NHS Lanarkshire logo

Greater Trochanteric Pain Syndrome (GTPS)

On this page

Additional Information

Related pages

Information about Greater Trochanteric Pain Syndrome

Download

What Is Greater Trochanteric Pain Syndrome

Greater trochanteric pain syndrome (GTPS) is a common condition characterised by pain along the outer side of your hip/thigh/buttock. This is usually caused by an injury or irritation to the soft tissue structures(muscles/tendons/bursa) that lie over the top of your outer thigh bone. GTPS was traditionally more commonly known as hip/trochanteric bursitis as it was thought that pain was mainly related to inflammation of the bursa (fluid-filled sac that cushions between bone and tendons). Research has shown that pain in this area is due to small (and often repetitive) injuries to the gluteal (buttock)muscles and tendons (usually gluteus minimus and gluteus medius). This can cause what is called gluteal tendinopathy.

What Are The Symptoms?

Pain is felt on the outside of your hip/thigh/buttock area.

Symptoms can vary for different individuals but you may commonly experience pain with one or more of the following:

  • Lying on your side
  • When you are walking
  • Climbing the stairs
  • When you are standing on the affected leg for prolonged periods
  • After longer periods sitting
  • When you stand up after sitting
  • Crossing your legs
  • With a smaller amount of physical exercise or activity than you are normally able to do

How Common Is The Condition?

You are more likely to develop GTPS if:

  • You are female (4 times as many women get GTPS than men)
  • You are aged between 40-60 years old
  • Up to 35% of people with lower back pain will also have GTPS

It’s quite common- between 20-25% of the population will have it at some point in their lives.

What Causes The Condition? 

There are a number of different factors that can contribute towards developing GTPS.  These will vary from person to person but common causes are:

  • A fall on to your hip
  • Excessive/sudden increase in physical activity or repetitive movements
  • Crossing your legs
  • Sitting for long periods
  • Sitting in chairs that are too low
  • Standing/weight bearing more through one leg for longer periods
  • Reduced strength of the muscles around your hip
  • Secondary to osteoarthritis of the hip/knee
  • Having low back pain
  • Morphology (Shape) of the pelvis
  • Being overweight
  • An inactive lifestyle

Combinations of the above may lead to the development of GTPS as they put more repetitive friction/ stress and weight through the gluteal muscles, tendons and bursa.

What Can Help With The Condition?

Timescales/ Prognosis

GTPS responds very slowly to treatment. On average it can take 6 -9 months and, in some cases, longer for your symptoms to improve. You need to have patience and ensure that you follow the steps outlined below.

The initial and most effective approach to treating GTPS involves taking the following steps

  • With guidance from your, GP or Pharmacist take medications to manage the pain
  • Balance your physical activity levels at work and home
  • Modify your day to day activities and avoid repetitive (provocative) movements
  • Do exercises to strengthen the muscles of your hip
  • Maintain a healthy body weight
  • Manage other health conditions that you have

In a small number of people with GTPS, surgery and corticosteroid injections may be considered. However, research has showed these to be less effective in improving the symptoms and are only considered when all the above steps have failed.

Pain management

  • Try to keep active and continue gentle exercise. Avoiding all activity can make the pain worse over time. Continue to exercise as long as it is not making the pain worse.
  • Try to stay at work, speak with your employer and modify your duties if necessary.
  • To manage pain, you can apply ice wrapped in a towel directly on the area for up to 20mins.
  • The use of painkillers and anti-inflammatory medications can be used as advised by your pharmacist or family doctor (GP).
  • In extreme cases or cases which do not get better with time and exercise, corticosteroid injections may be used. This can be discussed with you Physiotherapist or GP

Helpful tips

It’s good to keep active, however if activity is making symptoms worse avoid overdoing it.

  • You could try using a pedometer to monitor how many steps you take each day. Keep a diary on how you feel based on how many steps you have taken. Try to reduce your steps if it makes your pain worse. Over time try to slowly add the steps back in.
  • If exercises if flaring up your symptoms then try to make some changes. First try reduce how much exercises you are doing, try to slowly reintroduce that exercises over time. Also consider different forms of exercise such as swimming or cycling which may put less stress on your hip.

Try to be mindful of your postures and body positions during the day

  • Avoid sitting with legs crossed for long periods
  • Avoid sitting with knee wide apart or too close together for long periods
  • Try to change positions frequently throughout the day
  • Avoid standing with your weight on the on leg or pushing one hip out to the side
  • Avoid very low chairs
  • When going up stairs take one step at a time or use hand rail if needed.
  • Limit walking up steep hills where possible

Sleeping positions can causes discomfort at night. Try out the following positions and find the most comfortable.

