Greater Trochanteric Pain Syndrome (GTPS)

Information for you

All our publications are available in other formats Greater Trochanteric Pain Syndrome (GTPS)

Information for you

Greater trochanteric pain syndrome (GTPS), also known as lateral hip pain or trochanteric bursitis, is a common condition where you can experience pain and tenderness on the outside of the hip and buttock region, shown in the picture below. Sometimes it may travel down as far as the outside of the knee.

GTPS is more common in people over 40 years old, and affects more women than men. It can affect both hips and can be associated with low back pain. In most cases, the symptoms from GTPS will ease with time. For those people whose pain persists, treatment is usually GTPS is morepainkillers, common strengtheningin people over exercises 40 years for the old, weak and muscle affects more women than men. It can affect bothgroups hips andand occasionallycan be assoc corticosteroidiated with injection. low back pain. In most cases, the symptoms from GTPS will ease with time. For those people whose pain persists, treatment is usually painkillers, strengthening exercises for the weak muscle groups and occasionally corticosteroidCausesinjection. There are many factors that can contribute to GTPS: Causes: there are many factors that can contribute to GTPS • Inflammation of one of the bursae (a small cushioning • Inflammationfluid filledof one sac of that the lies bursae between (a the small tendons cushioning and fluid filled sac that lies between bones of the hip); the tendons and bones of the hip); 2 • Reduced strength and flexibility of the muscles around the hip and buttock. This in turn can cause a secondary inflammation of one of the bursae around the hip joint; • Secondary to low back pain; • Inactive lifestyle, causing weakness in the buttock muscles; • Being overweight; • Postural habits, for example, standing on one leg for long periods of time, crossing legs when sitting, or lying on affected side for long periods; • Secondary to osteoarthritis (OA) of the hip or knee.

Symptoms

These can vary from person to person depending on the initial factors that are causing the condition. People may experience: • Pain when walking; standing for long periods; sitting with legs crossed. • Pain at night when lying on the affected side. • Reduced strength and flexibility of the muscles around the hip and buttock. This in turn can cause a secondary inflammation of one of the bursae around the hip joint; • Secondary to low back pain; • Inactive lifestyle, causing weakness in the buttock muscles; • Being overweight; • Postural habits, for example, standing on one leg for long periods of time, crossing legs when sitting, or lying on affected side for long periods; • Secondary to osteoarthritis (OA) of the hip or knee.

Symptoms These can vary from person to person depending on the initial factors that are causing the condition. People may experience:

• Pain when walking; standing for long periods; sitting with legs crossed. • Pain at night when lying on the affected side. • Pain from the hip joint or the lower buttock region travelling down the outside of the thigh to the knee.

3 Management Helpful tips

• Avoid sitting with your legs crossed as this will reduce the pressure on the painful area. • Avoid sitting with your knees wide apart or close together. • When standing, try not to push one hip out to the side or stand on one leg. • Avoid very low chairs. • Keep active but avoid overdoing it. • Use a handrail when climbing the stairs if needed, or take one step at a time with your good leg leading going up and the sore leg leading coming down.

4 • Pain• fromPain the from hip thejoint hip or jointthe loweror the buttock lower buttock region regiontravelling travelling down the down outsidethe outside of the of the thigh tothigh the knee.to the knee.

ManagementManagement

HelpfulHelpful tips tips • Avoid• sittingAvoid withsitting your with legs your crossed legs crossed as this aswill this reduce will reduce the pressure the pressure on the onpainful the painful • Pain from thearea. hip jointarea. or the lower buttock region travelling down the outside of the thigh to the• knee.Avoid• sittingAvoid withsitting your with knees your wideknees apart wide or apart close or together. close together. • When• standing,When standing, try not tryto pushnot to one push hip one out hipto theout sideto the or sidestand or on stand one on leg. one leg. Management • Avoid• veryAvoidlowvery chairs.low chairs. • Keep• activeKeep, activebut avoid, but overexertion avoid overexertion or activities or activities that you that are you not are used not to. used to. Helpful tips • Use• a handrailUse a handrail when climbing when climbing the stairs theif stairs needed,if needed, or take or one take step one at stepa time at witha time with • Avoid sitting yourwith yourgoodyour legs leg good leadingcrossed leg leading going as this up going will and reduce up the and sore the the legpressure sore leading leg onleading coming the painful coming down. down. area. • AvoidSleep sittingingSleep with positions youring positionsknees wide apart or close together. • When standing, try not to push one hip out to the side or stand on one leg. • AvoidAvoidSleepingvery lowlyingAvoid chairs. on positionslying the onpainful the painfulside or sidewith orthe with painful the painfulleg crossedleg crossed over the over other the as other in the as picture in the picture • Keep below.active,below.but avoid overexertion or activities that you are not used to. • Use a handrail when climbing the stairs if needed, or take one step at a time with your good• Avoid leg leading lying going on the up andpainful the sore side leg or leading with thecoming painful down. leg crossed over the other as in the picture below. Sleeping positions

