Greater Trochanteric Pain Syndrome: Causes, Symptoms and Effective Treatment for Hip Pain

Hip pain is easy to dismiss as aging or overuse, but when it starts disrupting sleep, workouts, or daily activities, it deserves attention. Up to 23.5% of adults experience lateral hip pain at some point¹, making it a common yet overlooked issue.

A leading cause is Greater Trochanteric Pain Syndrome (GTPS), which affects the tendons and bursa around the greater trochanter, the bony point on your hip.

Many mistake it for joint pain, but it’s actually a soft tissue problem. GTPS is common in runners, middle-aged women, and those with prolonged sitting or standing habits. The good news? With proper movement, strengthening, and treatment, you can reduce pain and stay active².

What is Greater Trochanteric Pain Syndrome (GTPS)?

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of pain on the outside of the hip. It happens when the tendons or bursae near the hip bone get irritated or inflamed.

This isn’t a problem with the hip joint itself but rather the soft tissues around it. If you feel a deep ache or sharp pain when walking, climbing stairs, or lying on your side, GTPS might be the reason.

How Common is GTPS?

GTPS is more common than people think. It affects about 1 in 4 adults at some point in their lives¹. Women, especially those over 40, are four times more likely to develop it than men³. This is because of hormonal changes, wider hips that put more strain on the tendons, and a higher chance of having conditions like osteoarthritis.

What Causes It?

GTPS usually happens when the tendons and bursae get overloaded or irritated. Here’s what can trigger it:

• Too Much Activity – Running, hiking, or standing for long periods can strain the hip.
• Sudden Changes – A new exercise routine or walking more than usual can cause irritation.
• Weak Muscles or Poor Posture – If your core or hip muscles are weak, the tendons work harder and may get sore.
• Foot and Leg Problems – Flat feet, uneven leg lengths, or bad shoes can put extra stress on the hip.

GTPS is also more likely in people with low back pain or arthritis, since these conditions change how you move and put more pressure on the hip⁴.

Common Signs and Symptoms of Greater Trochanteric Pain Syndrome (GTPS)

• Pain on the outside of the hip – A dull, aching pain over the bony part of your hip that gets worse with activity.
• Pain when lying on your side – Sleeping on the sore hip feels uncomfortable or wakes you up at night.
• Pain when walking or climbing stairs – Everyday movements like walking, going upstairs, or standing too long make the pain worse.
• Stiffness after sitting too long – When you stand up after sitting for a while, your hip feels tight or sore for the first few steps.
• Pain when crossing your legs or stretching – Simple movements like putting on shoes or crossing your legs cause discomfort.
• Soreness when pressing on the hip – The side of your hip is tender to the touch, and sometimes feels a little swollen.
• Weakness in the hip or leg – You may feel like your hip isn’t as strong, making it harder to walk without limping.

Why Does Greater Trochanteric Pain Syndrome (GTPS) Happen?

GTPS happens when the tendons and bursae around the hip get irritated or overworked. This isn’t usually caused by a single injury but rather by small amounts of stress building up over time. Let’s break down what’s going on inside your hip.

The Role of the Gluteal Tendons

Your hip muscles, especially the gluteus medius and gluteus minimus, help support your body when you walk, stand, or climb stairs. These muscles attach to the greater trochanter (the bony bump on the side of your hip) through strong tendons. When these tendons are overused or weakened, they can develop small tears and irritation, causing pain¹.

The Role of the Trochanteric Bursa

The trochanteric bursa is a small fluid-filled sac that cushions the tendons and bone. If the tendons are irritated, the bursa can also become inflamed, making the pain even worse³.

What Causes the Overload?

GTPS usually develops when the hip is under too much stress. Some of the biggest causes include:

• Weak hip muscles – If the muscles aren’t strong enough, the tendons take on too much strain.
• Repetitive movement – Activities like running, standing too long, or walking on uneven surfaces can wear down the tendons.
• Poor posture and movement – Standing with one hip “popped out” or walking with bad alignment puts extra pressure on the area.
• Tight muscles – A tight IT band or hip flexors can pull on the hip, making things worse⁴.
• Hormonal changes – Women, especially after menopause, are more at risk because estrogen helps keep tendons strong, and lower levels can make them more prone to injury².

Why Does GTPS Last So Long?

Tendons heal slowly because they don’t get as much blood flow as muscles. If you keep pushing through the pain without proper treatment, the irritation lingers. That’s why just resting isn’t enough—you need the right exercises and care to fully recover.

What Other Conditions Could It Be?

