What is greater trochanteric pain syndrome?

 

Your hip joints are among the biggest and strongest in your body. But they also take a lot of punishment, having to cope with loads of up to eight times your body weight just when you walk normally (i). So it’s no wonder many people develop painful problems in the hip area, including one called greater trochanteric pain syndrome (GTPS).

If you have GTPS you’ll usually experience pain on the outer side of your hip and sometimes also pain on the outer side of your thigh and downwards towards the knee. The pain – which can often feel like a deep ache or a burning sensation – can get worse when you sit for a long time, when you climb stairs, when you do a lot of high-impact physical activity (or indeed any exercise), when you get up out of a chair or bed, or when you lie on the affected side.
 
Some people with GTPS may struggle to stay physically active, and they could find it difficult to walk (some may even walk with a limp). Other things you may notice include joint stiffness, a clicking sensation in your hip, and your hip joint may seem warm and swollen. If you have GTPS, pressing on the side of the affected hip at its widest part can feel particularly painful or tender.
 
For most people the pain appears gradually over time, though in some cases it can develop suddenly – having a fall or a sports injury can trigger it, for instance. Repetitive movements can cause it too. According to Patient runners may develop GTPS, plus it can become a problem for people who’ve had hip surgery (iii).
 

What is the greater trochanter?

 

GTPS gets its name from part of your thigh bone (femur) called the greater trochanter. This is the large bony bump near the top outside of your thigh bone, not far from the hip ball and socket joint where your thigh bone meets your pelvis. You can easily feel the greater trochanter yourself, as it marks the widest point in the hip area.
 
The greater trochanter is the attachment point for tendons of several muscles, including the gluteus medius and gluteus minimus (these are some of the muscles in your buttocks). Where these gluteal tendons attach onto the greater trochanter are also a number of bursae – fluid filled sacs – which cushion the tendons and reduce friction between the tendons and the bone.

Years ago experts used to think GTPS was caused by inflammation of one or more of these bursae, so the condition was called trochanteric bursitis. Now, however, it’s thought that most cases of GTPS are caused by damage to the muscles or tendons in this area, and that it’s far less likely to be caused by an inflamed bursa. Indeed, experts now believe the symptoms of GTPS are more likely to be associated with myofascial pain – that is, pain caused by muscular irritation – than inflammation (vii). This explains why most medical professionals use the term greater trochanteric pain syndrome these days, rather than trochanteric bursitis.

The good news, however, is that for most people GTPS symptoms are self-limiting, which means they’re likely to get better without any treatment. NHS experts claim six out of 10 people with GTPS recover within a year – though some can take longer to get back to normal (viii). You may also recover more slowly if you are older, or if your symptoms are particularly severe. 
 

How common is greater trochanteric pain syndrome?

 

GTPS may not be the best-known hip complaint but it’s a fairly common one. According to the National Institute for Health and Care Excellence (NICE) it affects around 1.8 - 5.6 per 1,000 people every year (ii), while figures from Patient suggest one in 300 people develop GTPS annually (iii):
 

• Women aged 40 - 60 years are the most likely to experience GTPS (more women are affected than men, with one study suggesting 15 per cent of women aged 50+ are affected by unilateral GTPS – that is, they have the problem in one rather than both hips – compared with 6.6 per cent of men (iv)).

• The condition is also common in younger people, especially those who are very physically active such as runners, footballers and dancers.

• Between 10 and 20 per cent of people who see their GP for problems with hip pain are diagnosed with GTPS (v).

• Up to 35 per cent of people with low back pain also experience GTPS (vi).     
   

What causes GTPS?

The tendon damage thought to cause GTPS is called tendinopathy. This is a breakdown of the fibres that are found inside the tendon. There are a number of things that can cause this and other types of tissue damage involved in GTPS, including:
 

• Overuse of the muscles or excessive pressure (long-distance running, for instance, or standing for very long periods)

• Prolonged or excessive pressure on the muscles in the hip area (again this can be caused by prolonged activity, while poor running technique can increase the load on this area of the hip too)

• Inactivity and sedentary lifestyle

• Hip injury (such as after a fall) or damage to a gluteal muscle (a tear, for instance) 

• Uneven leg length (one leg longer than the other)

• Being overweight

• Spine problems such as scoliosis (curvature of the spine) or arthritis 

• Foot problems such as a bunion, plantar fasciitis (pain caused by straining your plantar fascia, which is where your heel bone connects to your toe bones) and Achilles tendonitis (pain in the ankle and heel)

• Arthritis of the hip, knee or foot

• Muscle imbalance in the hips

• Certain postures (including standing while leaning to one side with most of your weight on one leg, and crossing your legs when sitting)

• Weak gluteal muscles (often caused by an inactive lifestyle)

• Bone spurs on the hip (bony projections that develop along the edges of bones)

• Having surgical wire, implants or scar tissue in the hip area following hip surgery

• Infections such as gout, arthritis and tuberculosis, which may inflame a bursa (though these aren’t that common)

 
If you have lower back pain, you may also be more likely to experience GTPS symptoms.
 

