Why Exercises are the way to go for Greater Trochanteric Pain Syndrome (GTPS)

Greater Trochanteric Pain Syndrome (GTPS) is a common condition that causes persistent lateral hip pain, often making everyday activities like walking, climbing stairs, or even lying on your side difficult. GTPS primarily affects middle-aged individuals, particularly women, and is commonly linked to issues such as gluteal tendinopathy and weakness in the hip stabilizing muscles.
At Melbourne Massage and Treatment, our focus is on evidence-based approaches to managing GTPS, and the latest research strongly supports the role of exercise as the first line of treatment for this condition.

GTPS Symptoms

Greater Trochanteric Pain Syndrome can present with a series of symptoms that are local to the side of the hip. Here are the most common:

• Lateral hip pain: Persistent pain on the outer side of the hip, which may extend down the thigh.
• Pain when lying on the affected side: Discomfort that worsens when lying directly on the hip.
• Tenderness to touch: Sensitivity around the greater trochanter, which may be painful to press.
• Pain with movement: Aggravation of pain during walking, climbing stairs, or standing for prolonged periods.
• Weakness in hip muscles: Reduced strength in the gluteal muscles, leading to instability in movement.
• Difficulty sitting for long periods: Sitting on hard surfaces can exacerbate discomfort.

Mechanism of Injury for GTPS

GTPS is primarily associated with tendinopathy of the gluteus medius and/or minimus muscles, with or without accompanying bursitis. As per many tendon injuries, this condition often arises from repetitive stress or overuse, leading to microtrauma and degeneration of these tendons. On the other hand, abnormal hip biomechanics can exacerbate the issue, as compressive forces cause impingement of the gluteal tendons and bursa onto the greater trochanter by the iliotibial band during hip adduction. Contributing factors to GTPS include acute trauma, such as a fall onto the lateral hip, prolonged pressure from lying on one side, and overuse from activities like running or stair climbing. Additionally, conditions like iliotibial band disorders and gluteal muscle weakness can increase the risk of developing GTPS.
Understanding these mechanisms is crucial for effective management and prevention of GTPS.

Evaluation of GTPS

Diagnosing GTPS typically involves a combination of clinical examination and medical history assessment. After taking your clinical history, including sports and work activity, I will perform a series of tests to validate the suspicions of GTPS. Those tests include single-leg stance and resisted hip abduction, which we would expect to show weakness in single-leg standing and pain during the abduction movement. Lastly, we would also palpate the area, which is a test that is kept for last because we want to avoid flair the presentation, which may be painful with any other test after that. In some cases, imaging techniques like ultrasound or MRI may be used to rule out other conditions and confirm gluteal tendinopathy or soft tissue abnormalities. I personally do not recommend image testing as the first way to go because the impact of seeing physical damage can also have a negative impact on self-perception, making a recovery harder.

At Melbourne Massage and Treatment, our focus is on evidence-based approaches to managing GTPS, and the latest research strongly supports the role of exercise as the first line of treatment for this condition.

The difference between GTPS and Femoroacetabular Impingement (FAI)

The difference between GTPS and FAI stands in the hip area involved in the injury. The GTPS is relative to the side of the hip and involves the gluteus medius and minimus tendon and the bursa that separate that tendon from the greater trochanter of the femur.

On the other hand, FAI is a presentation that still involves the hip, but it does take place on the anterior portion of the hip, as is characterised by and overgrowth of tissue on the femur head or the hip socket, and it does manifest with hip flexion and external rotation.

That’s why it is important to receive an evaluation of the presentation from a professional, in order not to mix the two presentation, or also, in order to evaluate if both presentation are present at the same time, which can also happen.

The Role of Exercise in GTPS Treatment

A recent systematic review and meta-analysis analyzing multiple randomized controlled trials found that structured exercise provides significant benefits for individuals with GTPS. The findings revealed that:

• Long-term pain reduction: Exercise can lead to slight but meaningful reductions in hip pain over time.
• Improved physical function: Patients who engage in targeted exercise programs experience better mobility and overall hip function.
• Increased likelihood of meaningful recovery: Compared to corticosteroid injections, exercise significantly increases the chances of noticeable improvement in symptoms.

One of the most notable takeaways from this research is that exercise has a long-lasting effect, whereas treatments such as corticosteroid injections may provide only short-term relief. Additionally, no serious adverse effects were reported with exercise-based interventions, making it a safe and sustainable approach to managing GTPS.

Why Choose Exercise Over Corticosteroid Injections?

