Need a hip physio?

Overview

Greater Trochanteric Pain Syndrome (GTPS) is an umbrella term which often describes lateral hip pain often tendinopathic (pathology of the tendon) in nature. Commonly, the glute medius and, or minimus is affected. Previously known as trochanteric bursitis, the three common bursa to be affected are the subgluteal minimus, maximus and medius. It is often rare to have a purely bursal or tendon pathology and often the two co-exist due to their close proximity (Cook and Purdum 2012). GTPS often presents in running athletes and is also very common in pre-menopausal women.

GTPS and Menopause

Pre-menopausal women often present with this condition and the condition is commonly associated with a change in load or an element of compression on the lateral structures of the hip (Cowan et al. 2020). Given the association with menopausal women, research has indicated that there is a hormonal and an inflammatory element to this condition. There is also a correlation between obesity and developing GTPS. Patients may complain of trouble laying on the affected hip and often have pain and discomfort with walking, running and stairs. Some present with pain radiating down into the lateral aspect of their lower leg. Some also have trouble sitting cross-legged.

Clinical Diagnosis

On clinical examination palpating the gluteal tendons often causes a positive “jump sign” or is painful to touch. Resisted hip abduction and reduced active external rotation is also found to correlate with GTPS symptoms. Arguably, the most effective clues are the clinical signs and symptoms. Tests used without formulating a clinical picture, simply identify that there are structures in the hip which are painful. It does not necessarily identify the structure at fault. It is not uncommon to have a mixed picture of symptoms, however improving the function of the tendon is more effective than treating the pain. Therefore imaging and the use of corticosteroid injections should not be used as the first line of diagnostic and treatment methods for GTPS (Cohen et al. 2020). Tendon pain often remains due to the lack of adaptation to loading.

Rehabilitation

Education, early and gradual loading are essential to the success of how patients rehabilitate. Avoiding compression to the tendon (eg. lying on hip and crossing legs) and aggravating factors are initially suggested before progressing. The evidence suggests isometric exercises are a good way to load (found to be helpful in patella tendons); whereas other research suggests the type of muscle contraction or even exercise type does not change the overall outcome in patients. Education and modification of load is key, this may include modification of exercise, weight management and/or hormone management. Exercise prescription should focus on the entire kinetic chain, especially when considering returning to sporting activities (Cowan et. al 2022). Below are some examples of common exercises prescribed by physiotherapists. For full rehabilitation it is very important to go through full rehabilitation including strength training to enable to tendon and muscles to tolerate higher loads, this will often take at least 12 weeks for the tendon and strength adaptations to take place.

• 

• 

• 

About Leanne

Leanne is a physiotherapist from London, England passionate about all things lower limb rehabilitation. Leanne has gained a lot of her experience in the NHS and in the private sector, working with Sports Physiotherapists and Sports Physicians. Leanne has a interest in lower limb rehabilitation, implementing both manual techniques and exercise prescription. She has completed courses in acupuncture and has also completed an imaging course at Hertfordshire University. She worked as a physiotherapist at the Commonwealth Games, assisting with the athletics team.

References

• Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163-168
• Cowan R.M. et al. (2020) Muscle Size and Quality of the Gluteal Muscles and Tensor Fasiae Latae in Women with Greater Trochanteric Pain Syndrome, Clinical Anatomy, Volume 33 (7) pages 1082-90
• Cowan R.M. et al (2022) Does Menopausal Hormone Therapy, Exercise or Both improve Pain and Function in Women with Greater Trochanteric Pain Syndrome? A 2×2 Randomised Clinical Trial, The American Journal of Sports Medicine, Volume 50, Issue 2, page 515-25
• Images: https://www.news-medical.net/health/The-Role-of-Estrogen-in-Mene28099s-Health.aspx