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

Greater Trochanteric Pain Syndrome (GTPS) is an umbrella term used to describe chronic pain located on the outer side of the hip. In the past, this was almost exclusively called 'trochanteric bursitis', but modern medical research and NICE guidelines suggest that most cases actually involve the gluteal tendons (gluteal tendinopathy) rather than just an inflamed bursa.

This condition occurs when the tissues that lie over the bony prominence of the femur (the greater trochanter) become irritated or overloaded. It is particularly common in women aged 40 to 60, but it can affect runners, athletes, and anyone who has recently increased their activity levels. While the pain can be persistent and frustrating, GTPS is rarely a sign of serious underlying joint damage like osteoarthritis.

The hallmark symptom of GTPS is pain felt on the outside of the hip and upper thigh. Patients often describe the following experiences:

• Tenderness: Intense pain when touching or pressing on the bony part of the outer hip.
• Night Pain: Difficulty sleeping, specifically when lying on the affected side or when the legs are crossed.
• Activity-Related Pain: A dull ache that worsens after walking long distances, climbing stairs, or standing on one leg.
• Stiffness: A feeling of tightness in the hip area, particularly after periods of inactivity.

The pain may occasionally radiate down the side of the leg toward the knee, but unlike sciatica, it rarely travels into the foot or causes numbness and tingling.

GTPS is typically a 'wear and repair' issue rather than a sudden injury. The NHS identifies several common triggers for the onset of outer hip pain:

• Overuse: Rapid increases in walking, running, or hill-climbing without allowing the tendons time to adapt.
• Biomechanical Factors: Changes in gait, often caused by knee or back problems, can increase the load on the lateral hip.
• Sedentary Lifestyle: Weakness in the gluteal muscles can lead to poor support of the hip joint.
• Hormonal Changes: There is evidence to suggest that falling oestrogen levels in perimenopausal women can affect tendon health.

Being overweight or having a direct fall onto the hip can also contribute to the development of symptoms.

The primary treatment for GTPS is 'load management'. This means staying active while avoiding movements that aggravate the pain. NICE guidelines suggest the following self-care steps:

1. Modify Your Activity

Avoid sitting with your legs crossed or standing 'hanging' on one hip. When sleeping, place a pillow between your knees to keep the hips aligned and reduce pressure on the tendons.

2. Therapeutic Exercises

Strengthening the gluteus medius and minimus muscles is essential. Simple exercises like side-lying leg lifts (once the acute pain subsides) or 'clamshells' help the tendons cope with weight-bearing loads.

3. Pain Relief

Over-the-counter medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can manage discomfort. Always consult a pharmacist or doctor before starting new medications.

4. Ice and Heat

Applying an ice pack to the area for 15 minutes can help if the area feels warm or swollen, while heat may help relax tight muscles in the surrounding area.

If your hip pain is not improving after 4-6 weeks of self-care, it is advisable to speak to a GP. In the UK, accessing a GP online can be a fast and convenient way to discuss your musculoskeletal concerns.

An online doctor can review your symptoms via video consultation, offer a provisional diagnosis, and provide the following services:

• Clinical Advice: Tailored guidance on which movements to avoid and which exercises to prioritise.
• Prescription Medications: If over-the-counter options are insufficient, they may prescribe stronger anti-inflammatories.
• Sick Notes: If your job involves heavy lifting or prolonged standing that hinders recovery, a Fit Note (sick note) can be provided.
• Referral Pathways: Advice on when you might need a private referral for physiotherapy or an ultrasound-guided corticosteroid injection.

Consulting a GP online allows you to receive evidence-based care from the comfort of your home, avoiding the need to travel while your hip is painful.

GTPS is not a quick-fix condition. Tendons heal slowly, and it can take anywhere from three to twelve months to achieve full recovery. Consistent adherence to a physiotherapy programme is the most effective way to prevent the pain from returning.

While corticosteroid injections are sometimes offered in the UK, these are generally reserved for patients who have not responded to exercise. Recent studies have shown that while injections provide short-term relief, exercise-based therapy provides better long-term outcomes for lateral hip pain.