How do you treat greater trochanteric pain syndrome?

 

Getting the right diagnosis

There are a few other conditions that have similar symptoms as GTPS, which can sometimes make diagnosis difficult, including:

• Osteoarthritis of the hip

• Hip impingement 

• Sciatica 

• Hip fracture

• Rheumatoid arthritis

• Referred back pain

• Pelvic problems

All of these conditions can be mistaken for GTPS. However there are ways to determine whether GTPS is likely to be causing your symptoms. Pressing the area on the outside of your affected hip is one – this has been described as the ‘jump sign’, since the pain can be so severe it can literally make you jump (if you don’t have pain at all when you press that part of your hip, it’s unlikely you have GTPS). You could also try standing on one leg (the affected leg): if you feel pain within 30 seconds, it’s a good sign of GTPS. On the other hand if you find it painful to put on your shoes and socks, you probably have another condition and not GTPS.
 
These and other simple tests are often used to diagnose GTPS, though occasionally someone with less typical GTPS symptoms may need more advanced tests to confirm the diagnosis, such as an x-ray, ultrasound or an MRI scan.
 

Types of greater trochanteric pain syndrome treatments

 

If diagnosed, what treatments might you be offered? If your symptoms are mild you may not be offered any treatment at all, since GTPS pain usually resolves on its own. According to NICE, 90 per cent of people with GTPS recover fully with conservative treatment such as rest, pain relief, physiotherapy or corticosteroid injection (ix):
 

• Rest: you may be advised to avoid any activity that makes the pain worse such as repetitive movements (running, for instance). Some gentle exercise, however, is recommended.

• Pain relief: taking over-the-counter painkillers such as paracetamol or anti-inflammatory drugs such as ibuprofen are often recommended for GTPS pain.

• Physiotherapy: if you’re referred to a physiotherapist they can show you exercises to help strengthen your quadriceps (thigh muscles) and your hip abductors (the muscles on the outside of your hips) as well as exercises to strengthen and stretch your gluteus medius and minimus. 

• Steroid injections: these are often offered if other treatments haven’t worked, though they may only offer short-term pain relief.

• Shock wave therapy – a type of ultrasound therapy – may also help treat GTPS, but clinical evidence for its effectiveness is scarce, so it’s only recommended for use under special circumstances.
   

How to help relieve greater trochanteric pain at-home

 

There are a few things you can do at home to relieve the pain of GTPS or stop it getting any worse. These include:

 

• Applying a cold pack (or ice wrapped in a towel) to the painful area for 10 minutes every few hours during the early stages of GTPS may help relieve your symptoms.

• Try not to sit with your legs crossed, as this can put extra pressure on the hip area. Also try not to sit with your knees wide apart or close together.

• Avoid sitting on very low chairs.

• Wear comfortable, low-heeled shoes that offer good support.

• Avoid standing for long periods and adopt a good standing posture – try not to push one hip out to the side or put most of your weight on one leg (try to make sure your weight is evenly distributed over both legs).

• In bed, lie on your back. If you must lie on your side, use the unaffected side, and keep your knees level (that is, not one higher than the other). Putting a pillow or cushion between your knees can help keep you in a good position. 

• Try to relax, since stress can make pain worse. Make time for relaxing activities that help you feel calmer. Also try a meditation or mindfulness app such as Headspace, Calm or Buddhify (available for Apple and Android devices).

• Get as much sleep as you need, as a lack of sleep can make pain seem worse. For tips on getting a more restful night, read our guide to sleep and insomnia. 

• Finally, if you have GTPS because you have one leg slightly shorter than the other, speak to your doctor about getting some orthotics (shoe inserts) made for you that will help you stand and walk more evenly.
   

What are the best exercises for greater trochanteric pain?

 

There are several exercises you can do at home that may help relieve the pain of GTPS. The experts at Guy’s and St Thomas’ hospital in London have put together a simple guide to exercises you can do in the different stages of GTPS (x) – here’s a quick selection:
 

Early stage exercises

1. Stand, holding on to a stable surface such as a chair or table for balance. Lift your painful leg out to the side and then slowly lower back to the normal standing position. Aim to complete three sets of 10 - 12 repetitions.

