In this article, you will find out everything you need to know about trochanteric pain and the most effective ways to treat it, including an advanced treatment called Prolotherapy.

Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome (GTPS) also known as hip bursitis is a familiar infection of the greater trochanter that results in irritation over the outside of your affected hip or thigh muscles. Clinical findings have shown that , the gluteus medius tendon, and the tendons of hip abductors(muscles in the buttocks) supplement the greater trochanter of the femur. So, that’s why you feel pain and stiffness in the gluteal tendon (tendinopathy), at the site of the greater trochanter, the bone tendon intersection, or the superimposed fluid-filled pouch called a bursa. Bursa is one of the soft tissues structure that can easily get inflamed.

Each hip has two significant bursae. The greater trochanter, which is the outermost tip of the hip, has a bursa termed the trochanteric bursa. (The bursa on the inner aspect of the hip is known as the iliopsoas bursa.) When that external hip bursa/ trochanteric bursa gets swelled up, you will have a condition called trochanteric bursitis or hip bursitis. In ancient times, greater trochanteric pain syndrome was called trochanteric bursitis. It was believed that this pain was due to an infected trochanteric bursa (a tiny fluid-filled sac over the area of the greater trochanter). According to stats, the incidence of hip pain on the lateral aspect is about 1.8 out of 1000 patients annually.

People suffering from greater trochanteric pain syndrome or hip bursitis complain of pain in their lateral thigh that intensifies with prolonged climbing stairs, sitting, lying over the infected region, or some hard physical exercise. Recent  MRI and Ultrasound investigations reveal that hip joint pain is more frequently caused by inflammation in tendon structure such as the gluteal muscle tendons (gluteus minimus, medius, and Maximus), and the soft tissue structure, and the head of the femur bone.

How Does Greater Trochanteric Pain Syndrome Affect?

The most recent research on this syndrome has shown that greater trochanter pain syndrome has been most predominant over the last four to six decades and affects gluteal tendons and trochanteric bursa, resulting in severe pain in the hip muscles.

It was revealed by medical science dealing with epidemics and treatment (epidemiology) that the inflammation of a trochanteric bursa or hip bursitis has a very intense mutual relation with the female gender and obesity. The female gender is more predominant due to hip joint osteoarthritis (degeneration of the joint that 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 of Lateral Hip Pain

There are hundreds of possible factors that can cause greater trochanteric pain syndrome. 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 greater trochanteric pain syndrome to worsen are as follows:

 Any physical trauma 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. Thigh bone injuries or gluteal tendon tears can also aggravate hip pain over some time.

Also, you can also suffer from GTPS because of muscle overuse, this can be both short-term and 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 gluteal muscles and lead to conditions such as scoliosis (abnormal lateral curvature of the spine), arthritis (inflammation of joints), and other spine complications.

Additionally, according to the clinical trials, excessive hip adduction is observed in individuals with weak hip abductors, particularly GMed, resulting in greater compression of the   GMed and GMin tendons at the greater trochanter. With increasing adduction, the ITB generates greater compressive stresses on the gluteal tendons, hence intensifying compression. Hip positions in greater ranges of flexion may also enhance the compression of the  GMin and GMed tendons as a result of upsurged tension in the Iliotibial band, which explains why prolonged sitting causes pain due to hip bursitis.

Obesity:

Trochanteric bursitis 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 bursitis 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 trochanteric bursitis. 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/ hip bursitis.

Hip bursitis/ primary bursitis is more likely to occur in those who are prone to joint pain due to other inflammatory disorders, such as rheumatoid arthritis and gout.

Symptoms of Greater Trochanteric Pain Syndrome:

Some 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, and 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 presenting with 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.

Home Remedies to Cure Trochanteric Pain Syndrome:

If the trochanteric bursitis is at its initial stage, it can be improved at home by just performing some regular exercises. According to the randomised clinical trial, people who exercise reported a significant pain reduction associated with hip bursitis. 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:

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, lie on your right side, then straighten up your right arm. Now extend your left unaffected leg as far as possible and slowly raise your leg above the ground.

Medical Treatment:

In some instances, trochanteric bursitis at a chronic stage can’t be treated by just home remedies. You need to get help from an orthopaedic immediately.

