Greater Trochanteric Pain Syndrome
Understanding Greater Trochanteric Pain Syndrome
Greater trochanteric pain syndrome (GTPS) is a prevalent condition characterised by discomfort along the outer aspects of the hip, thigh, and buttocks. It often arises from injury or irritation to the soft tissues, such as muscles, tendons, and bursae, situated over the outer thigh bone. Initially referred to as hip or trochanteric bursitis, this condition was once thought to be primarily linked to inflammation of the bursa—a fluid-filled sac that provides cushioning between bones and tendons. However, contemporary research highlights that GTPS is typically caused by minor, often repetitive injuries to the gluteal muscles and tendons, particularly the gluteus minimus and gluteus medius, leading to a condition known as gluteal tendinopathy.
Common Symptoms
Pain associated with GTPS usually manifests on the outer side of the hip, thigh, or buttocks. While symptoms can differ among individuals, common experiences include:
Discomfort when lying on the affected side
Pain during walking
Discomfort while climbing stairs
Difficulty standing on the affected leg for extended periods
Increased pain after prolonged sitting
Pain when rising from a seated position
Discomfort while crossing legs
Pain with less physical activity than usual
Prevalence of GTPS
The likelihood of developing GTPS is higher for certain demographics, including:
Women: GTPS is four times more common in females than males
Individuals aged 40 to 60 years
Approximately 35% of people experiencing lower back pain also have GTPS
It's estimated that between 20% to 25% of the population will experience GTPS at some point in their lives.
Causes of Greater Trochanteric Pain Syndrome
Several factors can contribute to the onset of GTPS, and these often vary among individuals. Common contributors include:
Falling onto the hip
A sudden or excessive increase in physical activity or repetitive movements
Crossing legs frequently
Prolonged sitting
Sitting in chairs that are too low
Prolonged weight-bearing on one leg
Weakened hip muscles
Osteoarthritis affecting the hip or knee
Existing lower back pain
Dimensions and shape of the pelvis
Being overweight
A sedentary lifestyle
A combination of these factors can increase repetitive friction and stress on the gluteal muscles, tendons, and bursae, leading to GTPS.
Management and Treatment
GTPS generally has a slow response to treatment, often taking between 6 to 9 months or even longer for symptoms to improve. Patience and adherence to the following steps are essential for recovery:
1. Consult a physiotherapist/GP for an accurate diagnosis and pain management advice. As
2. Balance your levels of physical activity both at work and at home.
3. Adjust daily activities to avoid movements that exacerbate pain.
4. Perform exercises aimed at strengthening the hip muscles.
5. Maintain a healthy body weight.
6. Manage any other existing health conditions.
7. If exercise therapy under physiotherapist supervision does not work they may advise a course of Shockwave Therapy or onwards referral to Orthopaedics for review.
In some cases, surgical options or corticosteroid injections may be considered, but research indicates these treatments may be less effective and are generally reserved for situations where conservative measures have proven unsuccessful.
Pain Management Strategies
To manage pain effectively:
Remain active with gentle exercises, as inactivity can worsen symptoms over time.
Maintain employment and consider adjusting work duties if necessary.
Use ice packs wrapped in a towel on the affected area for up to 20 minutes for relief.
Use over-the-counter pain medications and anti-inflammatory drugs as advised by your healthcare provider.
In persistent cases, Shockwave Therapy or corticosteroid injections may be advised by your physiotherapist or GP.
Helpful Tips
Staying active is beneficial but avoid overexerting yourself if it increases your symptoms:
Consider using a pedometer to track your daily steps and keep a journal of your pain levels related to activity. Aim to gradually reduce and then incrementally increase your step count.
If specific exercises worsen your symptoms, reduce intensity and slowly reintroduce them. Alternative activities like swimming or cycling may be easier on your hips.
Pay attention to your posture throughout the day:
Avoid crossing your legs for extended periods.
Change sitting positions regularly.
Steer clear of low chairs.
