg (sometimes called hanging on the hip)
• pain when climbing stairs
• pain when lifting your legs in or out of a car or bed

Greater trochanteric pain syndrome (GTPS) often comes on for no apparent reason. Still, a few things seem to contribute to it. These include:

• a sudden increase in the load on your hip
• a change in your activity levels, like walking longer distances or at a faster pace
• more pressure on your hip area from sitting or standing in one position for too long, or from putting your weight on one leg
• less strength and flexibility in the muscles around the hip and buttock
• having a sedentary, inactive lifestyle or being overweight
• an injury, like a fall onto the side of your hip
• hormone changes, which may also influence GTPS
• osteoarthritis of the hips and knees, or low back pain, which can also be linked to it

The first thing to work out is which of your activities cause or worsen the pain in greater trochanteric pain syndrome (GTPS). Once you know, changing those activities can help ease your symptoms.

The key to getting better is slow, progressive loading of the soft tissues, using exercises that strengthen the muscles involved. Over time, you should gradually increase the exercises so the tendons and muscles become stronger, less painful and better able to cope with your normal activity levels.

Other things that can help improve symptoms include:

• spreading your weight evenly across both feet and not leaning on just one leg
• avoiding low chairs
• avoiding sitting with your legs crossed
• avoiding sleeping on the painful side, and trying instead to lie on your back with a pillow under your knees, or on your good side with a pillow between your legs to keep them in line with your hip joints
• trying to keep active and stay at work, even if you have to modify your duties
• losing weight if you are overweight

GTPS can often take 6 to 12 months of rehabilitation to settle, but this will depend on the cause.

It is normal to have flare ups during this time. If this happens, it may be best to reduce the repetitions or rest for a few days before starting again.

Pain medicine can help you move more comfortably, and moving comfortably helps your recovery.

If painkillers aren't helping to control the pain from greater trochanteric pain syndrome, your doctor may talk to you about having a corticosteroid injection into the outer hip.

Corticosteroids are medicines that help reduce pain and inflammation. They may also be given with a local anaesthetic.

The injection may not cure your condition. It is used to help with the pain.

With greater trochanteric pain syndrome (GTPS), you may sometimes need to take some time off work while you recover. How long you stay off depends on your condition and on the kind of work you do.

You don't have to be free of symptoms before you think about going back. Carrying on with work, or returning as soon as you're able to, will help your recovery.

Getting back to your normal daily activities bit by bit can also help build up your strength and stamina.

If you follow this advice, you should see gradual improvements over time.

Talk to a doctor if:

• your symptoms haven't improved within 6 weeks of following this advice
• your symptoms get worse

Find out about access to MSK services in your area.

Whatever condition you're dealing with, look after your mental wellbeing too, because it can affect your recovery.

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