Greater trochanteric pain syndrome (GTPS): symptoms, causes and treatment

Greater trochanteric pain syndrome (GTPS) is pain over the outside of the hip. St George's University Hospitals NHS Foundation Trust describes it as a common hip condition that usually occurs when the tissues that lie over the greater trochanter, the bony prominence on the outside of the hip, become irritated.

Royal Devon University Healthcare NHS Foundation Trust says the name is a blanket term for lateral hip pain and that you may also hear it called trochanteric bursitis or gluteal tendinopathy, because the condition often involves those tissues. It adds that the name bursitis suggests there is inflammation, but most research shows that there is usually very little to no inflammation.

The NHS lists bursitis among the common causes of hip pain, describing pain that may spread to the upper leg (thigh) and feel worse when moving or lying on your side.

Royal Devon describes pain around the outside of the hip that may radiate down the side of the thigh. Many people describe a deep ache or a burning sensation. Symptoms often come on gradually but may also come on after an injury.

Activities that can aggravate the pain include walking uphill, running, climbing stairs, lying on the affected side, standing on one leg and getting out of low chairs or car seats.

• Pain on the outside of the hip, sometimes spreading down the outer thigh.

• A deep ache or burning sensation.

• Pain lying on the affected side, which can disturb sleep.

• Pain on stairs, walking uphill, running or standing on one leg.

• Pain getting out of low chairs or car seats.

St George's says the exact cause of GTPS is not fully understood but several factors contribute. Royal Devon explains the idea of load: weakness in the muscles around the hip can overload the soft tissues, and either too much or too little activity can be a problem for tendon health. Pain may be felt when the tendon is expected to do more than it is used to.

Often you cannot put your finger on a single factor. Royal Devon gives the example of a gradual increase in body weight and a reduction in general fitness over time.

• Being overweight.

• Sudden changes in activity levels, such as taking up walking, particularly up hills or stairs.

• Post-menopausal women (listed by St George's).

• Falling or landing on the outside of the hip.

• Rheumatological diseases and regular use of steroids (listed by St George's).

• Reduced strength of the hip muscles.

• Prolonged sitting with the legs crossed.

St George's says a clinical examination can be enough to diagnose GTPS. An ultrasound scan over the outside of the hip or upper thigh can be used to confirm the diagnosis but is not always necessary.

Royal Devon notes that other areas of the body, such as the spine or pelvis, can give similar symptoms and advises seeing your GP or a physiotherapist if you think that might be the case, especially if you have pins and needles or numbness as well as pain.

Both leaflets stress that activity should be adjusted rather than stopped. St George's says load management does not mean stopping all activity but modifying some, for example taking a quick 5-minute seat during a long walk, changing your sitting position or using cushions to support your hips.

Royal Devon suggests the following self-help measures.

• Walk on the flat, avoid hills and keep stairs to a minimum until the pain settles. Start with 10 minutes of walking and build up gradually, checking symptoms at night and the next day.

• Avoid crossing your legs or ankles while standing or sitting, avoid lying on the painful side, and avoid low chairs or sitting on the floor.

• Lie on your back with a small pillow under the knees, or on your non-painful side with a thick pillow between the legs.

• Spread weight equally between both legs when standing, avoid hanging on one hip, and sit to put on socks and trousers.

• Use heat or cold, whichever works for you: a bag of frozen peas wrapped in a damp tea towel for up to 15 minutes, or a covered hot water bottle, checking the skin regularly.

• Lose weight if you are overweight, and seek support to stop smoking.

Royal Devon says strengthening the muscles around the hip and back can help, and that a physiotherapist will assess you and give a tailored programme. It advises avoiding stretches for the bottom muscles and the side of the leg. St George's likewise advises avoiding stretching the hip and avoiding lying on your affected hip.

On how hard to work, Royal Devon suggests using a pain scale of 0 to 10 and keeping at or below 4 to 5, with any increased discomfort settling within 30 minutes of finishing. St George's suggests aiming for two to three sessions of exercises per week, in progressive levels from isometric hip abduction to bridging and split-stance dips.

Flare-ups are a common part of recovery, according to Royal Devon. It suggests continuing with modified exercises, such as fewer repetitions for a few sessions, and says that hurt does not mean harm, resting for long periods can make it worse, and that you should gradually return to normal activities over several weeks. St George's says a flare-up does not mean you have damaged the hip but that you have done more than it can tolerate.

Royal Devon says you may be prescribed simple pain relief or anti-inflammatory medicine, taken as prescribed until the pain settles, or a topical anti-inflammatory gel that your GP or pharmacist can advise on. St George's notes that many people find an anti-inflammatory such as ibuprofen helpful, and says to discuss medicines with your GP or a pharmacist.

St George's says some patients may be offered a corticosteroid injection if pain is not improving with exercise and load management. It says an injection is not appropriate for everyone and is always an adjunct alongside physiotherapy, and that research has shown corticosteroid injections are no more effective than physiotherapy at treating GTPS in the long term. They can be useful for short-term pain management but do not resolve the underlying cause.

The NHS advises seeing a GP about hip pain if it is stopping you doing normal activities or affecting your sleep, if it is getting worse or keeps coming back, or if it has not improved after treating it at home for 2 weeks. In many areas you may be able to refer yourself to NHS community musculoskeletal (MSK) services, such as physiotherapy, without a GP referral.

Ask for an urgent GP appointment or call NHS 111 for severe hip pain that started suddenly without a fall or injury, a swollen hot hip, skin colour change around the hip, or hip pain with feeling generally unwell and a high temperature. Call 999 or go to A&E for severe hip pain after a fall or injury, being unable to walk or put weight on the leg, or tingling or loss of feeling in the hip or leg after an injury.

On the NHS, outer hip pain is usually managed through a GP or an NHS physiotherapy or MSK service, often with a self-management leaflet and exercises while waiting. Referral on to an orthopaedic or sports medicine service is considered if pain does not improve.

Some people choose private physiotherapy or a private orthopaedic or sports medicine opinion, usually without needing a referral for physiotherapy. The core of treatment, loading and strengthening, is the same in both routes.