Avoid lying on the painful side or with the painful leg crossed over the other as in the picture below.

Try• TrylyingTry lying on lying your on on back your your with backback a pillowwith with a underpillow a pillow yourunder kneesunder your, kneesor your lie on, orknees, your lie on good your side good with side pillows with pillows between your legs to keep them parallel as shown below. betweenor lie your on yourlegs to good keep themside parallelwith pillowsas shown betweenbelow. your legs to keep them parallel as shown below.

Try lying on your back with a pillow under your knees, or lie on your good side with pillows between your legs to keep them parallel as shown below.

ExercisesExercises

Exercises 5 Exercises

Below Beloware some are exercisessome exercises which will which help will strengthen help strengthen the affected the muscles and over time help reduceaffected the musclespain. If you and are over seeing time a help physiotherapist reduce the they pain. will advise you further on these. If you are seeing a physiotherapist they will advise you further on these. • Isometric abduction - Lie on your back with the affected leg closest to a wall. Press • theIsometric foot of the abduction affected leg - Lie against on your the backwall and with hold the for ten seconds. Repeat the sameaffected exercise, leg closest but standing to a wall. up. Press the foot of the affected leg against the wall and hold for ten seconds. Repeat the same exercise, but standing up.

Below are some exercises which will help strengthen the affected muscles and over time help reduce the pain. If you are seeing a physiotherapist they will advise you further on these.

• Isometric abduction - Lie on your back with the affected leg closest to a wall. Press the foot of the affected leg against the wall and hold for ten seconds. Repeat the same exercise, but standing up.

• Single leg stand – practice standing on one leg. Try to build up the length of time you can do this for.

• Single leg stand – practice standing on one leg.6 Try to build up the length of time you can do this for.

• Side lying hip abduction - lie on your good side, painful leg on top and supported on a pillow. Lift the painful leg a couple of centimetres off the pillow and hold for ten seconds.

• Side lying hip abduction - lie on your good side, painful leg on top and supported on a pillow. Lift the painful leg a couple of centimetres off the pillow and hold for ten seconds. Below are some exercises which will help strengthen the affected muscles and over time help reduce the pain. If you are seeing a physiotherapist they will advise you further on these.

• Single leg stand – practice standing on one leg. Try to build up the length of time you can do this for.

• Single leg stand - practice standing on one leg. Try to build up the length of time you can do this for.

• Side lying hip abduction - lie on your good side, painful leg on top and supported on a • Side lying hip abduction - lie on yourpillow. good Lift side,the painful painful leg a couple of centimetres off the pillow and hold for ten leg on top and supported on a pillow.seconds. Lift the painful leg a couple of centimetres off the pillow and hold for ten seconds.

• Wall squat - stand with your back against the wall and your feet out in front of you. Slide down the wall within a comfortable range and then come back up keeping your back against the wall.

• Wall squat - stand with your back against the7 wall and your feet out in front of you. Slide down the wall within a comfortable range and then come back up keeping your back against the wall.

• Pelvic dips - stand on a step with one foot hanging over the side. Use your hip muscles for control as you dip the unsupported foot down towards the floor and bring it back up before it touches.

• Pelvic dips - stand on a step with one foot hanging over the side. Use your hip muscles for control as you dip the unsupported foot down towards the floor and bring it back up before it touches. • Wall squat - Stand with your back against the wall, • kneesWall• Wall squat apart squat - stand and - stand withyour with you feet ryouba routckba againstck in against front the walltheof you.wall and and yourSlideyourfeet feetout inoutfront in front of you. of you. • WalldownSlide• squatSlide Walldown the down- squat standwallthe wallthe -withinwithstand wall within you withinwith ar a bacomfortable comfortableyouck a comfortableagainstr back against therange range wallrange andthe and andwallandthenyour thenand comethenfeet yourcome out backfeet inback upfront outkeeping up inofkeeping frontyou. your of you.your Slidecomeback backdown againstSlide back against the down up thewall keepingwallthe within wall. . awithin comfortable your a backcomfortable range against andrange thethen and wall.come then back come up backkeeping up keeping your your back againstback against the wall the. wall.

