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

Greater Trochanteric Pain Syndrome (GTPS) is a clinical term used to describe chronic pain on the outside of the hip. In the past, this was almost always referred to as 'hip bursitis', but we now understand that the pain is more commonly caused by small tears or inflammation in the gluteal tendons that attach to the hip bone (the greater trochanter).

According to NHS and NICE guidance, GTPS is most common in women aged 40 to 60, though it can affect anyone, including active runners and athletes. The pain occurs when the soft tissues—the tendons and the bursa—become overloaded or irritated, leading to localized sensitivity that can make daily activities like walking or climbing stairs challenging.

The hallmark of GTPS is pain felt on the outer side of the hip. Symptoms often develop gradually rather than appearing suddenly after an injury. Common signs include:

• Tenderness: Intense sensitivity when pressing on the bony point of your outer hip.
• Night Pain: Difficulty sleeping on the affected side, or even the unaffected side if the top leg falls across and pulls on the painful hip.
• Activity-Related Ache: Pain that worsens during weight-bearing activities, such as walking, running, or standing on one leg.
• Transferred Pain: The ache may track down the outside of the thigh towards the knee, though it rarely goes below the knee.
• Pain after sitting: Stiffness and discomfort when getting up after sitting cross-legged or in a low chair.

GTPS is typically an 'overuse' or 'overload' injury. It occurs when the demand placed on the hip tendons exceeds their ability to recover. Common triggers in the UK population include:

1. Sudden Increases in Activity

Starting a new exercise regime or significantly increasing walking distance without gradual conditioning can stress the gluteal tendons.

2. Biomechanical Factors

Changes in how you walk (gait) due to knee or back issues, or having a wider pelvis, can increase the tension on the structures of the outer hip.

3. Sedentary Lifestyle

Conversely, prolonged sitting or lack of muscle strength in the glutes can lead to tendon weakness, making them more prone to irritation when you do move.

4. Hormonal Changes

There is anecdotal evidence and ongoing research into the link between the menopause and GTPS, as declining oestrogen levels can affect tendon health in women.

In most cases, a GP or physiotherapist can diagnose Greater Trochanteric Pain Syndrome based on your medical history and a physical examination. NICE clinical knowledge summaries suggest that imaging—such as X-rays or MRI scans—is usually not required unless the diagnosis is uncertain or the pain does not respond to initial treatment.

During a consultation, a clinician will ask where the pain is located and what movements trigger it. A key 'special test' involves palpating the greater trochanter; if this is the primary source of pain, it strongly points towards GTPS rather than osteoarthritis of the hip joint itself.

The good news is that GTPS is highly treatable, although it can take 6 to 12 months for full recovery. Management focuses on reducing load and strengthening the area.

• Activity Modification: Avoid activities that aggravate the pain. This includes standing with your weight shifted toward one hip or sitting with your legs crossed.
• Physiotherapy: This is the 'gold standard' treatment. A physiotherapist can provide specific exercises to strengthen the gluteal muscles, which helps support the hip joint.
• Pain Relief: Over-the-counter medications like paracetamol or ibuprofen (if suitable for you) can help manage the ache. Topical anti-inflammatory gels are also an option.
• Corticosteroid Injections: If pain is severe and preventing physical therapy, a GP might suggest an injection for short-term relief, though this is usually not a permanent cure.
• Sleep Hygiene: Placing a pillow between your knees when sleeping on your side can reduce the 'pull' on the outer hip and improve sleep quality.

If you are struggling with persistent hip pain, you can speak to a GP online through OnlineDoctor24. An online consultation is a convenient way to discuss your symptoms and receive a professional assessment without leaving home.

A UK-based doctor can help by:

• Reviewing your symptoms to confirm if it sounds like GTPS or another musculoskeletal issue.
• Providing medical advice on the best types of pain relief for your specific health profile.
• Providing a private sick note if your condition significantly impacts your ability to work.
• Discussing referral options for NHS or private physiotherapy services.
• Advising on when further investigations, like blood tests or imaging, might be necessary.