Treatments Classes

Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome (GTPS) is a condition characterised by chronic pain and tenderness on the outside of the hip, specifically around the greater trochanter, which is the bony prominence at the top of the femur (thigh bone). It is often associated with inflammation or injury to the structures surrounding the greater trochanter, including the muscles, tendons, and bursae. GTPS can be caused by various factors including tendinopathy or overuse of the tendons within the area, bursitis, direct trauma to the hip such as a fall or blow to the outer hip, repetitive stress, biomechanical issues, or muscle imbalances.

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Symptoms

1.Lateral hip pain: Pain on the outer side of the hip, which can radiate down the thigh or buttock.
2.Tenderness: Tenderness to touch over the greater trochanter.
3.Pain with movement: Pain that worsens with activities such as walking, running, climbing stairs, or lying on the affected side.
4.Swelling: Swelling or warmth over the greater trochanter area (in cases of bursitis).

Treatments

GTPS can be treated with several treatment modalities, and your physiotherapist will be able to identify the most appropriate for you based on symptoms.
Initial treatment will often involve physiotherapy designed to control the pain by minimising the compression of the structures around the lateral hip whilst managing the load on the tendons in this area. Early-stage treatment will involve relative rest, ice, and advice around pain relief medications to control symptoms (1). Exercising of the gluteal muscles is also vital to reduce the symptoms of GTPS, and exercises should focus on gluteal muscle control and increasing strength, whilst a gradual return to activity or sport should be implemented once appropriate to ensure that symptoms do not progress or worsen (1). Massage and manual therapy to the hip and leg musculature have also been found to facilitate recovery, particularly when used in conjunction with exercise therapies (2).
Shockwave therapy, or Extracorporeal Shockwave Therapy Treatment (ESWT), has been shown in several studies to be effective in the treatment of GTPS (3). EWST is considered to stimulate healing through stimulating cellular activity and increasing blood flow to the target area, and has been shown to provide a reduction in symptoms that are maintained 12 months later (4,5).

References

1.French HP, Woodley SJ, Fearon A, O’Connor L, Grimaldi A. Physiotherapy management of greater trochanteric pain syndrome (GTPS): an international survey of current physiotherapy practice. Physiotherapy. 2020 Dec 1;109:111-20.
2.Torres A, Fernández-Fairen M, Sueiro-Fernández J. Greater trochanteric pain syndrome and gluteus medius and minimus tendinosis: nonsurgical treatment. Pain Management. 2018 Jan;8(1):45-55.
3.Reid D. The management of greater trochanteric pain syndrome: a systematic literature review. Journal of orthopaedics. 2016 Mar 1;13(1):15-28.
4.Kaux JF, Forthomme B, Le Goff C, Crielaard JM, Croisier JL. Current opinions on tendinopathy. Journal of sports science & medicine. 2011 Jun;10(2):238.
5.Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. The American journal of sports medicine. 2009 Oct;37(10):1981-90.
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