Greater trochanteric pain syndrome (GTPS) causes lateral hip pain from gluteal tendon dysfunction. Learn about causes, physiotherapy treatment, recovery timelines, and prevention strategies.
Greater trochanteric pain syndrome is an umbrella term that describes pain and tenderness originating from the lateral (outer) aspect of the hip at or around the greater trochanter — the bony prominence you can feel on the outside of your upper thigh. Historically, this condition was labelled "trochanteric bursitis," but research over the past decade has demonstrated that isolated bursal inflammation is actually quite rare. Instead, GTPS most commonly involves tendinopathy (degeneration and disorganization of tendon fibres) of the gluteus medius and gluteus minimus tendons where they attach to the greater trochanter (Grimaldi et al., 2024, Rheumatology Advances in Practice).
The updated terminology reflects a more accurate understanding of the pathology: while some degree of bursal irritation may be present, the primary driver of symptoms is typically a breakdown in tendon health rather than pure inflammation.
GTPS is most prevalent among women aged 40–60, though it can affect anyone. Studies estimate a prevalence of 10–25% in the general population, with women being affected roughly three to four times more often than men. Post-menopausal women face an elevated risk because hormonal changes can reduce tendon resilience. Runners, people who have recently increased their walking or stair-climbing volume, and individuals with sedentary occupations that involve prolonged sitting are also commonly affected.
The greater trochanter is a large, bony projection at the top of the femur (thigh bone). It serves as the primary attachment site for several muscles that stabilize and move the hip, most notably the gluteus medius and gluteus minimus. Think of the greater trochanter as an anchor point — the tendons of these hip muscles wrap around it in a way that is biomechanically similar to how the rotator cuff tendons wrap around the shoulder.
The gluteus medius and gluteus minimus are the workhorses of lateral hip stability. Every time you take a step, these muscles fire to prevent your pelvis from dropping on the opposite side. Their tendons insert onto different facets of the greater trochanter:
When these tendons are healthy, they handle the repetitive loads of walking, running, and stair climbing without issue. When they become overloaded or degenerated, they lose their capacity to manage force, and pain develops.
Several bursae (fluid-filled sacs designed to reduce friction) surround the greater trochanter. The subgluteus maximus bursa is the largest. While bursal irritation can accompany tendon dysfunction, imaging studies have confirmed that isolated bursitis without tendon involvement is uncommon. This is why modern treatment focuses on the tendon rather than the bursa.
The most common mechanism behind GTPS is a mismatch between the load placed on the gluteal tendons and their capacity to handle that load. This can happen when someone suddenly increases physical activity — for example, starting a new walking program, training for a race, or taking on a hiking trip after a period of inactivity.
A key insight from contemporary research is that compressive forces on the gluteal tendons significantly contribute to GTPS (Grimaldi et al., 2024, Rheumatology Advances in Practice). Compression occurs when the tendon is squeezed against the bone in positions of hip adduction. Common aggravating postures include lying on the affected side, standing with the hip hitched out, sitting with legs crossed, and stretching the ITB by pulling the leg across the body.
Weakness in the hip abductor muscles leads to altered movement patterns that place additional stress on the gluteal tendons. A Trendelenburg gait — where the pelvis drops on the unsupported side during single-leg stance — is a hallmark sign of gluteus medius insufficiency.
Oestrogen plays a protective role in tendon health. During and after menopause, declining oestrogen levels reduce tendon collagen synthesis and repair capacity, making post-menopausal women particularly susceptible to gluteal tendinopathy.
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A landmark randomized controlled trial — the LEAP trial — compared education plus exercise, corticosteroid injection, and a "wait and see" approach for gluteal tendinopathy (Mellor et al., 2018, BMJ). At both 8-week and 52-week follow-ups, the education-plus-exercise group achieved significantly better outcomes in pain reduction and functional improvement than either the injection or wait-and-see groups.
A 2025 systematic review and network meta-analysis confirmed that exercise-based interventions rank among the most effective conservative treatments for GTPS, outperforming corticosteroid injections, shockwave therapy, and NSAIDs in long-term outcomes (Wang et al., 2025, Journal of Orthopaedic Surgery and Research). A 2024 systematic review with meta-analysis found that progressive resistance training showed the strongest effects for gluteal tendinopathy (Patricio Cordeiro et al., 2024, Scientific Reports).
Physiotherapy addresses GTPS at its source by: restoring tendon health through progressive loading that stimulates collagen remodelling; strengthening the hip stabilizers to reduce abnormal forces; correcting movement patterns that contribute to overload; and educating patients on load management to prevent recurrence.
Weeks 1–4: Focus on pain management, education, and isometric exercises. Most patients notice meaningful reduction in night pain within two to three weeks.
Weeks 4–8: Introduction of isotonic strengthening with progressive loading. Functional activities like stair climbing become more manageable.
Weeks 8–12: Advancement to higher-load and functional exercises, sport-specific drills if applicable.
Months 3–6: Full recovery for most patients. Some with chronic tendinopathy may require up to 12 months. A randomized clinical trial found therapeutic exercise produced sustained improvements at 6 months (Notarnicola et al., 2023, Journal of Personalized Medicine).
Every GTPS rehabilitation program begins with a thorough assessment including detailed symptom history, palpation, muscle strength testing of hip abductors and core stabilizers, functional movement analysis, and lumbar spine screening.
Phase 1 — Isometric Loading (Weeks 1–3): Isometric hip abduction against a wall, side-lying holds, and standing band isometrics provide pain relief while beginning tendon reconditioning.
Phase 2 — Isotonic Strengthening (Weeks 3–8): Side-lying hip abduction with weight, standing cable abduction, bridging progressions, step-ups, and lateral step-downs with gradually increasing resistance.
Phase 3 — Functional Loading (Weeks 8–12+): Single-leg balance challenges, lateral band walks with speed, plyometric progressions for athletes, and sport-specific drills.
Soft tissue massage, hip joint mobilizations, dry needling, and shockwave therapy (ESWT) may be used as adjuncts. A randomized trial found combining shockwave with exercise produced positive outcomes for recalcitrant cases (Notarnicola et al., 2023, Journal of Personalized Medicine).
Not exactly. GTPS is a broader term encompassing bursitis, gluteal tendinopathy, and other lateral hip pain sources. Research shows most cases involve tendinopathy rather than isolated bursitis (Grimaldi et al., 2024).
Most patients improve significantly within 8–12 weeks. Chronic cases may take 3–6 months. Consistent adherence to the exercise program is the key factor.
Yes — tendons need mechanical loading to heal. Your physiotherapist will guide which activities to continue, modify, or temporarily avoid.
An MRI is not routinely necessary. A skilled physiotherapist can diagnose GTPS clinically. Imaging may be recommended if symptoms are atypical or treatment response is poor.
They provide short-term relief but do not outperform exercise at 12 months (Mellor et al., 2018, BMJ). Repeated injections may harm tendon tissue.
Avoid sleeping on the affected side without cushioning, crossing your legs, standing with weight shifted to one hip, aggressive ITB stretches, and sudden increases in high-impact activities.
Recurrence is possible if contributing factors are unaddressed. Patients who complete physiotherapy and maintain hip-strengthening routines have significantly lower recurrence rates.
At Vaughan Physiotherapy, our experienced team develops personalized rehabilitation plans based on the latest evidence.
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