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

Greater Trochanteric Pain Syndrome (GTPS) is a medical term used to describe chronic pain felt over the outside of the hip. In the past, this was almost always referred to as 'hip bursitis', but we now understand that the condition is more complex. It usually involves a combination of gluteal tendinopathy (irritation of the tendons) and inflammation of the trochanteric bursa (a small fluid-filled sac that acts as a cushion).

Unlike osteoarthritis, which affects the hip joint itself and often causes pain in the groin, GTPS causes tenderness specifically on the bony prominence on the side of your upper thigh, known as the greater trochanter. According to NHS data, it is most common in women aged between 40 and 60, though it can affect anyone, particularly runners or those who have recently increased their physical activity levels.

The hallmark of GTPS is pain on the lateral (outer) aspect of the hip. Symptoms often develop gradually over several weeks or months. Patients typically report:

• Tenderness: Intense pain when pressing directly on the bony part of the outer hip.
• Pain at Night: Difficulty sleeping, particularly when lying on the affected side or even the unaffected side if the top leg crosses over.
• Activity-related Pain: A dull ache that worsens after walking, climbing stairs, or standing for long periods.
• Stiffness: A feeling of tightness in the hip area, especially after sitting for a long time (known as 'start-up' pain).

GTPS is usually caused by repetitive 'micro-trauma' to the tendons that attach your buttock muscles to your hip bone. In the UK, NICE clinical knowledge summaries suggest several contributing factors:

• Overuse: Sudden increases in exercise intensity, such as starting a new running programme without sufficient rest.
• Biomechanical Stress: Lower back issues, differences in leg length, or an altered walking pattern (gait) can put extra strain on the hip tendons.
• Sedentary Habits: Prolonged sitting with legs crossed or standing while 'hanging' on one hip.
• Direct Injury: A fall onto the side of the hip can inflame the bursa.

The majority of GTPS cases are managed conservatively. The primary goal is to manage the 'load' placed on the hip tendons. National health guidelines suggest the following self-care steps:

Sleep Adjustments

If you are a side sleeper, place a pillow between your knees to keep your hips aligned and prevent the top leg from pulling on the hip tendons. If you sleep on your side, using an extra mattress topper can help reduce direct pressure on the bursa.

Modification of Activity

Avoid activities that aggravate the pain, but do not stop moving entirely. Low-impact exercises like swimming or cycling are often better tolerated than running or uphill walking. Avoid sitting with your legs crossed, as this stretches the tendons over the bone and increases irritation.

Pain Relief

Over-the-counter medications such as paracetamol can help manage discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be useful, provided they are suitable for you; always consult a pharmacist or doctor before starting a new medication.

Physiotherapy is considered the 'gold standard' for GTPS treatment in the UK. A physiotherapist will prescribe specific strengthening exercises for the gluteal muscles. Strengthening these muscles helps support the hip joint and reduces the tension on the tendons. Isometric exercises (where the muscle is held under tension without moving) are often the first step in reducing tendon pain.

The Role of Corticosteroid Injections

If conservative measures fail to provide relief after several months, your GP might discuss a corticosteroid injection. While these can provide rapid short-term pain relief, evidence suggests that exercises are more effective for long-term recovery. Injections are generally reserved for those whose pain is so severe it prevents them from participating in physiotherapy.

If your hip pain is persistent and has not improved with two to three weeks of rest and self-care, it is advisable to seek medical advice. Speaking to an online doctor in the UK can be a convenient way to get an initial assessment without leaving home.

During a GP consultation online, the doctor will ask about the location of your pain, your activity levels, and how it affects your daily life. They can:

• Provide a formal diagnosis based on your clinical history.
• Issue a sick note if your hip pain prevents you from performing your job (especially if your work involves heavy lifting or long-distance walking).
• Suggest appropriate pain management strategies.
• Refer you to private or NHS physiotherapy services for a structured rehabilitation plan.