GTPS is a common cause of hip pain, but other conditions can feel similar. Here are five possible causes and how they are different:

Hip Osteoarthritis

This is wear and tear inside the hip joint, while GTPS affects the soft tissues outside. Arthritis pain is usually felt in the groin and comes with morning stiffness¹.

Sciatica (Nerve Pain from the Lower Back)

A pinched nerve in your back can cause shooting pain down the leg, sometimes with tingling or numbness, which doesn’t happen with GTPS⁴.

Iliotibial Band Syndrome (ITB Syndrome)

This causes tightness along the outer thigh and gets worse with running or cycling, while GTPS pain stays mostly in the hip².

Hip Bursitis

This happens after a fall or injury, causing swelling, while GTPS usually develops gradually from overuse³.

Femoral Stress Fracture

A small crack in the thigh bone causes sharp, deep pain that worsens with walking and does not improve with rest or stretching, unlike GTPS⁵.

Common Mistakes When Treating Greater Trochanteric Pain Syndrome (GTPS)

GTPS won’t just go away on its own if you don’t handle it properly. Many people unknowingly make mistakes that slow down recovery or even make the pain worse. Let’s go over the most common ones and why they can be harmful.

Ignoring the Pain and Pushing Through It

It’s tempting to keep moving and hope the pain goes away, but that often makes things worse. GTPS happens because the tendons around your hip are irritated. If you keep overloading them with the same activities that caused the problem, they don’t get a chance to heal. Over time, a mild ache can turn into constant pain that makes walking, standing, or even sleeping uncomfortable.

Resting Too Much and Avoiding Movement

On the other hand, some people go to the other extreme—they stop moving completely. While avoiding painful activities is smart, too much rest weakens the muscles around your hip, which puts even more stress on the tendons when you start moving again. The key is gentle movement and specific strengthening exercises to help rebuild support around your hip.

Doing the Wrong Exercises

Not all exercises help with GTPS. Stretching too much—especially deep hip stretches—can actually make it worse by pulling on the already irritated tendons. Instead, the focus should be on strengthening the muscles around your hip to give the tendons better support. Exercises should be done in a slow and controlled way to avoid flaring up the pain.

Relying Only on Painkillers or Injections

Painkillers and steroid injections can help in the short term, but they don’t fix the root problem. In fact, repeated steroid injections can weaken the tendons over time, making them more prone to damage⁶. Medication should be part of a bigger treatment plan, not the only solution.

Wearing the Wrong Shoes or Sitting in Bad Positions

What you wear and how you sit affect your hip more than you think. Flat, unsupportive shoes or high heels can change the way you walk, putting extra strain on your hip. Sitting for long periods, especially with legs crossed or slouched, can also increase pressure on the tendons. Small adjustments, like wearing supportive shoes and sitting with both feet flat on the ground, can make a big difference.

What Happens if GTPS is Neglected?

If GTPS isn’t treated, the pain can become a long-term problem. Simple activities like walking, standing, or climbing stairs may become painful every day. Some people start limping without realizing it, which can lead to other aches and pains in the lower back or opposite hip. The longer it goes untreated, the harder and longer recovery will be.

Types of Scans

If your hip pain isn’t getting better with basic treatment, a scan can help confirm what’s going on inside your hip. Here are the three most common types of scans used for GTPS and what we look for in each.

Ultrasound – The First Choice

Ultrasound is often the first scan we use because it’s quick, painless, and doesn’t expose you to radiation. It allows us to see the tendons and bursae in real-time while you move your hip. We look for:

• Swelling in the bursae (a sign of inflammation).
• Tears or thickening in the tendons (showing irritation or damage).
• Fluid buildup around the hip, which could be causing extra pain.

MRI (Magnetic Resonance Imaging)

If we need a more detailed look, an MRI is the best option. It gives clear images of the tendons, muscles, and bursae. We use an MRI when:

• Pain isn’t improving and we suspect a tendon tear.
• We need to rule out other issues, like hip arthritis or a stress fracture.
• The ultrasound didn’t give a clear answer, but pain is still there.

X-Ray

X-rays don’t show tendons or bursae, but they’re still useful if we suspect something else, like arthritis or a stress fracture. We use an X-ray to check for:

• Bone spurs that could be irritating the tendons.
• Signs of hip arthritis, which can sometimes feel like GTPS.
• A stress fracture, especially in people who do a lot of running or high-impact exercise.

Is Surgery Needed?

For most people with Greater Trochanteric Pain Syndrome (GTPS), surgery isn’t necessary. The latest research recommends trying non-surgical treatments first because most cases improve with the right rehab approach¹. However, in rare cases where pain doesn’t go away, surgery might be an option.