Corticosteroid injections have often been used for GTPS pain relief, but the research indicates that exercise leads to better long-term outcomes. While injections may offer temporary symptom relief, they do not address the underlying causes of GTPS, such as gluteal muscle weakness or tendon dysfunction. Exercise, on the other hand, strengthens the hip muscles, improves joint stability, and reduces the likelihood of recurring pain. In a previous blog post, I spoke about the key role of Gluteus Medius as a pelvis stabiliser.

Effective Exercises for GTPS

At Melbourne Massage and Treatment in Fitzroy North clinic, I design individualized exercise programs to help patients with GTPS regain strength and function. Some of the most effective exercises for GTPS include:

• Isometric exercises: Holding static positions to engage the hip muscles without excessive movement, reducing pain and improving muscle endurance.
• Strength training: Progressive strengthening of the gluteus medius and minimus muscles to enhance hip stability.
• Functional movement training: Exercises that mimic daily activities to help improve movement patterns and prevent pain triggers.

These exercises can be performed both at home and under professional supervision to ensure proper technique and effectiveness.

Recovery Time for Greater Trochanteric Pain Syndrome

The recovery timeline can be long and slow with all tendon injuries. Generally, with conservative treatments—including activity modification, physical therapy, and pain management—symptoms may improve within 2 to 3 months.

However, in many cases, a longer duration of 6 to 9 months is typical for significant improvement.

It’s important to note that recovery can be gradual, and patience is essential. If symptoms persist beyond these time frames, is then legit to look into furher investigation for this type of presentation, including surgery.

In conclusion, if you are experiencing pain and symptoms that recall GTPS, book now your myotherapy session and start a recovery journey.

Frequently Asked Questions (FAQs) About Greater Trochanteric Pain Syndrome (GTPS)

Q: What is Greater Trochanteric Pain Syndrome (GTPS)?

A: GTPS is a condition that causes persistent pain on the outer side of the hip, often making activities like walking, climbing stairs, or lying on your side uncomfortable. It is commonly associated with gluteal tendinopathy and hip muscle weakness.

Q: Who is most at risk for GTPS?

A: GTPS primarily affects middle-aged individuals, especially women. Factors like weak hip stabilizing muscles, overuse, and poor biomechanics can increase the risk.

Q: What are the main symptoms of GTPS?

A:

• Pain on the outer side of the hip
• Discomfort when lying on the affected side
• Tenderness when pressing the hip
• Pain with activities like walking, standing, or climbing stairs
• Weakness in the gluteal muscles
• Difficulty sitting for long periods

Q: What causes GTPS?

A: GTPS is usually caused by overuse or repetitive stress, leading to gluteal tendon irritation or degeneration. Other contributing factors include:

• Abnormal hip biomechanics
• Prolonged pressure on the hip (e.g., lying on one side)
• Falls or trauma to the lateral hip
• Gluteal muscle weakness

Q: How is GTPS diagnosed?

A: A clinical examination, including movement tests like single-leg stance and resisted hip abduction, helps diagnose GTPS. Palpation of the hip is also performed to assess tenderness. Imaging (ultrasound or MRI) is sometimes used to rule out other conditions, but it is not always necessary.

Q: What is the best treatment for GTPS?

A: Research supports exercise as the first-line treatment. Strengthening the gluteal muscles improves hip stability and reduces pain. Other conservative treatments include activity modification, manual therapy, and pain management strategies.

Q: Are corticosteroid injections effective for GTPS?

A: Corticosteroid injections can provide short-term pain relief but do not address the root cause, such as muscle weakness or poor movement patterns. Exercise has been shown to provide longer-lasting improvements in pain and function.

Q: What types of exercises help with GTPS?

A:

• Isometric exercises to reduce pain and improve muscle endurance
• Strength training for the gluteus medius and minimus muscles
• Functional movement training to enhance daily movement patterns

Q: How long does it take to recover from GTPS?

A: Recovery varies by individual, but:

• Mild cases may improve within 2-3 months
• More severe cases often take 6-9 months
• Patience and consistency with rehabilitation exercises are key

Q: When should I seek professional treatment?

A: GTPS is a presentation that tunr worst with time. If you are start to experiencing symptoms, and they don’t settle within 1 to 2 weeks, you better reach out to a professional who can assist you with a recovery plan. Here at Melbourne Massage and Treatment in Fitzroy North, I work with patient who has GTPS and I offer a mix of hands ont treatment and exercises program to overcome the presentation. Reach out today with your question and enquire about the treatment plan.