Injuries Unpacked #10: Greater Trochanteric Pain Syndrome (GTPS)

Anatomy

The gluteus medius muscle runs from your hip bone and ends behind a bony prominence on your femur called the greater trochanter. The muscle joins to the greater trochanter through a piece of connective tissue called a tendon.

This muscle is very important for keeping the pelvis stable when you walk. It also moves your leg out sideways.

Mechanism of Injury

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of pain on the outside of your hip.

GTPS occurs when there is a gluteus medius tendinopathy and/or bursitis of the trochanteric bursa. Tendinopathy is a term for injury to a tendon, it develops when there is compression and excessive loading. Bursitis is inflammation of a fluid-filled sac called a bursa, it is also caused by compression. GTPS generally develops if your gluteal muscles are not strong enough for the activities you do. This results in the gluteus medius tendon being wrapped around the greater trochanter and compressed. You can visualise this like a phone charger that always gets bent in one spot and eventually gets damaged.

Risk Factors

Risk factors for GTPS can include:

  • Poor control of pelvic, back and hip position
  • Weak gluteal muscles
  • Tight muscles around the hip
  • Walking with a crossover foot pattern
  • Recent increase in activities like walking or running
  • More common in women – possibly due to shape of the pelvis
  • More common in people over 40 years old

What a physiotherapist can help with

Tendons respond really well to specific load and gradual return to activity, and your physiotherapist will develop an individualised program to help you get back to moving without pain.

Physiotherapists can help with:

  • Assessing and diagnosing the extent of the injury.
  • Explaining the prognosis and discuss treatment options.
  • Providing specific exercises for your gluteus medius and other contributing muscles
  • Addressing the causative factors to help you avoid tendinopathies in the future
  • Ensuring you are ready to return to sport or normal activity safely!

Tips for managing GTPS

Strength and control exercises are essential to reduce your pain. Another important factor is avoiding aggravating the tendon. Initially, you should avoid the following activities until you are stronger and have less pain.

  • Sitting with crossed legs
  • Sitting on low chairs (use pillows to make it taller if needed)
  • Do not lie on the sore side
  • If lying on the opposite side put a pillow between your legs