When is Surgery Considered?

Surgery is usually a last resort if pain has been ongoing for more than 6–12 months and nothing else has worked. The main reasons for surgery include:

• Severe tendon tears that aren’t healing⁷.
• Long-term inflammation in the bursae that doesn’t improve, even after injections.
• Significant weakness making it hard to walk or do daily activities.

What Surgery is Done?

The most common procedure is Endoscopic Gluteal Tendon Repair. This is a minimally invasive surgery where small incisions are made, and the damaged tendon is repaired using a tiny camera and surgical tools⁸. In some cases, a bursectomy (removing the inflamed bursa) is also done to reduce pain.

Physiotherapy After Surgery

Surgery alone won’t fix the problem—you’ll need physiotherapy to fully recover. After surgery, your tendons need time to heal, and the muscles around your hip need to regain their strength. Physiotherapy will help you:

• Regain movement without straining the healing tendon.
• Build strength in the hip and glutes to prevent the pain from coming back.
• Improve walking and balance so you can move normally again.

Most people recover well after surgery, but rehab can take a few months. The key is to follow the right exercises and avoid overloading the hip too soon.

Treatment Options for Greater Trochanteric Pain Syndrome (GTPS)

If you’re dealing with GTPS, the good news is that it can be treated without surgery. As your physiotherapist, my goal is to help you reduce pain, improve movement, and strengthen your hip so you can get back to doing what you love. Let’s go over the best treatment options available for you.

Exercise for Hip Pain

The right exercises will help heal your hip and prevent the pain from coming back. If your hip muscles are weak, your tendons take on extra strain, which is why strengthening them is so important¹. Here’s how we’ll do it:

• Glute Strengthening – Exercises like bridges and side leg lifts to give your hip the support it needs.
• Core Stability Work – A strong core takes pressure off your hip tendons and helps you move better.
• Gradual Resistance Training – Over time, we’ll increase intensity to make your tendons stronger so they don’t flare up again.

Myofascial Release

Sometimes, tight muscles around your hip are pulling on the tendons and making things worse. I can use hands-on massage techniques to help relax your glutes, IT band, and hip flexors. This can reduce tension and improve movement so your hip feels more comfortable⁴.

Orthopedic Manual Therapy

If your lower back or pelvis is stiff, it can put extra stress on your hip. I can use gentle mobilization techniques to improve your hip movement and take pressure off your tendons³.

Laser Therapy for Hip Pain

Laser therapy uses low-level light energy to reduce inflammation and speed up healing. It’s completely painless and can be a great addition to your treatment plan².

Dry Needling

If you have muscle knots (trigger points) around your hip, I can use dry needling (similar to acupuncture) to release tight spots and improve circulation. This can help ease tension and reduce pain around the hip area.

Strapping and Taping

If you’re struggling with daily activities, taping can help offload pressure from the hip tendons while we work on strengthening. This gives you some relief while your hip heals.

Shockwave Therapy

Shockwave therapy stimulates healing by sending sound waves into the tendons. It can help break down scar tissue, improve circulation, and reduce pain when other treatments haven’t worked⁶.

Conclusion

Greater Trochanteric Pain Syndrome (GTPS) doesn’t have to control your life. With the right exercises, treatments, and a bit of patience, you can reduce pain, rebuild strength, and move comfortably again.

Recovery takes consistent effort, but every step—whether it’s strengthening your hip muscles, improving your posture, or avoiding movements that aggravate your tendons—gets you closer to healing. It won’t happen overnight, but with the right plan, you’ll notice real progress.

I’m here to guide you, support you, and adjust your treatment as needed. You don’t have to go through this alone. Together, we’ll get your hip strong again so you can walk, sleep, and move pain-free. Let’s take that first step toward your recovery!

References

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7. Rompe, J. D., Segal, N. A., Cacchio, A., Furia, J. P., Morral, A., & Maffulli, N. (2009). Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. American Journal of Sports Medicine, 37(10), 1981–1990.
8. Domb, B. G., Linder, D., Finley, Z., & Botser, I. B. (2012). Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up. American Journal of Sports Medicine, 41(5), 988–997.
9. Konyves, A. (2020). Platelet-rich plasma injections for greater trochanteric pain syndrome. Orthopedic Reviews, 12(1), 8675.
10. Gazendam, A., Ekhtiari, S., Bozzo, A., Phillips, M., Khan, M., & Bhandari, M. (2021). Comparative efficacy of nonoperative treatments for greater trochanteric pain syndrome: A systematic review and network meta-analysis. American Journal of Sports Medicine, 49(5), 1328–1338.