Greater trochanteric pain syndrome presents as pain and tenderness over and around the greater trochanter, or lateral hip, that may worsen with walking, climbing stairs or when lying on the affected hip. Most often the painful tissue will be the gluteal tendons and bursa. Often resulting from overuse or repetitive stress, greater trochanteric pain syndrome is primarily linked to inflammation or injury of the tendons, particularly the gluteus medius and gluteus minimus, or irritation of the nearby bursa. Greater trochanteric pain syndrome is frequently seen in active individuals, particularly runners, cyclists, and those who engage in activities involving repetitive hip movement. Early intervention through physiotherapy can help manage symptoms, reduce pain, and improve function, enabling a return to normal activity.
Frequently Asked Questions
What causes greater trochanteric pain syndrome?
Greater trochanteric pain syndrome is often caused by overuse or repetitive stress to the tendons around the hip, particularly the gluteus medius and gluteus minimus. It can also be linked to poor biomechanics, such as weakness in the hip abductors, or abnormal walking or running patterns. Other factors include aging, obesity, and certain activities that put strain on the hip.
How is greater trochanteric pain syndrome diagnosed?
Your physiotherapist may begin with taking a history of the patient and performing a clinical examination. Observation and palpation can be used to diagnose greater trochanteric pain syndrome by identifying deformities, asymmetry or abnormal posture, and tenderness over the greater trochanter. With palpation, if there is no tenderness of the greater trochanter, there will be no gluteal tendinopathy shown on an MRI. Special tests such as resisted hip abduction and external rotation test, FABER test, resisted external de-rotational test and trendelenburg test can contribute to the diagnosis of greater trochanteric pain syndrome.
If necessary, diagnostic imaging like x-ray, ultrasound and MRI can be completed to show a clearer diagnosis. Research shows an MRI has found gluteal pathology in 88% of individuals and can show tears and other soft tissue pathologies if there is any suspicion.
What treatment is used by physiotherapists to manage greater trochanteric pain syndrome?
Your physiotherapist will determine what impairments you have and then treat these with passive and active interventions. Impairments may include hip abductor weakness, loss of pelvic control, or ITB tightness and thickening. Passive interventions may include manual therapy such as soft tissue mobilisation or joint mobilisations. The use of TENS and ice as an adjunctive therapy can reduce pain and inflammation.
Active interventions can strengthen the hip and surrounding structures. An exercise program may start with isometric exercises with a submaximal contraction. The principle of progressive overload is applied to work towards heavy resistance exercises and eccentric loading. Through graded exposure, the goal is to return to normal activities and reduce the likelihood of recurring flare ups. Patient education is important and is geared towards activity and postural modifications, as well as exercise adherence and consistency.