Try laying on your back with pillow under your knees to relieve pressure from your hip.

Man lying down

Try laying on your side with painful side up and pillow between your legs.

Pacing And Spacing

  • Pacing and spacing methods can help you manage your pain better.
  • Pacing is the term used for breaking down an activity or task. This can be done by taking regular breaks. Prioritising daily activities can also help. This can prevent “over stimulating” your pain system.
  • When completing challenging tasks or activities, it may be useful to set a “baseline”. This is the amount you can manage on a good or bad day without increasing your symptoms. Therefore you can plan rests and set achievable goals.

Pain Activity Ladder

  • By following the pain activity ladder (Click here for a video explanation https://youtu.be/e9SEqd8bvII) which can be seen below, you can identify activities that you would consider severely painful, moderately painful and mildly irritating and act to change your habits.
  • The pain scale, most often used in healthcare, measures pain from 0-10 (zero being no pain and 10 representing the worst pain you could imagine).
  • If you can identify the level of pain you are experiencing, you will find out if you are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing your activity.
  • When you are completing your rehabilitation exercises it is often best to work within the green (and sometimes amber zones depending on what you deem is an acceptable level of pain) both during the exercises and within 48 hours of completing your exercises. If you find yourself in the red zone you are likely pushing yourself too hard and may flare up the pain.

Exercises to strengthen the muscles around the painful area are the most effective treatment for GTPS. Strengthening the muscles of your hip will reduce your pain over time. If you are attending physiotherapy your therapist will advise you further.

It is normal to experience some discomfort or pain during rehabilitation exercises and for a short time after. However this should settle within a relatively short period of time.  The Pain Activity Ladder can be used as a useful guide to what level of pain may be acceptable.

When completing the exercises please start with the early exercises. When you find these easy then you may progress to the Middle and then the late exercises as able.

If pain has gotten progressively worse within 24 hours of completing your exercises then this is a sign that the soft tissue structures have been irritated. This is due to doing too much exercise and/or doing exercises that are too hard too soon. This is normal and you should try to modify your exercises to suit.

Aim to reduce the number of sets and repetitions of your exercises. You can also reduce the load you are using or try an easier exercise. Over time slowly increase the load, volume and exercise difficulty.

Help And Support

If after following the above advice, your symptoms have not improved within 6 to 12 weeks, a referral to a physiotherapist may be beneficial.

You can access physiotherapy by any of the following:

Additional information

Acute Injury Management

POLICE is an acronym (Protection, Optimal Loading, Ice, Compression and Elevation) that is used as a management strategy for many injuries and conditions for the first 24 to 72 hours.

  • Protection and relative rest are advised immediately after injury for the first 24 to 72 hours.
  • Optimal Loading refers to having a balanced rehabilitation program which encourages early and gradual activity to improve recovery. How you progress will vary from person to person depending on the injury. It is about finding the injured areas happy place and increasing slowly and gradually.
  • Ice may be used for reducing pain and swelling. There are safety points to follow when you use ice:
    • Don't ice over a numb area or open wound. If the skin is numb you won't notice if you're developing an ice burn and ice on an open wound can increase the risk of infection.
    • Be wary of ice burns – don't apply ice directly to the skin, wrap an ice pack in a clean, damp tea towel before applying. Avoid prolonged exposure to ice, 10-20 minutes is usually adequate.
    • Apply crushed ice/frozen peas wrapped in a damp towel for 10-20 minutes, 2-3 times per day for the first 5-7 days post injury/ flare up of pain.
    • Stop applying ice if there are any negative effects such as increase in pain or swelling or skin soreness.
  • Compression and Elevation are helpful for reducing inflammation. This can be done by keeping your joint raised on a pillow and compressed by wrapping a bandage around it.
    Do not make the bandage too tight and do not wear tubi-grip or any compression bandage in bed at night.
  • Heat: After 2-3 days, you may find that heat is more relaxing.

You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and is not directly touching your skin.

You should do this for 10 to 15 minutes, 3 to 4 times a day.

What do I do if my symptoms flare up?

Flare ups of pain are common. Some people have recurrent flare ups of pain so it is important to know how best to manage these flare ups. In most cases a pain flare-up will settle within 6 weeks.

Top Tips

  • You will likely find it helpful to rest a bit more but it is still important to keep active. This will help to avoid becoming stiff and your muscles becoming weak.
  • If you aim to get a balance between rest and activity it should help your pain to settle down. You may be sore at first, however, start slowly and gradually increase the amount you do.
  • Reduce movements or tasks that aggravate your symptoms. This can help especially in the early days.
  • Adopting positions or movements that reduce your pain can be useful.

