Lateral Hip Pain “Greater Trochanteric Pain Syndrome” (GTPS) Information for patients suffering from lateral hip pain. Feb 2016

Greater trochanteric pain syndrome – (GTPS) is a common clinical syndrome that used to be called trochanteric bursitis. More common in females F:M= 4:1 More common in 40-60 year old patients Occurs in 10-25% of the population Occurs in 35% with low back pain

Patients usually complain of pain at the side of the hip radiating down the side of the thigh- and sometimes below the knee

What makes it worse? Walking Sitting Standing Getting in and out of the car Stairs Laying on the painful side Laying on the opposite side

What causes the pain? Research shows us that lateral hip pain is caused by wear and tear in the tendons of the muscles around your hip as they insert on the bone.

It is unlikely to be “bursitis” It used to be thought that the pain was caused by the sacs of fluid filled bursa around the tendons. But research shows us that it is most likely to be the tendons themselves that cause the pain.

“Why did this happen to me?” There are lots of reasons why this may have happened. But commonly this is down to the muscles’ inability to cope with the demands of daily life that are placed on them. You may have “asked” the muscles to do to much and they are not strong enough to cope with that demand. The tendons have been repeatedly compressed by the positions we adopt during daily life causing micro trauma to the tendon over time.

What happens next? This overload or compression to the tendon irritates the tendon, causing the muscle to become stiffer / tighter and tender to touch and can often refer pain down the leg. The muscle becomes weaker as we use it less, and so the cycle continues.

Muscle fatigue and tightness Reduced hip range of motion Tendon irritation due to overload or compression from day to day activities Pain Gluteal weakness Muscle fatigue and tightness Lack of use Reduced hip range of motion Pain

Positions during daily life that can compress the tendons. These positions often seen in people can cause continual micro trauma to the tendons over time. So if you can avoid these positions it can reduce your symptoms.

How can I ease my pain? Exercise to improve the hip muscle activation and strength is the best way to improve symptoms and stop it coming back in the future. Often patients are given an injection- and for some patients this can help reduce the pain temporarily- but this will not specifically address the route cause of your problem. Often patients’ pains return a few months later. Try and avoid aggravating positions or activities that may induce compression on the tendons. Try some massage around the hip muscles Try sleeping with a pillow between your knees, to prevent the leg falling across the body and compressing the top hip through over tensioning the thigh soft tissues

What exercises should I try? Side Leg lift hold Put hand on pelvis and push the top leg nice and long. This stacks the hips directly on top of each other. Lift the leg up to hip height Don’t let the hip hitch up Push hard with the hand Hold for 1 minute Repeat 2-3 times It should feel achy after the exercise just around your hip bone. Relax and let the foot go floppy This static hold will help activate the hip muscle required to support your pelvis alignment and help decrease pain.

What exercises should I try? 1 leg balance- 30 secs Keep shoulders level Don’t lean to the side Keep your foot under your shoulder Don’t let it drop on the opposite side Keep your pelvis level Stand on your worst leg Hold on to the wall if required so that you can feel the exercise working in the side of your hip of your standing leg

What exercise should I try? Step Ups Put the worst leg on the step Keep the back leg straight DO NOT bend and jump / push off the back leg. Peel the foot slowly from the heel to the toe as you step up Push up slowly through the worst leg Leave the worst leg on the step, and step down with the better leg. Slowly paste the foot back down Keep your knee pointing forwards over your toes, don’t let it fall inwards as you step up and down