(Part 1)
Greater trochanteric pain syndrome (GTPS) is a term used to describe pain overlying the outer aspect of the hip, it was also described as trochanteric bursitis. Ultrasonography and MRI has revealed that the deep abductor muscle tendons (gluteus medius and minimus) develop changes (tendinopathy) and these muscles develop weaknesses. The adjacent bursae (fluid filled pouch) may also become inflamed.
Symptoms of GTPS consist of persistent pain on the outside of the hip and can radiate along the outer aspect of the thigh to the knee or into the buttock. Physically pressing reveals tenderness of the bony area on the outside of your hip (Greater Trochanter).
These symptoms are three times more common in women than men, particularly over the age of 50. This is due to women’s hips generally being wider increasing the force on the gluteal tendons.
Repetitive overuse or a sudden change in activity can cause increased compression and tension on the tendons particularly if there is an underlying weakness of the muscles around the pelvis. Examples include starting to run or doing high impact classes after a long lay-off.
(Part 2)
The latest proposed treatment regime is to reduce the compression of the deep abductor tendons on the greater trochanter (bone), by initially reducing the work load on the tendon and then progressively strengthening these deep muscles. In 2018 a randomised control trial in the BMJ compared advice/exercise versus corticosteroid injection versus wait and see. The patients were followed up over 1 year. The advice/exercise gave the best results. Marked improvements occurred within 8 weeks of performing the progressive exercise programme.
Continuing to do the exercises long-term will provide a long-term preventative programme.
Here at Fontwell the physiotherapist will initially perform an examination to establish:
1. the diagnosis and exclude other pathologies.
2. the underlying cause/s which will be unique to your posture and the movement mechanics pertaining specifically to your activities.
The exercise programme is progressive and will take at least 3 sessions. For best results you will be expected to do exercises daily. The advice below is key to the success of the programme and you can start on these prior to your visit.
In the case of severe pain (with no response to the programme) an ultrasound guided injection may be helpful, if the bursae are inflamed (this can be seen on the ultrasound). The injection is not put into the tendons. The injection may reduce pain and thus allow the exercises to be performed which improves the muscle/tendon unit’s ability to withstand load. Shockwave therapy directed at the tendon is an intervention sometimes used if there is no response to the treatments outlined.