Pain Relief

Analgesia

  • Analgesia also known as pain relief can be an important part in helping you manage your symptoms and allow you to stay active.
  • Taking suitable pain relief regularly allows you to move more normally and continue your usual activities without causing any damage. It is unlikely that medication alone will resolve your pain totally. For this reason we are using the term pain relief (A 30-50% reduction in pain would be deemed to be a good success).

Paracetamol

  • Paracetamol is a good general pain management medication. It is used to help manage lots of different types of pain.
  • Sometimes people believe they need something ‘stronger’ than paracetamol when in fact, taking a regular dose rather than a one-off dose is more effective.
  • Spreading the doses of the paracetamol evenly out over a day will help you control your pain. Visit NHS Inform for more detailed information on paracetamol.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

  • NSAIDs are medications that can reduce swelling around joints and nerve endings to give pain relief. They are particularly useful
    in treating inflammatory type pain. Two commonly prescribed NSAIDs are ibuprofen and naproxen.
  • Although NSAIDs can be very useful they are not suitable for everyone. Visit NHS inform for further information related to NSAIDs.

There are other forms of pain relievers available. If you feel your current pain relievers are not helping your pain or you are
experiencing any side effects from your medication, please seek advice from your GP or pharmacist.

For general information on medication visit NHS Inform.

Staying in work and returning to work

We know that staying in work or returning to work as soon as possible is good for your mental and physical health.

If you have problems with activities at work, it may be helpful to ask for a workstation/workplace assessment or talk with your manager or Occupational Health Department. This can help with alterations or provision of equipment or altering your working day or tasks.

There are organisations which can support you at work or help you return to work. You can visit Knowledge Scotland for further information.

Weight Management

Weight Reduction – People who are overweight tend to have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve the healing process.

A good indicator of whether you need to lose weight is your body mass index (BMI), which you can calculate with the NHS BMI calculator.

If your BMI states you are overweight or obese it is likely that losing weight will reduce your symptoms. Carrying extra fat also increases your risk of heart disease, stroke, type 2 diabetes, and some cancers. Reducing your portion sizes and eating a balanced diet can be helpful in reducing weight. NHS informs provides a free online 12-week weight management programme to get you started right away.

If you need a little more help and feel that you would benefit from working with others in group sessions NHS Lanarkshire’s Weigh to Go programme, groups in North and South Lanarkshire, will help you become more active, eat well and lead a healthier lifestyle.

Smoking

Smoking can affect how your body recovers from musculoskeletal problems. If you smoke then the good news is that by stopping smoking it can improve your health in many different ways. Giving up smoking is not something you have to do on your own. You’re twice as likely to stop smoking successfully if you get the right support from the NHS. There is a free NHS stop smoking service available in Lanarkshire to help you succeed.

Chronic Pain

Some people will have pain which persists beyond the expected time frame for their condition. For further information on this and how best to manage it please visit our Chronic Pain webpage.

Pain Association Scotland is a national charity that delivers professionally led self-management pain education in the community.

Active Health Programme

South Lanarkshire

Active Health is a programme for residents of South Lanarkshire living with long term conditions. Residents are referred via Acute, Physio & specialist nurses to a 10-week programme and then signposted onto a wide variety of mainstream physical activity, sport & outdoor opportunities.

South Lanarkshire Leisure and Culture have many active community opportunities as well as specialised referral programmes. Full details of the 20 leisure centres can be found on the SLL website. Contact details across South Lanarkshire or call 01698 476262 to find out the number of your local leisure centre.

Please contact your health professional to discuss this referral or contact SLLC on 01698 476262.

Contact details

North Lanarkshire

North Lanarkshire Leisure’s Active Health Programme in partnership with NHS Lanarkshire provides a range of supported programmes to help individuals realise the benefits of becoming more physically active whilst also assisting those who are recovering from minor or even more serious illness.

The Active Health Programme has both a General Programme where individuals can access the mainstream health and fitness programmes running within NL Leisure Venues including swimming, jogging, golf and more!

A Specialised Health Class Programme which requires a referral from a health professional, this option is available to individuals who require additional specialised support in taking part in physical activity and classes include Strength and Balance, Cardio I, Cardio II, Back Care and Macmillan Move More classes.

A health and social care professional can make a referral by using the Active Health referral form found at the bottom of the page in the link below.

Contact Details - Health & Wellbeing Information

Mental Wellbeing

It is very important to look after your own mental wellbeing. This can have an influence on your recovery or management of your Musculoskeletal problem. Visit our mental wellbeing page for more information.

Back to top of page

Your Feedback - comments, concerns and complaints

NHS Lanarkshire is committed to improving the service it provides to patients and their families. We therefore want to hear from you about your experience. If you would like to tell us about this please visit our feedback page.

Near Me Lanarkshire