{"id":16542,"date":"2023-06-05T18:15:20","date_gmt":"2023-06-05T16:15:20","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=condition&p=16542"},"modified":"2026-08-13T13:20:42","modified_gmt":"2026-08-13T11:20:42","slug":"greater-trochanteric-pain-syndrome","status":"publish","type":"condition","link":"https:\/\/www.physiotutors.com\/conditions\/greater-trochanteric-pain-syndrome\/","title":{"rendered":"Greater Trochanteric Pain Syndrome (GTPS)"},"featured_media":16543,"template":"","tracking_tag":[2196,2313,2201],"class_list":["post-16542","condition","type-condition","status-publish","has-post-thumbnail","hentry","tracking_tag-hip","tracking_tag-lower-extremity","tracking_tag-muscle-tendon"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":16543,"background_image_alt_text":"Greater Trochanteric Pain Syndrome"},"heading":"Greater Trochanteric Pain Syndrome | Diagnosis & Treatment","subheading":"Hip Joint","content_editor":"","button_type":"url","button_label":"","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/running-rehab-course-2\/","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Introduction & Epidemiology","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Clinical Picture & Examination","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Treatment","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Running Rehab Online Course","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":22104,"button_anchor":"","button_url":"","button_file":""},"button_description":""},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Greater Trochanteric Pain Syndrome | Diagnosis & Treatment<\/h2>\r\n

Introduction<\/h3>\r\n\"\"\r\n\r\nGluteal tendinopathy or greater trochanteric pain syndrome (GTPS) describes lateral hip pain originating from irritation of the tendons of the gluteus medius and minimus. It used to be called trochanteric bursitis though the nomenclature has changed as more evidence from radiological, histological, and surgical studies emerged that showed non-inflammatory changes to the tendons rather than inflammation of the bursa (Grimaldi et al. 2016<\/a>).\r\n\r\nGenerally speaking, tendons that experience normal and regular load are in a state of homeostasis; slightly greater than normal load will lead to a net anabolic biological response which results in increased tensile strength and favors the tendon\u2019s load-bearing capacity.\r\n\r\nA sedentary person may not induce these net anabolic responses through regular tendon loading and being overweight requires more load-bearing capacity, which may induce catabolic biological responses and reduce the tensile strength of the tendons.\r\n\r\nOn the other hand, a very active person who repeatedly puts the tendon under loads much greater than normal without adequate recovery time hinders the tendon to adapt appropriately and can lead to the development of tendinopathy (Magnusson et al. 2010<\/a>).\r\n\r\n \r\n

Epidemiology<\/h3>\r\nGluteal tendinopathy is considered to be the most common tendinopathy of the lower extremity and is most prevalent in women over the age of 40 (Albers et al. 2014,<\/a> Segal et al. 2007<\/a>). Typical patients tend to be rather sedentary and overweight, though the condition can also be encountered in athletic populations, specifically runners (Del Buono et al. 2012<\/a>).\r\n\r\n[cta]"},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Clinical Picture & Examination<\/strong><\/h3>\r\nAccording to Grimaldi et al. (2015)<\/a>, the hallmark symptom of the condition is moderate to severe pain and tenderness over the greater trochanter with possible radiation into the lateral thigh. Sleeping on the affected leg is difficult, which impairs sleep quality. Prolonged sitting and subsequent rising up from the seated position are painful, especially from low sitting positions, where the hip is flexed beyond 90\u00b0. This is due to the fact that tensile and compressive forces of the tendons around the greater trochanter are higher in these positions.\r\n\r\n \r\n

