Greater Trochanteric Pain Syndrome: Causes and Treatment

Pain on the outside of the hip is often described as hip bursitis. However, the source of the discomfort may involve more than inflammation of a bursa.

Greater trochanteric pain syndrome is a broader term describing pain associated with the tendons, bursae, and other tissues surrounding the outer hip.

Symptoms may become worse while walking, climbing stairs, lying on the affected side, or standing after prolonged sitting. Without an accurate diagnosis, patients may repeatedly treat the painful area without addressing the underlying tendon or movement problem.

What Is Greater Trochanteric Pain Syndrome?

The greater trochanter is the prominent bone on the outside of the upper femur. Several important muscles and tendons attach near this area, including the gluteus medius and gluteus minimus tendons.

Bursae are small fluid filled sacs that reduce friction between tendons, muscles, and bone.

Greater trochanteric pain syndrome may involve:

1. Gluteus medius tendinopathy

2. Gluteus minimus tendinopathy

3. Partial tendon tearing

4. Irritation of a nearby bursa

5. Compression of the outer hip tissues

6. Weakness or altered movement of the hip muscles

Although bursitis can contribute to symptoms, research increasingly recognizes gluteal tendon problems as an important cause of persistent lateral hip pain.

What Does Greater Trochanteric Pain Syndrome Feel Like?

The most common symptom is pain or tenderness on the outside of the hip.

Patients may experience pain while:

1. Lying on the affected side

2. Climbing stairs

3. Walking uphill

4. Standing on one leg

5. Getting out of a chair

6. Entering or exiting a car

7. Running or exercising

8. Crossing the legs

9. Standing for extended periods

Pain may extend down the outside of the thigh but typically does not follow the same neurological pattern as lumbar radiculopathy.

Some patients experience both hip and spinal conditions, making a thorough examination important.

Why Does Lying on the Hip Hurt?

Lying directly on the painful side compresses the gluteal tendons and bursae between the greater trochanter and the sleeping surface.

Lying on the opposite side may also increase tension across the affected hip if the upper leg drops inward.

A pillow between the knees may help keep the hips in a more neutral position. However, sleep adjustments alone do not address underlying tendon weakness or movement patterns.

What Causes Lateral Hip Pain?

Greater trochanteric pain syndrome may develop gradually or following a sudden increase in activity.

Potential contributing factors include:

1. Repetitive walking or running

2. Sudden increases in exercise

3. Weakness of the hip abductor muscles

4. Changes in walking mechanics

5. Prolonged standing on one leg

6. Hip arthritis

7. Lower back conditions

8. Differences in leg length

9. Direct trauma to the side of the hip

10. Repeated compression of the gluteal tendons

The condition is often related to the way force is distributed through the hip rather than a single isolated episode of inflammation.

How Is Greater Trochanteric Pain Syndrome Diagnosed?

Diagnosis is primarily based on the patient’s symptoms and physical examination.

The physician may assess:

1. Tenderness over the greater trochanter

2. Pain while standing on one leg

3. Hip abductor strength

4. Pain during resisted hip movement

5. Walking mechanics

6. Hip joint mobility

7. Signs of lumbar nerve irritation

A combination of clinical tests may help determine whether the outer hip tissues are the likely source of pain.

Ultrasound or magnetic resonance imaging may be used when symptoms are persistent, the diagnosis is uncertain, or a tendon tear is suspected.

Imaging can also help distinguish greater trochanteric pain syndrome from hip arthritis, stress injury, or other conditions.

Exercise and Physical Therapy

Education and progressive exercise are generally considered central parts of treatment.

A rehabilitation program may focus on:

1. Strengthening the gluteal muscles

2. Improving pelvic stability

3. Correcting movement patterns

4. Gradually increasing tendon tolerance

5. Reducing repeated compression of the hip

6. Improving trunk and lower extremity strength

A 2024 systematic review supported exercise as a first line treatment for clinically diagnosed greater trochanteric pain syndrome. Exercise was also more likely than corticosteroid injection to produce meaningful overall improvement in the studies reviewed.

Exercises should be progressed carefully. Aggressive stretching or strengthening may worsen symptoms if the tendon is not ready for the load.

Activity and Sleep Modifications

Temporary changes may help reduce irritation while the tendon is recovering.

Patients may be advised to avoid:

1. Standing with most body weight on one hip

2. Crossing the legs for prolonged periods

3. Sleeping directly on the painful side

4. Sudden increases in running or walking distance

5. Repeated deep hip positions that increase compression

The goal is not to eliminate movement indefinitely. The goal is to reduce excessive irritation while gradually rebuilding strength and tolerance.

Corticosteroid Injections

A corticosteroid injection may reduce pain and inflammation around the affected tissues.

Ultrasound guidance can help the physician visualize the tendons, bursae, and nearby structures while placing medication into the targeted area.

Corticosteroid injections may provide relatively rapid symptom relief for some patients. However, the benefit may decrease over time, particularly when the underlying tendon weakness or mechanical stress is not addressed.

The potential benefits and risks should be considered carefully, especially when repeated injections are being considered near a tendon.

Platelet Rich Plasma for Gluteal Tendon Pain

Platelet rich plasma is prepared from a patient’s own blood. The blood is processed to concentrate platelets and other components that may support the body’s healing response.

The preparation is then injected into the targeted tendon or surrounding tissue using ultrasound guidance.

Research examining platelet rich plasma for greater trochanteric pain syndrome has shown promising results, particularly for symptoms that have not improved with conservative care. However, preparation methods and study protocols vary, and additional high quality trials are still needed.

Platelet rich plasma is not expected to provide immediate numbing relief. Improvement may develop gradually as the tissue responds to treatment and rehabilitation progresses.

Other Treatment Options

Depending on the diagnosis and treatment history, additional options may include:

1. Shockwave therapy

2. Targeted tendon procedures

3. Medication management

4. Treatment of an underlying lumbar spine condition

5. Treatment of hip arthritis

6. Surgical evaluation for severe tendon tearing

Shockwave therapy has shown potential for reducing pain in some patients, although study results and treatment protocols remain variable.

Surgery is generally reserved for carefully selected patients with significant structural damage or symptoms that continue despite appropriate non surgical treatment.

Greater Trochanteric Pain Treatment at Ospina Medical

At Ospina Medical, lateral hip pain is evaluated by considering the tendons, bursae, hip joint, lower back, nerves, and movement patterns.

Treatment may include physical therapy, ultrasound guided injections, platelet rich plasma, other regenerative procedures, or treatment of an additional pain source.

The goal is to determine why the hip hurts and create an individualized plan that supports long term movement and function.

Contact Ospina Medical to schedule an evaluation for persistent pain on the outside of the hip.

This information is intended for general educational purposes and does not replace an individualized medical evaluation.