Greater Trochanteric Pain Syndrome (GTPS) is a form of hip pain that results in irritation over the outside of your hip or thigh muscles. Medical research has shown that the tendons of the medial glute muscle (muscles in the buttocks) supplement the greater trochanter of the femur. So, that’s why you feel pain and stiffness in the tendon (tendinopathy), the bone tendon intersection, or the superimposed fluid-filled pouch called a bursa.
In ancient times, greater trochanteric pain syndrome was named trochanteric bursitis. It was believed that this pain was due to an infected bursa (a tiny fluid-filled sac). According to stats, the incidence of lateral hip pain is about 1.8 out of 1000 patients annually.
People suffering from the condition complain of pain in their lateral thighs that intensify with prolonged climbing stairs, sitting, lying over the infected region, or some hard physical exercise.
How Does Greater Trochanteric Pain Syndrome Affect?
The most recent research on this syndrome has shown that greater trochanteric pain syndrome has been most predominant from the last four to six decades and affects gluteal tendons and bursa, resulting in severe pain in the buttock muscle.
It was revealed by medical science dealing with epidemics and treatment (epidemiology) that trochanteric pain syndrome has a very intense mutual relation with the female gender and obesity. The female gender is more predominant due to osteoarthritis (degeneration of joint and causes pain and stiffness in hip joints), osteoporosis (decreased bone density), and hernia in pregnant women. It is also prevalent in obese people.
Common Causes Causes of Lateral Hip Pain:
There are hundreds of possible factors that can cause GTPS. It is found frequently in women and middle-aged or older people. Factors vary from person to person according to their health condition. The most frequent and basic conditions that can cause trochanteric pain syndrome to worsen are as follows:
Any Injury on the Buttocks:
Any wound or injury on the hips followed by a fall, smashing the buttock into an object, jerk on the hip muscle, or lying on the constant side for a long period may cause greater trochanteric pain syndrome. Thighbone injuries or tendon tears can also aggravate hip pain over a period of time.
Also, you can also suffer from GTPS because of muscle overuse, this can be both short-term or long term depending on the underlying pathophysiology of the disease.
Inappropriate Standpoint:
A wrong standing position, particularly while doing exercises or any physical activities, can result in stiffness and tightness in buttock muscles and lead to conditions such as scoliosis (abnormal lateral curvature of the spine), arthritis (inflammation of joints), and other spine complications.
Obesity as a cause of greater trochanteric pain syndrome:
Greater trochanteric pain syndrome is frequently widespread in obese people. Being overweight exerts pressure on the thigh and hip muscles, leading to severe pain in the buttock muscles.
The difference in Legs:
Some people have one leg larger than the other, leading to more exertion of force on the soft tissues of one leg, which causes pain in that buttock joint.
Besides the causes mentioned above, in some rare situations, the causes of greater trochanteric pain syndrome are unidentified, like if the patient is also suffering from other medical health issues.
Trochanteric Bursitis
Trochanteric bursitis is an inflammation of the trochanteric bursa. It can also aggravate the greater trochanteric pain syndrome. The latest research now defines non-inflammatory tendinopathy of the gluteus medius muscles to be the major factor behind lateral hip pain as well as low back pain.
Iliotibial band (ITB) is a cause of pain and inflammation secondary to trochanteric impingement and consequent development of trochanteric bursitis.
Symptoms of Greater Trochanteric Pain Syndrome:
Some certain conditions and symptoms indicate that you might suffer from gluteal tendinopathy (aka greater trochanteric pain syndrome):
- Pain is felt in buttock muscles while doing physical activities for a long period like running, walking, standing.
- More noticeable stiffness and irritation when lying on that side. Sometimes, the pain reaches its peak value and may awaken the patient from sleep.
- Patients suffering from this syndrome also account that the pain minimizes their strength and feels weakness in their legs.
- Initially, the pain is acute, but it may convert into a chronic form and get worse and worse with time.
- When an affected region is touched, soreness and bruising are found.
Exercises for Trochanteric Pain Syndrome:
If the greater trochanteric pain syndrome is at its initial stage, it can be improved at home by just performing some regular exercises. Initially, keep the exercise duration short, but you can gradually increase the workout time. This will strengthen your hip and thigh muscles, stabilize your muscles, and protect them from injury.
Lying leg circle:
First, stretch your legs and on your back straight, then excite your left leg 3 inches above the ground and make small circles with it. Carry out three sets of 5 repetitions on each leg.
Hip bridges for greater trochanteric pain syndrome:
Bend your knees, lie on your back with your feet straight on the ground, and then elevate your buttocks until they queue up with your shoulder and knees. At last, lower your hips to the ground slowly. Carry out five sets of 20 twirls.
Lying Lateral Leg Raises:
To start off, lie on your right side, then straighten up your right arm. Now extend your left leg as far as possible and slowly raise your leg above the ground.
Medical Treatment:
In some instances, greater trochanteric pain syndrome at a chronic stage can’t be treated by exercise so you would need to seek orthopaedic treatment:
Prolotherapy
The structures in and around the greater trochanter have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.
Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is needed to heal them and provide pain relief.
As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.
- Some clinicians may recommend non-steroidal and anti-inflammatory drugs along with complete rest. NSAIDs may help with analgesia in the acute phase, but it is not advised in chronic gluteal tendinopathy.
- The doctors also suggest physiotherapy. A physiotherapist teaches you some physical activities that strengthen your buttock muscle and provide flexibility to your musculoskeletal system.
- Local corticosteroid injections (steroid injections) are also used for trochanteric pain syndrome patients to limit inflammation and offer pain relief.
- Other conservative treatments include shockwave therapy (SWT), PRP injection, and activity modification. If all else fails, Iliotibial band surgery of the affected side is an option too if needed.
Diagnosis:
Your healthcare professional may recommend the following tests to help with diagnosing the condition:
- MRI (magnetic resonance imaging)
- X-Ray
- Ultrasound
- Bone Scanning
- FADER test (flexion, adduction and external rotation)
These tests are of great help in diagnosing greater trochanteric pain syndrome.
Safety Measures to Avoid Trochanteric Pain Syndrome:
If you adopt some steps as safety measures, you can avoid and keep yourself away from trochanteric pain syndrome. Your buttock muscles become more healthy, strong, flexible, and injury-free.
Appropriate Posture:
Correct standing and perfect position while doing hard physical exercises play a significant role in protecting you from greater trochanteric pain syndrome.
Reduction of Body Weight for greater trochanteric pain syndrome:
Increased body weight exerts some extra pressure on your joints. So, it is imperative to lose weight if you’re obese. This can help you to relieve pressure on joints.
Repetitive Activities:
If your muscles cannot do repetitive exercises, avoid this as it puts stress on the hips.
Prevent Falls and Jerks:
Always wear rubber-soled shoes and use a walker or cane if you have mobility problems. This will provide flexibility to your muscles and joints and keep you away from greater trochanteric pain syndrome.
Strength Exercises for greater trochanteric pain syndrome:
It is important to strengthen your gluteal muscles (especially gluteus minimus as it is a hip abductor) to avoid greater trochanter pain syndrome.
Bottom line:
Usually, you’ll first notice pain on the outside of the hip. The greater trochanteric pain syndrome can be quite challenging to live with as it can impede your day to day activities. Physical therapy is a great option to get started it if you’re looking for conservative treatment options. It is very important to avoid any risk factors discussed above to lower the chances of developing lateral hip pain. If the condition gets worse, it is imperative to seek primary care and consult an expert orthopaedic.
Frequently Asked Questions
How do you treat greater trochanter pain syndrome (GTPS)?
There are several ways through which greater trochanter pain syndrome can be treated. The first and foremost approach that you may take is to rest the area and apply ice for 20 to 30 minutes after almost every 4 hours. Other treatment strategies include:
- Physiotherapy
- Anti-inflammatory medication
- Local corticosteroid injection
- Weight reduction
What causes greater trochanteric pain syndrome?
Many reasons may cause greater trochanteric pain syndrome. The most common cause is overusing or stressing the hip during repetitive exercises like running and cycling. Other causes include:
- Keep standing for long periods
- Injury
- A hard hit to the hip bone
- Obesity
What does greater trochanteric pain feel like?
Greater trochanteric pain changes its magnitude during its course. At first, it is usually intense, extreme, and sharp. But as the time passes, it may turn out to hurt more significantly. Pain is generally felt at the side of the hip, which may likewise be felt outwardly of the thigh.
How long does greater trochanteric pain syndrome take to heal?
As greater trochanteric pain is a deep-rooted condition, it requires a lengthy treatment. Most instances of Greater Trochanteric Pain Syndrome settle on their own in no less than a little while or months. However, side effects might continue for up to some months. Generally, it can require 6 to 9 months of centered recovery activities to get back to regular pain-free exercises.
Is walking good for Greater Trochanteric Pain Syndrome?
Generally, strenuous exercises are not good for such medical conditions, so jumping and running should be avoided but walking would make a better alternative. Walking more than 3 km can aggravate the pain, so, taking precautions, you should limit your walk to 2 km. In a nutshell, walking is good if it is done within limits.
What are the first signs of greater trochanter pain syndrome?
Many changes and signs of your body will tell you about greater trochanteric pain syndrome, the first one of which is pain. The pain aggravates when you try to lay down on one side or walk hastily. Walking patterns also change due to pain. Other signs include tenderness and swelling.
References
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- Orenstein, B. W., Theobald, M., Suszynski, M., Orenstein, B. W., Vann, M. R., & Editors, E. H. (2021). 5 common causes of hip chronic pain in women. EverydayHealth.com. Retrieved January 8, 2022, from https://www.everydayhealth.com/hip-pain/five-common-causes-of-hip-pain-in-women.aspx
- Clinic, C. (2018). Trochanteric bursitis: Symptoms, causes, treatments. Cleveland Clinic. Retrieved January 8, 2022, from https://my.clevelandclinic.org/health/diseases/4964-trochanteric-bursitis
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