Greater trochanteric pain syndrome

Greater trochanteric pain syndrome (GTPS) is a common hip condition that causes pain over the outside of your thigh or buttock muscle.

GTPS (previously called trochanteric bursitis) is due to small changes to the nearby muscles or tendons. GTPS often mimics pain generated from other sources, including degenerative joint conditions, i.e. osteoarthritis of the hip and spinal problems.

Between 20 and 30% of people with low back pain experience GTPS. It is more common in people over 40, and affects women more than men.

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Causes and symptoms

Causes of GTPS

An injury such as a fall on to the side of your hip area.
Excessive repetitive movements involving your hip area such as increased walking distances, brisk walking pace, running too far a distance.
Prolonged or excessive pressure to your hip area such as sitting for long periods in chairs that are too low, crossing your legs, weight-bearing through one leg whilst standing or a change in mattress.
Reduced strength and flexibility of the muscles around the hip and buttock.
A consequence of osteoarthritis of knees and hips.
Inactive lifestyle and being overweight can contribute.

Symptoms of GTPS

A burning or aching pain in the outer bottom, thigh or buttock area. This can travel down to your knee.
Pain when lying on your side.
Pain that increases with exercise such as long periods of walking, standing or running, and ascending stairs.
Altered walking pattern.
More noticeable pain when walking briskly.
Tenderness to touch.
Pain to sit with your legs crossed.

Diagnosis of GTPS

Pain on palpation of the bony prominence (also known as the greater trochanter) is a common marker.
There are other tests your clinician will undertake to assess the strength of the buttock muscles, as well as ruling out other causes of hip pain.
Imaging such as x-rays and ultrasound scans are rarely useful, but may be warranted if symptoms do not improve with appropriate treatment.

Self management of GTPS

General advice

Decrease aggravating activities, such as running or excessive walking; but try to remain active. When you are standing still, avoid leaning on one hip and keep your weight evenly through both feet. Avoid sleeping on the aggravated side. If sleeping on the opposite hip, try placing a pillow between your knees to stop your painful leg crossing over. Avoid sitting with your legs crossed, or on low chairs.

Weight loss

Losing weight will reduce the pressure through your joints. There are useful tools to find out if your weight is contributing to your GTPS and advice on losing weight on the NHS website:

BMI calculator Weight loss plan Exercise advice

Pain killers

Pain killers may be used to provide short term pain relief: anti-inflammatory gels or tablets can be helpful. Ice can also be helpful: wrap an ice pack in a damp towel and place onto the area for up to 20 minutes. If you have any questions your local pharmacy will be able to advise about what is safe.

Footwear

Wear cushioned comfortable footwear to reduce impact when walking.

Exercises for GTPS

Exercise 1: knee bend in lying

Lying on your back
Bend your hip and knee to your chest
Return to a lying position
Repeat

Exercise 2: piriformis stretch

Lying supine with your knees bent
To stretch your right buttock
Rest your right ankle up onto the left knee
Rotate your knee out to the side

Progression:

In this position, pull your left knee up assisting with your hands
Feel the stretch in your buttock

Exercise 3: clam (lateral hip rotation in side lying)

Lying on your left side with your hips and knees bent
Lift your right knee up and rotate your hip
Forming a gap between your knees
Repeat

Exercise 4: hip abduction in standing

Stand sideways
Make sure you are supported
Keep your knee straight
Take your leg out to the side
Repeat

Exercise 5: bridge

Lie face up on the floor, with your knees bent and feet flat on the ground
Keep your arms at your side with your palms down
Lift your hips off the ground until your knees, hips and shoulders form a straight line
Squeeze your buttocks
Hold your bridged position for a couple of seconds before easing back down

Exercise 6: chair squat

Stand in front of chair of an appropriate height (a lower chair increases the difficulty and a higher chair is less difficult)
With your feet about shoulder width apart, sit with your hips back as if to sit into a chair whilst raising your arms front of you
Touch the chair with your bottom and then return to standing whilst lowering your arms

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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