Greater Trochanteric Pain Syndrome
Greater Trochanteric pain syndrome (GTPS) is an umbrella term which describes pain along the outer side of your hip. This is usually caused by an injury or irritation to the soft tissue structures that lie over the top of your outer thigh bone. The soft tissue structures that are commonly involved are the gluteus minimus and gluteus medius muscles and tendons and also the trochanteric bursa. One, or a combination of two or three, of these structures may be involved in this pain syndrome.
Common symptoms can involve pain at night, especially if lying on your side. Additionally, other common symptoms may include pain when sitting, moving from sitting to standing, ascending or descending stairs or slopes, or simply weight bearing on the leg involved.
What Causes Greater Trochanteric Pain Syndrome ?
Compressive and tensile loads are known to adversely affect tendon health. The gluteus minimus and medius tendons alongside the trochanteric bursa are naturally exposed to higher compressive loads. This is because they wrap around the outer part of the hip bone, especially where they are attached to the bone. Certain postural habits or muscle imbalances can cause the overlying more superficial muscles to amplify these compressive forces. Over time the gluteus medius and/or minimus muscles and/or the trochanteric bursa begin to complain and become painful. Quite quickly, they start to complain with any compressive force that is applied to them and even light touch. The trochanteric bursa especially, contains millions of pain sensitive nerves and if involved can quickly become very painful.
Things to Avoid:
If you are experiencing Greater Trochanteric Pain Syndrome, there are certain activities and postural positions worth avoiding. Which in turn will help to minimise further tendon/bursa compression and allow the structures to heal. Highest compressive loads may be applied when the hip is in a position of adduction. Adduction is a term used when the leg is moved towards the centre line of the body for example if you were to cross your left leg over your right leg.
The Following Positions Are Worth Avoiding:
Sitting with crossed legs.
Sitting in low chairs, where the knee is higher than the hip.
Sleeping on the sore hip. If you sleep on the other side then you need to place a pillow between your legs to stop the top leg falling into adduction.
Hip hitching when standing. Instead stand with equal weight through your feet so that your pelvis is level. This is a common postural habit to watch if you are a mother or grandparent carrying a baby or young child.
Sitting with your weight shifted to the side. Instead sit with equal weight through both buttocks.
Tips to Help Recovery:
Place pillows between your legs at night.
Sit equally on both bottom cheeks.
Stand equally through both feet. Weight bear on your mid foot so that you have equal weight through all of your toes and heels.
If you have to lie on your sore side for example in an exercise class, place a pillow under the sore hip to help cushion it.
Avoid low chairs and don’t sit for too long at a time.
Ice may help the pain. Place ice in a damp tea towel and apply for 15 -20 minutes at a time to the painful area. 3 times a day. Applying some baby oil to the skin where you apply the ice will prevent an ice burn. Don’t have an ice pack? We do sell them in the clinic so feel free to pop in or enquire during your next appointment!
Treatment of Greater Trochanteric Pain Syndrome
Load management education and specific exercise is the routine evidence based approach for management of this painful condition. Exercise prescription will be specific to the individual and will depend on a number of factors, such as postural habits and previous medical history. For example, previous injuries and pain syndromes may have caused compensational strategies resulting in some muscles weakening and some muscles becoming tight. The aim of treatment will be to reduce pain by preventing adverse compressive loads to the soft structures involved. As well as improving postural habits, muscle imbalances and carefully improving the load tolerance to the gluteal tendons and bursa involved. Once the pain starts to resolve, then your therapist will be keen to progress your rehab to include functional weight bearing exercises that correlate with your activities of daily living, sporting and work goals.
Our goal is to get your hips soft tissues tolerating load really well for all those activities you want to be able to achieve, to prevent the problem from coming back.
If you are suffering from lateral hip pain, the sooner you seek help from your physiotherapist or chiropractor the better!
They will diagnose the problem and get you on the correct path to recovery. The sooner you address pain, the easier and quicker it is to get it resolved. If you have no significant past medical history and you have had pain for less than 3 months, then usually it takes about 3 months from when you start your rehab program for Greater Trochanteric Pain Syndrome to start resolving.
Recovery times tend to double if the pain has been there for longer than 3 months.
Whilst you are waiting for your first therapy consultation here are a few exercises that will very carefully expose your outer hip soft tissue muscles to a bit of loading to help them in their recovery. Stretching your thigh muscles (quadriceps) is also helpful, as tightness in this muscle can increase compressive forces to the outer hip structures (exercise 3).
Exercises
Shoulder bridge and band.
Place a resistance band around your knees. Knees and feet hip width apart so that there is some tension on the band.
Inhale to prepare.
Exhale, gently roll your lower back into the mat, scoop your tail bone upwards and continue to peel your spine off the mat until you are resting on your shoulder blades.
Inhale and hold, lengthening your knees over your toes. Notice your bottom muscles engage.
Exhale and lower one bone at a time, starting with your breastbone and finishing with your tailbone.
Keep hips, knees and feet in line throughout.
Repeat 10 reps 2-3 sets in one session. 1-2 x a day.
Sit to stand and band.
Place a resistance band around your knees. Knees and feet hip width apart so that there is some tension on the band.
To stand: press your mid foot ( balls of feet and just behind) down into the floor as if you are squashing a pancake with the balls of your feet as you stand.
To sit: push your knees forwards over your toes and bring your hips back so that your weight sinks down through your heels as you sit.
Keep your toes down throughout. Keep your hips, knees and feet in line throughout. Avoid your knees from rolling in. The aim is to feel your bottom muscles and legs work.
Repeat 8-15 times and 2-3 sets in one session.
Quadriceps stretch.
Stand behind and hold a chair for support with one hand.
Stand on the mid foot of one leg. Knee a little soft, but grow up tall to feel your core engage.
Use the other hand to grab your ankle or trouser leg to bring your heel towards your bottom. Aim to point your knee towards the floor keeping your pelvis slightly tucked under. Aim is to feel a gentle stretch on the front of the thigh.
Hold 30 seconds about 4 times a day.
If you are struggling with lateral hip pain or have any questions, do get in touch or book online here for a Physiotherapy Initial Consultation. We are here to help!
