Greater Trochanteric Pain Syndrome (GTPS): Symptoms, Causes and Treatment in the UK

Greater Trochanteric Pain Syndrome (GTPS) is an umbrella term used by UK health professionals to describe chronic pain on the lateral (outer) aspect of the hip. While it was previously commonly referred to as 'hip bursitis', modern clinical research suggests that the pain is more frequently caused by small tears or degenerative changes in the gluteal tendons (tendinopathy) rather than just inflammation of the bursa.

According to the National Institute for Health and Care Excellence (NICE), GTPS is particularly prevalent in women aged between 40 and 60. It can be a frustrating condition because it significantly impacts mobility and sleep, yet the underlying structures are often intact, meaning it is a functional rather than structural problem in many cases.

If you are suffering from GTPS, the primary symptom is pain localized to the bony prominence on the side of your hip, known as the greater trochanter. This pain can manifest in several ways:

• Tenderness to touch: Pressing firmly on the outer hip bone is usually very sensitive.
• Sleep disturbance: Many patients find it impossible to lie on the affected side at night, and lying on the 'good' side can also be painful as the top leg drops across the body, stretching the hip tissues.
• Activity-related pain: Pain often increases when walking, climbing stairs, or running.
• Stiffness: You may feel stiff in the morning or after sitting for long periods, though the hip joint itself usually retains a full range of movement.

GTPS is typically an 'overuse' or 'load' injury. It occurs when the tissues on the outside of the hip are unable to cope with the amount of stress placed upon them. Common triggers in the UK population include:

Biomechanical Factors

Weakness in the gluteal muscles often leads to poor control of the pelvis during movement, which increases compression on the tendons. Changes in walking gait or different leg lengths can also contribute.

Sudden Changes in Activity

Increasing your walking distance or starting a new exercise programme too quickly (the 'too much, too soon' phenomenon) is a frequent cause of flare-ups.

Systemic Factors

Hormonal changes, particularly during the menopause, are thought to affect tendon health. Additionally, being overweight can increase the static load on the hip joints, while sedentary lifestyles can lead to muscle atrophy.

In the UK, a GP or physiotherapist will usually diagnose GTPS based on a physical examination and your clinical history. X-rays or MRI scans are rarely required in the early stages as they often don't change the management plan. During an assessment, the clinician will check for specific 'red flags' and may perform a 'single-leg stance test' to see if staying on one leg triggers your symptoms.

If you consult an online doctor, they will ask detailed questions about the location of your pain and your activity levels to rule out other causes, such as hip osteoarthritis or referred pain from the lower back (sciatica).

The core of GTPS management is 'load management' and strengthening. Following NHS guidance, the following steps are usually recommended:

• Activity Modification: This does not mean complete rest. Instead, you should find a level of activity that doesn't significantly increase your pain the next day. Avoid sitting with your legs crossed, as this compresses the outer hip.
• Physiotherapy: A progressive strengthening programme for the gluteal muscles is the most effective long-term treatment.
• Pain Relief: Paracetamol or topical non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen gel can help manage symptoms. Oral NSAIDs may be used for short periods if appropriate for the patient.
• Weight Management: Reducing body weight can significantly lower the mechanical load on the hip.
• Sleep Hygiene: Placing a pillow between your knees when sleeping on your side can prevent the affected hip from being stretched.

You should speak to a GP online if your hip pain is affecting your ability to work, sleep, or complete daily activities. An online consultation can help clarify the diagnosis and provide you with a structured plan.

Our clinicians can offer advice on:

• Prescription pain relief if over-the-counter options are insufficient.
• Appropriate exercises and when to start them.
• Providing a private sick note (Fit Note) if the condition prevents you from performing your job.
• Referral pathways if the condition does not improve with self-care after 3 to 6 months.