Greater trochanteric pain syndrome

Greater trochanteric pain syndrome (GTPS) is an umbrella term for lateral hip pain and commonly involves an issue with the gluteal tendons (gluteus medius and minimus). The gluteal tendons become irritated where they attach to the greater trochanter (the hard-bony bump on the side of your hip). Underneath the gluteal tendons lies a bursa (a sac of fluid to reduce friction of the tendons) which can become inflamed when compressed.

Causes of GTPS

There are many causes of GTPS, but it is most commonly caused by being overloaded.

Risk factors associated with developing GTPS can be found below (Plinsinga, M et al 2019):

  • High BMI- causes excessive mechanical load on the tendons and the elevated inflammatory markers (caused by high BMI) may reduce tendon load tolerance.
  • Gender – there is a 4:1 prevalence in females to males.
  • Ages 40-60 years old – Hormonal changes associated with menopause are linked to reduced collagen tensile strength, reduced size of tendon and increased tendon degradation.
  • Anatomy – larger greater trochanteric width can increase compression on gluteal tendons.
  • Hip abductor strength – reduced strength of hip abductors increases risk of injury.
  • Abnormal hip biomechanics- increased hip adduction when walking results in compression of the gluteal tendons.

Symptoms of GTPS

  • An aching/ burning or sharp pain felt on the outside of the hip and may radiate to the outside of your thigh.
  • Pain notably on single leg standing.
  • Pain may be worse when lying on the affected side, particularly at night.
  • Pain during and after certain exercises – including walking, running and going upstairs.

Hip Joint Anatomy

The deep gluteal muscles – gluteus medius and minimus (see image below) both facilitate mostly hip abduction but also assist with internal rotation of the femur. They both also stabilise and control movements at the hip and pelvis and are therefore important with a variety of activities, including walking, going upstairs and running.

The gluteus medius and gluteus minimus both attach to the greater trochanter. The greater trochanter is the large bony prominence on the outside of the top of the femur (long thigh bone).

The gluteus maximus muscle is the largest muscle in the body and lays over the top of the gluteus medius and gluteus minimus. Its main role is extending the hip and supporting the pelvis with movements, particularly when standing on one leg. The gluteus maximus does not attach to the greater trochanter (see image below).


How to diagnose

During your appointment, your physiotherapist will take an in-depth history and perform a series of tests to check your strength, mobility and biomechanics. This will help develop a diagnosis, determine what led to your injury and help form your treatment plan on how to return to full activities without pain.

Diagnostic ultrasound can be performed in the clinic to check the gluteal tendons and bursa to confirm diagnosis.

Greater trochanteric pain syndrome



Physiotherapy Treatment

Current research shows that conservative management is the gold standard for treating GTPS with a 90% success rate (Speers at al, 2017).

The main goals of treatment are to manage load and reduce compressive forces across the greater trochanter, strengthen gluteal muscles and treat comorbidities.

Shockwave Therapy

Shockwave therapy can be a great adjunct alongside physiotherapy. Research has found it to be very effective for reducing pain and increasing function for 4-15 months (Carlisi et al, 2019),

This allows a window of opportunity for the patient to undertake their rehabilitation.

Greater trochanteric pain syndrome

Injection therapy

You may want to consider undergoing an ultrasound guided steroid injection or PRP injection if your symptoms are not settling with physiotherapy and shockwave therapy.

Steroid injection for GTPS

Steroid injections use a small dose of corticosteroid (a strong anti-inflammatory drug) and are injected under ultrasound-guidance.  Current evidence found that injections performed under ultrasound guidance are more accurate and more effective at reducing pain and improving function than landmark guided injections (Daniels et al, 2018).

PRP Injections

PRP injections are made up from your body’s own blood constituents. Blood is drawn from the patient (usually a vein in the arm). The blood is then spun very quickly in a specialist piece of equipment known as a centrifuge. The process causes the various constituents in the blood to separate into separate layers. One specific layer of the separated blood is plasma which will contain 2-5 times the usual number of platelets for a similar sample of normal blood. This layer is then extracted into a syringe ready to be injected back into the damaged area to stimulate healing.

If you are experiencing hip pain and want to find out what is causing your symptoms, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you.  Please contact us on 020 3475 5767 or email