Physical Examination<\/strong><\/h3>\r\nGrimaldi et al. (2016)<\/a> conducted a diagnostic accuracy study on different diagnostic tests that were contrasted to MRI findings indicative of gluteal tendinopathy.\r\n\r\nGrimaldi's study setup mimics clinical situations better as we don\u2019t see the unsymptomatic patient and judging from their findings, a positive test can practically establish that Gluteal tendinopathy is present though excluding the condition with a negative test is not possible, which is why we give it a strong clinical value in including the condition.\r\n\r\nYou should clear the lower back or SI Joint as a possible source for somatic referred pain to the lateral hip region.\r\nEssentially forming the diagnosis requires (Grimaldi et al. 2017<\/a>):\r\n\r\n1) Pain on palpation<\/strong>\r\n\r\nPain on palpation was the most specific test in the study with a sensitivity of 80% and a specificity of 46,7%. This was the most sensitive test in the study and due to its negative likelihood ratio of point four three we give it a rather weak clinical value in excluding gluteal tendinopathy\r\n
\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=V31QbCpp5NM[\/embed]\r\n\r\n<\/div>\r\n2) 1 positive active test of the following:(e.g. FADER-R, ADD-R, SLS)<\/strong>\r\n\r\nSLS<\/em><\/strong><\/a>\r\n\r\nThe Single leg stance test<\/a> was the most specific test in the study.\r\n
\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=3vdJhti9tZE[\/embed]\r\n\r\n<\/div>\r\n \r\n\r\nFADER-R<\/strong><\/em><\/a>\r\n\r\nTo conduct the test the patient lies supine. Then flex the hip to 90\u00b0, adduct the hip, and add external rotation to\u00a0 end of range. Now, ask the patient to perform isometric internal rotation against your resistance, which will increase both tensile and compressive forces on the tendon of the gluteus medius and minimus. A positive test is the reproduction of the patient\u2019s lateral hip pain in the region of the greater trochanter of at least 2\/10 on the NPRS.\r\n
\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=Q_x3Cv4_Q3Y[\/embed]\r\n\r\n<\/div>\r\nADD-R<\/strong><\/em><\/a>\r\n\r\nTo conduct the test the patient lies on the bench in a diagonal side-lying position on their unaffected side with the hip and knee flexed to 80-90 degrees.\r\n\r\nSupport the affected leg with the knee extended, in neutral position so that leg is in line with the trunk. The anterior superior iliac spines are perpendicular to the treatment table. Whilst stabilizing the pelvis, the leg is moved into end-range hip adduction with overpressure. Subsequently, the patient is asked to perform isometric hip abduction against resistance. This position adds both passive and active tensile and compressive loads on the tendons of the Gluteus medius and minimus.\u00a0 A positive test is the reproduction of the patient\u2019s lateral hip pain in the region of the greater trochanter of at least 2\/10 on the NPRS.\r\n
\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=myMISIQQ18A[\/embed]\r\n\r\n<\/div>\r\n \r\n\r\n3) Imaging evidence correlating with clinical signs and symptoms<\/strong>"},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Treatment<\/strong><\/h3>\r\nGrimaldi et al. (2015)<\/a> wrote a clinical commentary on the proposed management of the condition as high-quality studies are still lacking. These recommendations are based on pathobiology, general information on tendon pain management, and principles and concepts of optimization of hip abductor muscle function, hip movement, and lower limb alignment.\r\n\r\nAs with many if not all tendinopathies load management is one of the key principles of rehab. In the case of GTPS, we want to avoid compression and stretch. Here are some things to consider to avoid:\r\n
\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=iGmcpJJQc60[\/embed]\r\n\r\n<\/div>\r\nAspects to consider in reducing compression<\/strong><\/em>\r\n\r\nAvoid hip adduction (\u201ehanging on one hip\u201c while standing, standing with legs crossed, sitting with knees crossed or knees together, as well as sleeping in a side-lying position. As sleep is often disturbed in GTPS, here are some Tips: sleeping on the back with legs slightly abducted reduces compression on the tendons, and you can also use a pillow between legs when sleeping in side lying. If symptoms are bilateral, the other hip can be cushioned with an eggshell mattress\r\n\r\nAspects to consider in reducing tensile loads<\/strong><\/em>\r\n\r\nAny activity that involves a rapid stretch-shortening cycle (contraction) should be reduced. For athletes, this may mean temporarily avoiding long distance, high tempo, hill running, and plyometrics. Water-based exercise can serve as a temporary alternative.\r\n\r\n \r\n

Isometric Exercises<\/strong><\/h4>\r\nIsometric exercises have been shown to be a good starting point in tendinopathy rehab though the optimal loading dose for the gluteals has yet to be determined. A good starting point for isometrics in GTPS is to perform isometric abduction in a side-lying position. Here the patient should use pillows in between the legs to keep the hip from adducting.\r\n\r\nFor bilateral issues the patient can lie supine with the hips slightly abducted and a theraloop can be used for light resistance. Even performing it in standing is an option.\u00a0 Patients are asked to ramp up the contraction slowly and minimize pain. They can hold the contraction for around 45 seconds and repeat it 4 times several times per day.\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=YNkxh046sa4\r\n\r\n \r\n

Low-velocity high load home exercises<\/h4>\r\nAs a next step, we will look at low-velocity high load exercises that are easily done at home. Here a fine balance has to be found as there is a chance of potentially overloading and thus aggravating the tendon. A good indicator to assess progress is the change in night pain that is common in GTPS.\r\n\r\nWhile we can target the hip abductors in a side-lying position with exercises such as (banded) clamshells or abduction, weight-bearing exercises have higher recruitment of the gluteals than non-weight-bearing exercises.\r\n\r\nExample exercises can be:\r\n