Greater Trochanteric Pain Syndrome Symptoms

Have you ever had that ‘aching, burning, and/ or gnawing’ pain on the outer side of the hip that is tough to shake? Does that pain make sleeping difficult because you can’t lay on that particular side, or are you limited with daily activities like walking, running, standing from sitting, and climbing or descending stairs? If this sounds like you, there is a high likelihood your ailment may fall under the umbrella diagnosis of Greater Trochanteric Pain Syndrome (GTPS).

What is Greater Trochanteric Pain Syndrome

GTPS is a non- specific diagnosis given to patients who have pain on the outside of the hip which doesn’t identify a specific site of nociception (pain producing tissue), although the gluteal muscles and tendons as well as the associated bursae (fluid filled sacs which serve to reduce friction between tissue in the body) are generally accepted to be the primary sources of pain in this condition. We see this a lot at City Physio in Martin Place, partly due to the demographic of our patients, i.e. people who spend a long time sitting prior to throwing themselves into an impromptu high intensity workout. Managing such an issue is most effectively done by identifying the specific movement patterns that are stressing the lateral hip during meaningful tasks to each patient and formulating an effective rehabilitation program based on these findings.

As stated above the structures which are most involved in GTPS are the gluteal tendons and multiple bursae around the hip. Risk factors for GTPS include female gender, obesity, low back pain, scoliosis, leg length discrepancy, knee pain or osteoarthritis and training errors/ overtraining. The movement strategy which commonly creates compressive loading on these structures usually involves a deficit in output from the hip abductor muscles creating a dynamic valgus (collapsing inward) at the knee and/ or a Trendelenburg sign (hip drop) at the opposite hip when standing on the painful side. Most of the risk factors cited have some correlation with the above movement strategy. Some factors are non- modifiable (female gender and scoliosis to an extent), and some are modifiable (knee/ back/ hip pain) and often associated with changes in muscle strength and length around the pelvic girdle.  It’s the modifiable impairments that should are the focus when looking at treatment.

Diagnostically, GTPS patients will always present with tenderness of the greater trochanter (outer bone of the hip). This is the most important test to rule in the condition. Patients may, but won’t always, have pain on functional testing depending on the irritability of the condition at the time of presentation but a battery of tests assessing hip and gluteal function should be included not only for identifying movement impairments but also as a means of reassessment and tracking a patients symptoms. Go- to tests may include a gait assessment, sustained single leg standing, single leg squat, step up/ down, and hopping. Differential diagnoses that must be considered and screened for include lumbar referred pain and hip joint pathology which can be cleared quickly in clinic with specific tests which will load both areas through various ranges of motion both actively and passively.

How Long Does Greater Trochanteric Pain Syndrome Last

After taking a good history and a comprehensive physical assessment we will have a great game plan revolving around short, mid and long- term goals. Rehabilitation will be incremental and involve optimising lumbo- pelvic/ core control (the pelvis is the socket of the hip so dissociating the femur from the pelvis and spine), and hip strengthening which may start with static loading, progressing into slow, control focussed loading into plyometric and task specific exercise. Treating this condition should always be approached actively before considering passive interventions such as corticosteroid injection (this is still an option for those stubborn hips,) because even if short- term relief is achieved, there is still an increased risk of recurrence if the weakness which causes compression to the lateral hip is not addressed.

If your hip pain has been persistent and crying out for attention don’t wait, pop in to City Physio in Martin Place and let one of our expert clinicians devise a plan to kick this pain ASAP and get you back to doing whatever it is you desire.

Get In touch with us today.

Matthew Hagerty