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Health condition · Clinically reviewed

Greater trochanteric pain syndrome, a gluteal tendinopathy, not just bursitis.

Lateral hip pain that flares at night is common and treatable. Loaded physiotherapy beats injection in the long run - and imaging matters when it does not settle.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BOA, BASEM and peer-reviewed hip and tendinopathy sources you can see at the end.

  • 03

    Current for 2026

    Reflects the modern understanding that GTPS is primarily a gluteal tendinopathy, not simple bursitis.

Key facts

GTPS at a glance.

The essentials, in plain English - what it is, who it affects, and how it is treated in the UK today.

  • What it is

    Greater trochanteric pain syndrome (GTPS) - lateral hip pain from gluteal tendinopathy, tears and secondary bursitis around the greater trochanter.

  • Who gets it

    Peak age 40 to 60, women affected four times as often as men - often triggered by walking, running or spinal problems.

  • Old name, new thinking

    Once called trochanteric bursitis - now recognised as primarily a gluteus medius and minimus tendinopathy with secondary bursal inflammation.

  • Classic symptom

    Sharp lateral hip pain, worse lying on the affected side, climbing stairs or standing for long periods.

  • Gold-standard imaging

    MRI or ultrasound show tendinopathy, partial or full-thickness tears and bursal thickening.

  • First-line treatment

    Progressive gluteal loading physiotherapy (LEAP-style programmes) beats corticosteroid injection at 12 months.

Why this guide matters

A tendon problem, not a shot in the bursa.

GTPS is common, treatable and often mishandled. Three principles run through everything else on this page.

  • It is primarily a tendinopathy

    Gluteus medius and minimus tendinopathy drives the pain - the bursa is usually reacting to it, not the primary problem.

  • Loading beats resting

    Progressive gluteal loading (LEAP-style physiotherapy) is the best-evidenced treatment - superior to injection at 12 months.

  • Imaging changes the plan

    MRI or ultrasound identifies gluteal tendon tears - a different problem needing surgical, not physiotherapy, answers.

How the diagnosis is made

From lateral hip pain to a clear plan.

The steps a UK GP or musculoskeletal specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Lateral hip pain, difficulty side-lying, worse with stairs and prolonged standing - and any radiation into the outer thigh.

  2. 02

    Assessing

    Palpation and gait

    Tenderness directly over the greater trochanter, and a Trendelenburg gait pointing to gluteus medius weakness.

  3. 03

    Assessing

    Provocation tests

    FADER (flexion, adduction, external rotation), single-leg stance and resisted abduction reproduce the pain.

  4. 04

    Confirming

    Rule out mimics

    Hip osteoarthritis, femoroacetabular impingement, lumbar radiculopathy, meralgia paraesthetica and sacroiliac referral all imitate GTPS.

  5. 05

    Confirming

    Ultrasound or MRI

    Specialist musculoskeletal imaging - the gold standard for tendinopathy, gluteal tears and bursal involvement.

  6. 06

    Preparing

    Plain X-ray if indicated

    Useful to rule out coexisting hip osteoarthritis or bony pathology, particularly in older patients.

  7. 07

    Preparing

    Specialist musculoskeletal review

    Persistent or high-impact cases go on to a hip preservation surgeon or musculoskeletal physician for a tailored plan.

Typical timeline: a first visit to a working plan in a week or two, with imaging when it changes management.

Symptoms

What GTPS actually feels like.

A recognisable pattern of lateral hip pain, night discomfort and stair-related flare-ups - and the features that mean it is time to escalate.

  • Lateral hip pain

    Sharp or aching pain directly over the greater trochanter - the bony prominence on the outer hip.

  • Night pain lying on the side

    Sleeping on the affected side is often the earliest and most disruptive complaint.

  • Pain climbing stairs

    Loading the gluteal tendons on a single leg reproduces the classic sharp pain.

  • Prolonged standing or walking

    Symptoms build over minutes to hours of upright activity and settle with rest.

  • Radiation down the outer thigh

    Pain travels along the iliotibial band and occasionally reaches the knee.

  • Trendelenburg gait

    A hip drop on the opposite side when standing on the painful leg - a sign of gluteus medius weakness.

  • Snapping sensation

    External snapping hip - the iliotibial band flicking over the greater trochanter with movement.

  • Red flag - sudden weakness

    A sudden loss of abduction strength suggests a full-thickness gluteal tendon tear needing urgent specialist review.

Treatment

How GTPS is treated in the UK.

Loaded physiotherapy first, injection and shockwave in selected cases, and surgery for confirmed gluteal tendon tears.

  • Relative rest and activity modification

    Reduce provocative loads - long walks, stairs and side-lying - without deconditioning. Pace, do not stop.

  • Specialist physiotherapy

    Progressive gluteal loading (LEAP-style programme) is the best-evidenced first-line treatment - Fitzpatrick 2018 JAMA.

  • Sleep positioning

    A pillow between the knees when side-lying and a softer mattress reduce compressive load on the tendons overnight.

  • NSAIDs and topical analgesia

    Short courses of oral or topical NSAIDs help settle flares - alongside weight optimisation where relevant.

