Greater Trochanteric Pain Syndrome
Perhaps you’ve been diagnosed you with greater trochanteric pain syndrome (GTPS). This article provides information on what GTPS is and how it can be managed. If you have any questions, please speak to your physiotherapist caring for you.
What is GTPS?
GTPS is a painful condition affecting the outer thigh and hip area.
It occurs when the tissues that lie over the bony prominence (the greater trochanter) at the top of the thigh bone become irritated.
These can include tendons, muscles or bursae (fluid-filled sacs that help smooth movement between muscles, tendons and the hip bone).
This irritation may have occurred for a number of reasons, but it is most often due to overload and weakness – the structures are unable to cope with the strain applied to them.
What are the symptoms of GTPS?
Pain in your outer thigh and hip area.
This may feel like an aching or burning pain.
The pain may be more intense when you are lying on your side, especially at night.
You may notice it more when first standing up and walking.
It may become worse with exercise and you may find you walk with a limp.
GTPS is diagnosed in the clinic through taking a history and doing specific tests of the hip.
Usually, scans are not required to diagnose this problem and often do not change the treatment.
What causes GTPS?
The exact causes of GTPS are not fully understood, but there are many factors that can contribute to it.
The most likely contributing factor is prolonged or excessive compressive forces to your hip area (for example, sitting cross legged or sleeping on your affected side) in combination with weakness of the muscles surrounding the hip, called the gluteus medius and minimus.
A direct fall on the outside edge of the hip, excessive load( for example prolonged standing or walking) can also lead to increased load on this area of the hip.
How is GTPS managed?
To improve symptoms in the short term, you can try the following:
- Decrease aggravating activities, such as running, excessive walking, hills or uneven ground.
- Do not cross legs whilst sitting. Keep knees well apart – this protects the tendons on the outside of the hip.
- When standing, DO NOT let your hip pop out to the side (keep even weight on both feet).
- Stand with feet a little wider than your hips, feet slightly turned out. Knees ‘soft’, not locked back hard.
- Avoid sleeping on your painful side. Eggshell foam or mattress toppers can help when sleeping on the affected side. When sleeping on the opposite hip, try placing a pillow or two between your knees to stop your painful leg dropping over.
- Losing weight. Even 1 or 2kg makes a big difference on load through your hips.
- Pain killers may be used to provide short term pain relief.
As GTPS is most often related to hip structures not coping with heavy/frequent load, exercises to strengthen this area are essential to help healing, improve load tolerance and returning to normal activity in the short and long term.
Your treatment will predominantly involve an individualised and carefully monitored loading and strengthening program.
Your physiotherapist may identify other specific exercises for you to complete, such as helping your posture, balance and gait.
You should follow the instructions and monitor your performance of these carefully.
Load is needed to aid recovery but overload of the structures may worsen your pain.
As a result, pain will be used to guide your treatment and progression.
Remember a little pain is OK when completing your rehabilitation, however too much may be an indication you are overloading your hip.
Using your PhysiApp and liaising with your physiotherapist will help guide you.
Recovery Time For GTPS?
Unfortunately, recovery times for GTPS can be highly variable.
Recovery will depend on the time frame since onset of symptoms, severity of the syndrome, baseline strength and other biomechanical factors.
Recovery can take anywhere from 3-12 months.
This does not mean you will be in significant pain for this amount of time, but may take this long to build up your hips ability to tolerate the loads required of it.
Remember, this syndrome has likely been developing over a number of years, it will take some time and commitment to correct it.