• Clinicians may recommend non-steroidal and anti-inflammatory medication along with complete rest. NSAIDs may help with analgesia in the acute phase, but it is not advised in chronic gluteal tendinopathy.
• Steroid injections: corticosteroid injection and local anesthetic may also be effective in reducing symptoms of hip bursitis. This is a simple and successful procedure that can be performed in the doctor’s office. A single local corticosteroid injection is administered into the hip bursa. The injection may either provides temporary pain relief or permanent pain relief. However,  inflammation and pain recur a few months after the initial injection, a second injection may be beneficial, but diagnosing the origin of the bursitis is necessary for definitive treatment. Additionally, it is essential to minimize the number of injections, as extended corticosteroid doses may cause tissue damage.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat Greater Trochanteric Pain Syndrome.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help Greater Trochanteric Pain Syndrome.

As prolotherapy is helping to treat the root cause of Greater Trochanteric Pain Syndrome, it is deemed to be a permanent fix, preventing the symptoms from returning.

• Conservative treatments include extracorporeal shockwave therapy (SWT) or radial shock wave therapy, PRP injection, and activity modification. If all conservative measures fail, orthopaedic surgeons may recommend surgical treatment of the Iliotibial band of the affected leg. Gluteal tendon repair will be performed in case of gluteal tendon tear. Similarly, in case of hip joint injuries or fractures, hip joint arthroplasty will be performed. To measure the outcome of patients after surgery, the HHS is used. The Harris Hip Score (HHS) is a clinician-based outcome metric commonly used to evaluate patients after total hip arthroplasty.
• Additional conservative treatment includes the use of therapeutic ultrasound to improve blood flow to the muscles and relieve pain.
• The doctors also suggest physical therapy. A physiotherapist teaches you some physical activities that strengthen your buttock muscle and improve hip abductor muscle function.
• A physiotherapist may recommend manual therapy to relieve greater trochanter pain as a result of hip bursitis. Myofascial constraints of the joints underneath the hip, the hip joint itself, and the lumbar spine might cause higher friction at the lateral hip; consequently, myofascial release is recommended if a restriction is identified. Where joint constraints exist,  ankle, knee, hip joint, and lumbar spine mobilization can be performed to enhance mobility, consequently improving pelvic biomechanics and minimizing friction at the lateral hip.
• Other treatments include Shockwave therapy with low energy. In this shockwave therapy, a gadget transmits acoustic shock waves through the skin.  According to the National Institute of Health and Clinical Excellence, more than two-thirds of patients treated with shock wave treatment were cured or significantly better after four months.
• A patient can also use other treatments such as rolling therapy, a form of massage that relaxes muscles, and promotes blood flow to the joint or muscle.

Diagnosis: 

GTPS is the clinical diagnosis for lateral hip pain and consists of lower limb tendinopathy and trochanteric bursitis. Your healthcare professional may recommend the following tests to help with diagnosing the greater trochanter pain syndrome

• MRI (magnetic resonance imaging)
• X-Ray
• Ultrasound
• Bone Scanning
• FADER test (flexion, adduction and external rotation)
• Single leg stance test( It has a positive predictive value of 100 percent).

These tests are of great help in diagnosing trochanteric bursitis. A doctor can also follow a diagnostic flow chart to eliminate the different causes of hip pain.

 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 trochanteric bursitis.

Body Weight Reduction:

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 and can cause trochanteric bursitis.

Prevent Falls and Jerks:

Always wear rubber-soled shoes, properly fitting shoe insert, 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 trochanteric bursitis.

Strength Exercises:

It is important to strengthen your gluteal muscles (especially the gluteus minimus as it is a hip abductor) to avoid greater trochanter pain syndrome. Hip or prosthetic implants will be required to restore mobility in case of severe fractures.

 Bottom line:

Usually, you’ll first notice pain on the outside of the hip. Trochanteric bursitis 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 with. if you’re looking for other treatments 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. However, in severe cases of tendon tear, surgical intervention will be required.

Frequently Asked Questions

• How do you treat greater trochanter pain syndrome (GTPS)?

During the early phase of injury GTPS, rest, ice, soft tissue therapy, and taping are advised to reduce pain and inflammation.

• What causes trochanteric bursitis?

GTPS is usually caused by stress placed on the hip from repeated activity or exercise, it can also be caused by long periods of standing, as people place more weight on one hip.

• What does great trochanteric pain feel like?

Pain begins on the most outer part of your hp and travels down the outside of the thigh towards the knee. Often described as aching or burning type pain and triggered by exercises or laying on the painful hip.

• How long does trochanteric bursitis take to heal?

There is no set scale as every case is different but usually within months rather than weeks.

References:

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