2. Lie on your unaffected side with a pillow between your knees. Bend your bottom leg at the knee, keeping your top leg straight and in line with your body. Lift your leg up towards the ceiling and slowly lower back to the starting position. Complete three sets of 10 - 12 repetitions.

Later stage exercises

1. Lie on your side with your painful leg towards the floor, with your knees bent behind you. Push up on your elbow, lifting your hips up so they’re in line with your body, Hold for 20 - 30 seconds and repeat three times. To make this more challenging you can keep both legs straight.

2. Stand at the bottom of your stairs, and without using the handrail step up onto the bottom step and then slowly down again using your painful leg. Complete three sets of 10 - 12 repetitions.

 

If you’re having a flare-up and your GTPS pain is particularly bad, stop or reduce your exercises until the pain returns to its normal level. Meanwhile a physiotherapist can show you other exercises that you can also practise at home.
 

Can your diet help?

Watching what you eat may be helpful if you have GTPS triggered by being overweight or obese, since eating a healthy balanced diet that’s low in saturated fats and sugar can help you lose excess weight. 
 
There are also some food supplements you could try. Inflammation isn’t thought to be the main cause of GTPS pain these days, but it can be a factor for some people. If you’re one of them, taking nutrients that help reduce inflammation could provide pain relief. Turmeric, for instance, contains a compound called curcumin that’s widely thought to have anti-inflammatory properties, and studies show it may treat pain effectively (xi).
 
Fish oil supplements are also believed to relieve inflammation, thanks to the action of their omega-3 fatty acids EPA and DHA. Indeed, there’s evidence omega-3 oils can help relieve the symptoms of inflammatory joint pain (xii). These days even vegans and vegetarians don’t have to miss out, since supplements that source omega-3 fatty acids from marine algae instead of fish are now more widely available.
 

PEA - also known as palmitoylethanolamide – may also help with inflammation and pain. A type of fatty acid made naturally by the body, PEA is found in all human cells, tissues and fluids, including the brain. It’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk. 

Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xiii), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xiv) with no known side effects (xiii). 

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xiii). When this happens, PEA supplements may be helpful. In fact a review of 16 clinical trials and meta-analysis of PEA suggests it does have analgesic actions – in other words it helps to relieve pain (xv).

Meanwhile magnesium is considered helpful for general muscle health and muscle function, and according to experts it has often been used to manage acute and chronic pain, including the pain of fibromyalgia and lower back pain (xvi). Epsom salt is a type of magnesium (namely magnesium sulfate), and taking a bath with added Epsom salts is often recommended for treating pain, particularly muscle pain, as well as for boosting relaxation.
 
If you need more help with relaxation you could try a theanine supplement. This amino acid is found almost exclusively in green, black, oolong and pekoe tea, and is thought to aid with relaxation by helping your brain produce calming alpha waves. Studies have also found taking a theanine supplement can help you feel relaxed but without making you drowsy (xvii). Lemon balm may also be useful, especially if you’re feeling stressed and anxious – which is common in people who are experiencing pain. In fact there’s some evidence – though studies are small in number and scale – that lemon balm can indeed help reduce anxiety (xviii).
 
You could also try using the power of aromatherapy with the help of some lavender essential oil, which has a long-established tradition of helping people feel more relaxed. Take a warm bath with a drop or two of lavender oil whenever your symptoms are making you feel stressed or anxious.
 
GTPS can be painful and may have an impact on your daily life. But the good news is it’s not a lifelong condition. Living with the condition for up to a year or more, however, can be stressful. This guide shows you what you can do to make your recovery as quick and easy as possible, helping you to get back to normal and enjoy your life to the fullest. To find out more about a range of other wellbeing issues and ways of helping yourself, try taking a look around our health library

References:

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12. Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007 ay;129(102):210-23. Available online: https://pubmed.ncbi.nlm.nih.gov/17335973/

13. Clayton P. et al., Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021 May;22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/

14. Clayton P. et al., Palmitoylethanolamide: A Potential Alternative to Cannabidiol. J Diet Suppl. 2021 Nov;28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733

15. Gabrielsson . L, Mattsson. S, Fowler. CJ. Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy. Br J Clin Pharmacol. 2016 Oct;82(4): 932–942.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094513/

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18. Kennedy, D.O., et al. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (lemon balm). Psychosom Med. (2004). ,66:607-613 . Available online: https://europepmc.org/article/med/15272110

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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