  • Corticosteroid injection

    Ultrasound-guided injection into the bursa gives short-term relief - inferior to exercise at 12 months. See our large-joint cortisone page.

  • Extracorporeal shockwave therapy

    ESWT has growing evidence for recalcitrant gluteal tendinopathy - delivered in specialist musculoskeletal clinics.

  • Platelet-rich plasma (PRP)

    Selective use in refractory tendinopathy - evidence emerging, offered by specialist musculoskeletal teams.

  • Gluteal tendon repair or endoscopy

    Open or endoscopic repair for full-thickness tears - and endoscopic bursectomy or ITB release in selected cases.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and landmark trials, current at the time of last review.

Key references

Guidelines, trials and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or musculoskeletal specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • Fitzpatrick J et al. Effectiveness of the LEAP programme in gluteal tendinopathy. JAMA 2018.

  • British Orthopaedic Association (BOA). Standards for hip and lower-limb care.

  • British Association of Sport and Exercise Medicine (BASEM). Tendinopathy guidance.

  • NICE Clinical Knowledge Summaries. Hip pain in adults.

Red flags

When lateral hip pain needs urgent attention.

Most GTPS is manageable in primary care and physiotherapy. These are the situations where a specialist opinion is needed sooner rather than later.

  • Sudden loss of abductor strength

    A sudden inability to stand on the affected leg suggests a full-thickness gluteal tendon tear and needs urgent hip specialist review.

  • Systemic features

    Fever, night sweats, weight loss or malaise with lateral hip pain warrant urgent assessment to rule out infection or malignancy.

  • Progressive neurology

    New leg weakness, saddle anaesthesia or bladder or bowel disturbance is a cauda equina red flag - go to emergency care immediately.

  • Trauma with severe pain

    Significant fall or impact with new severe hip pain needs imaging to rule out fracture, particularly in older or osteoporotic patients.

  • Failed 6 months of care

    Persistent disabling pain despite loaded physiotherapy deserves specialist musculoskeletal review for imaging and further options.

  • Rapidly worsening night pain

    Escalating night pain not eased by rest is not typical of GTPS - flag for imaging and specialist review.

  • Bilateral disabling symptoms

    Both hips deeply affected at once should prompt a broader review - inflammatory, endocrine and metabolic contributors included.

  • Post-operative flare

    Sudden lateral hip pain after hip surgery needs an early call back to the operating team.

  • Uncontrolled diabetes

    Poor glycaemic control worsens tendon healing and injection outcomes - optimise before intervention where possible.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - loaded physiotherapy, a sensible sleep set-up, patience with tendon healing, and knowing when to step up.

A quiet reminder

Tendons respond to load, not to rest.

A steady, progressive strengthening plan - kept up for months - does more than any single injection or scan.

  1. 01 Load

    Load the tendons, do not rest them

    Progressive gluteal strengthening under a physiotherapist is the treatment - not a bolt-on to rest.

  2. 02 Sleep

    Fix the side-lying set-up

    A pillow between the knees, a softer mattress and sometimes a night on your back can transform sleep quality.

  3. 03 Patience

    Think months, not weeks

    Tendon adaptation takes 12 weeks or more - stay the course before judging whether a plan is working.

  4. 04 Escalate

    Do not settle for chronic pain

    If loaded physiotherapy has been given a fair run, ask for a specialist review - shockwave, imaging and surgery all have a place.

Frequently asked

Everything we get asked about GTPS.

Quick answers on gluteal tendinopathy, injections, imaging and surgery.

  • What is greater trochanteric pain syndrome?

    GTPS is pain around the greater trochanter on the outer hip. It is caused mainly by tendinopathy of the gluteus medius and minimus tendons, with secondary inflammation of the surrounding bursae. It replaces the older term trochanteric bursitis, which underplayed the tendon component.

  • Is trochanteric bursitis the same thing?

    It is the older name for the same problem. We now know the primary issue is usually gluteal tendinopathy and tears, with bursal inflammation as a secondary feature. The change of name matters because it changes treatment - progressive loading beats rest and injection over the long term.

  • What does the pain typically feel like?

    Sharp or aching pain over the outer hip, often worst when lying on that side at night, climbing stairs, standing for long periods, or after a long walk. Pain can radiate down the outer thigh and occasionally reach the knee.

  • Do I need a scan?

    Not always. A confident clinical diagnosis based on history and examination is often enough to start treatment. Ultrasound and MRI are helpful when the diagnosis is unclear, symptoms are severe or persistent, or a gluteal tendon tear is suspected.

  • Should I have a steroid injection?

    Ultrasound-guided corticosteroid injection can help short-term pain, particularly during a flare. However the LEAP trial showed that structured loading physiotherapy is more effective at 12 months. Injection is a bridge, not a stand-alone answer.

  • When is surgery considered?

    Surgery is reserved for confirmed full-thickness gluteal tendon tears, or for cases that fail a proper course of loaded physiotherapy, injections and shockwave. Options include open or endoscopic gluteal tendon repair, bursectomy and iliotibial band release.

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