Greater trochanteric pain syndrome

Understanding greater trochanteric pain syndrome

Pain on the outside bony part of your thigh could indicate a soft tissue problem and is known as greater trochanteric pain syndrome (GTPS).

GTPS describes pain at the side of the hip, often felt on side-lying or when climbing stairs, which originates in the soft-tissues of the hip including muscles, tendons and bursa. A bursa is a small fluid-filled sac that allows tendons to glide over bone.

In the majority of cases, pain is usually a consequence of overloading the gluteus medius and/or gluteus minimus muscles and/or compression of their tendons in certain postures. It can occasionally be accompanied by an inflamed bursa (a bursitis). Tendons can be overloaded either with a significant change in physical activity (type or volume) or most commonly with a loss of strength in these muscles.

How is GTPS managed?

Exercises that target the strengthening of these muscles, together with avoiding stretches and provocative postures (in standing, lying or sitting) that place the tendons under compression have proven effective in improving symptoms within 8 to 10 weeks.

Postural advice

Avoid any position that allows your affected leg to cross the centre-line of your body. For example, do not sit with crossed-legs or stand with crossed ankles. If you prefer to sleep on your side, place a pillow between your knees.

Standing positions to avoid

Sitting position to avoid

Hip stretch to avoid

Sleeping position to avoid

Recommended sleeping position

GTPS exercises

Read below for advice and exercises to manage hip pain.This guidance has been produced by the Dynamic Health physiotherapy service. It offers simple measures to help you manage your hip problem safely. Often the right advice and exercises are all you need to improve the problem.

This information has been made available to your GP, who may ask you to try the advice and exercises prior to consulting a physiotherapist.

If your hip pain started suddenly after a recent significant injury, for example, a slip, trip or fall, and you are unable to weight-bear, or if you have a hot, swollen hip with a high temperature and fever, please seek urgent medical advice from A&E, minor injuries or NHS 111.

How much exercise should I do?

A senior couple on yoga mats outside in a park in a bent knee standing pose with arms outstretched.

Exercise every other day

Allowing enough rest is important to let soft tissues recover and develop.

cropped image of two people, one black and one while in shorts and t-shirts on an exercise bike pedalling. Close crop on their hands on handle bars and their legs moving.

Choose 3 or 4 exercises

Choose exercises that are challenging but manageable.

Young asian man running on the spot wearing a t-shirt and shorts in their living room on a wooden floor.

Repeat the exercise

Perform 3 to 5 repetitions of each exercise.

Rest

Rest for up to 1 to 2 minutes between each set.

Once an exercise is easy, progress it

Increase the number of repetitions (you could aim to increase it by 2 to 5 repetitions every 2 weeks). Or hold the positions for longer or move to a more challenging exercise.

How much pain is too much pain?

Read below for advice and exercises to manage hip pain.

Before exercising

Before exercising, rate your pain at the moment on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you can imagine.

A maximum pain level

A maximum pain level of 4/10 whilst exercising is fine as long as it eases within 45 minutes of the session and does not interfere with sleep or activities the next day.

If your pain increases

If your pain increases beyond this, simplify the exercise by reducing the range of movement or number of repetitions, or try an easier exercise.

Exercises that target the strengthening of these muscles, together with avoiding stretches and provocative postures (in standing, lying or sitting) that place the tendons under compression have proven effective in improving symptoms within 8 to 10 weeks.

Standing hip abduction

Resisted hip external rotation and abduction in sitting

Chair squat with hip external rotation

Place the loop of exercise band around your legs, under your knees, and ensure the slack is taken off.

Make sure the chair is at a suitable distance behind you.

Bend your knees and hips and squat down.

At the same time rotate your knees outwards against the resistance.

The knees and toes should point in the same direction.

Lightly sit down and then push back up to the starting position using your front thighs and bottom muscles.

Woman standing with her back to a chair and an exercise band looped around her legs under her knees. An image of the same woman on the right sitting on the chair behind her with the band still looped around her legs.

Bridge with hip external rotation

Standing hip abduction

Stand up tall with your back against a wall and hold onto a support as you need to.

Lift your leg sideways, keeping your leg against the wall and leading the movement with your heel.

Then bring your leg back to the start position.

Keep your upper body straight throughout the exercise.

A woman standing up straight holding onto a chair with her right hand. Underneath the same woman is holding onto the chair whilst lifting their left leg sideways.

Sidelying exercise 1

Sidelying exercise 2

Lateral side lunge

Bridge

Lie on your back with legs bent and feet on the floor.

Lift your pelvis and lower back (gradually vertebra by vertebra) off the floor.

Hold the position for 5seconds and then lower down slowly returning to starting position.

Once this is no longer challenging, progress to the single leg bridge.

Woman lying on her back on an exercise mat with her legs bent and feet on the floor. An image of the same woman underneath lying on her back on the exercise mat with her back, bottom and pelvis raised off the floor, whilst keeping feet on the floor.

Single leg bridge

Mini squat

Sit to stand

Wall sit

Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards.

Keep your chest up and your spine and neck in a neutral position.

Squat down by sitting back and bring your arms forward.

Push back up through the heels, chest up, and straighten your hips.

Keep your hips, knees and toes aligned and don't let your lower back round.

Keep your weight evenly on your whole foot.

Sumo squat

Stand tall with your feet wide apart. Trunk is active and buttocks tightened.

Hold a weight with straight arms in front of your body.

Squat down keeping most of your weight on your heels. Keep your spine in a neutral position and your trunk upright.

Push back to the starting position.

Push your knees outwards, to keep your knees and toes aligned.

Your weight should be evenly distributed between the heels and forefeet.

Squat alignment

Glute walk

Stand tall, with an exercise or loop band around your legs (slightly above or under the knee joint).

Take a hip-width stance so that the band tightens and squat down. In this position, step to the side then return, keeping the band tight at all times.

Focus on using your buttock muscles.

You can also step forwards and backwards, but remember to keep feet at least hip width apart.

Lateral step down

Need more help?

Consider self referring using the link below:

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Refer yourself to physiotherapy