When using stairs, take one step at a time and utilise handrails as needed.
Limit ascending steep hills whenever possible.
Sleep Positions
Sleep can also affect comfort. Try these positions to alleviate discomfort:
Lie on your back with a pillow under your knees to relieve pressure on the hip.
Lie on your side with the painful side up, placing a pillow between your legs.
Pacing and Spacing Activities
Applying pacing: breaking down activities into manageable segments with scheduled breaks can help in managing pain. Prioritising tasks can also prevent overstimulation of the pain response. Establishing a "baseline," or the amount of activity you can handle without increasing symptoms, allows for better planning of breaks and goal-setting. This approach ensures that you can gradually increase your activity levels while minimising discomfort.
What Home Physio Company can do to help you
Home Physio Company has a fantastic team of specialist Musculoskeletal Physiotherapists providing mobile physiotherapy services. Home visit physiotherapy for Greater Trochanteric Pain Syndrome (GTPS) provides a practical and effective way to manage this condition, which is characterised by pain and tenderness around the lateral hip area. Below is an outline of what home visit physiotherapy for GTPS typically involves, along with its benefits:
What to expect in a Home Visit Physiotherapy Appointment
Comprehensive Assessment:
Evaluation of pain levels, mobility, and function. Observation of gait patterns and postural alignment. Identification of aggravating activities (e.g., sleeping positions, sitting posture, stair use).
Personalised Exercise Program:
Stretching Exercises: Target tight structures like the iliotibial band (ITB) and hip flexors.
Strengthening Exercises: Focus on the gluteus medius and minimus to stabilise the hip and pelvis.
Functional Movements: Gradual reintroduction of daily activities with proper mechanics.
Manual Therapy:
Soft tissue massage to reduce tension in surrounding muscles.
Joint mobilisations (if necessary) to improve hip mobility.
Education and Ergonomic Advice:
Guidance on optimal sleeping positions (e.g., using a pillow between the knees).
Postural advice for sitting, standing, and other daily activities.
Tips to modify activities that exacerbate symptoms, such as avoiding prolonged sitting or crossing legs.
Pain Management Strategies:
Use of heat or cold therapy, as advised, for immediate pain relief.
Instructions for self-massage techniques or use of a foam roller.
Progress Tracking:
Regular reassessment of pain, strength, and function.
Adjustments to the treatment plan based on progress and patient feedback.
Benefits of Home Visit Physiotherapy for GTPS
Convenience and Comfort:
Eliminates the need for travel, which can be painful for GTPS patients. Patients can focus on recovery without logistical stress.
Real-World Adjustments:
The therapist can directly observe and modify the patient's home environment to reduce strain on the hip. Immediate feedback on how to perform exercises safely in their space.
Better Adherence to Treatment:
Therapists can ensure proper execution of exercises, which improves effectiveness and reduces the risk of further injury. Regular check-ins during home visits help patients stay committed to their recovery.
Holistic Care:
Treatment plans are tailored to the patient’s lifestyle and specific needs. The therapist can address psychological and emotional factors associated with chronic pain.
Prevention of Recurrence:
Focus on long-term strategies, such as maintaining strength and flexibility, to prevent future episodes.
Example Home Exercise Program for GTPS
Gluteal Isometrics:
Lie on your back with knees bent and squeese the glute muscles. Hold for 5–10 seconds. Repeat 10 times.
Side-Lying Clamshells:
Lie on your side with knees bent. Lift the top knee while keeping feet together. Repeat 10–12 times on each side.
Hip Abduction (Standing or Lying):
Place a pillow between your knees. Slowly lift the upper leg up lower it back. Perform 10–15 repetitions.
Sit to Stand:
Sit on a chair, place your hands in front and stand up, slowly lower back down to the chair without your hands. Repeat 10 times.
Bridging:
Lie on your back with knees bent. Lift your hips to form a straight line from shoulders to knees. Squeeze your glutes. Lower and repeat 10 times.