• Pelvic dips - stand on a step with one foot hanging • overPelvic• Pelvic the dips side. dips- stand- Usestand on your a on step a hipstep with muscleswith one onefoot foot hangingfor hanging control over over theas side.youthe side. Use Use your your hip hip musclesmuscles for controlfor control as you as youdip thedip unsupportedthe unsupported foot footdown down towards towards the floorthe floor and andbring bring • Pelvicdip• the dipsPelvic unsupported- stand dips -onstand a step onfoot witha step down one with foot towardsone hanging foot hanging theover floorthe over side. and the Use side. your Use hip your hip musclesit backit musclesback upfor before controlup beforefor it controlas touches. youit touches. asdip you the dipunsupported the unsupported foot down foot towards down towards the floor the and floor bring and bring itbring back itupit back backbefore up up itbefore touches. before it touches. it touches.

8 • Bridge - Lie on your back with your knees bent and • Bridgefeet- Lieflat on on your the back bed with or floor.your knees Squeeze bent andyour feet buttock flat on the bed or floor. Squeeze your buttock muscles together then lift your hips up. Hold for five seconds beforemuscles slowly loweringtogether back then down. lift your hips up. Hold for five seconds before slowly lowering back down.

• Bridge - Lie on your back with your knees bent and feet flat on the bed or floor. Squeeze your buttock muscles together then lift your hips up. Hold for five seconds before slowly lowering back down.

Pain management • Continue gentle exercise as best you can. • Try to stay at work even if you have to modify your duties slightly. • You can use something cold as pain relief such as wrapping an ice pack in a damp towel and pressing it against the affected area for up to 20 minutes. • ThePain use managementof painkillers and anti-inflammatory medications can be used as advised by your pharmacist or family doctor (GP). Pain management• Corticosteroid• Continue injections gentle exercise can be helpful as best for youpain managementcan. but will not resolve the • Continue gentlecause exercise of the asproblem best you and can. are never the first treatment. This can be discussed with • Try to stay atyour work• Try GP even to or stayifphysiotherapist. you at have work to modifyeven ifyour you duties have slightly. to modify your • You can use somethingduties coldslightly. as pain relief such as wrapping an ice pack in a damp towel Otherand pressing signs it against the affected area for up to 20 minutes. • The use of painkillers• You andcan antiuse-inflammatory cold as pain medications relief by wrappingcan be used an as ice advised by your pharmacistIf: orpack family in doctora towel (GP and). pressing it against the affected • Corticosteroid• your injections symptoms can behave helpfulnot improved for pain management or are getting but worse will notafter resolve treating the it yourself cause of the• problemyou areahave and fora very areup high neverto 20 temperature, the minutes. first treatment. Checkor you feel Thisyour hot can skin and be everyshiverydiscussed 5 with your GP or• physiotherapist.you minutescannot move in case the affected of damage. joint • you have very severe, sharp or shooting pains in the joint Other signs • The use of painkillers and anti-inflammatory Then pleasemedications review this with can your be GP used. as advised by your If: pharmacist or family doctor (GP). • your symptomsPrognosis have not improved or are getting worse after treating it yourself • you have a very high temperature, or you feel hot9 and shivery • you canResearcnot moveh shows the affected that six jointout of ten people get better within one year; however, some people • you havecan verytake severe,longer. sharp or shooting pains in the joint

Then please Furtherreview this advice with your GP.

Prognosis If you are still having difficulty please contact your GP, NHS inform on 0800 22 44 88 for more information, or you can access the MSK NHS Ayrshire & Arran website on Research showshttp://www.nhsaaa.net/allied that six out of ten people- healthget better-professionals within one-ahps/musculoskeletalyear; however, some -peopleservice/ can take longer.

Further advice

If you are still having difficulty please contact your GP, NHS inform on 0800 22 44 88 for more information, or you can access the MSK NHS Ayrshire & Arran website on http://www.nhsaaa.net/allied-health-professionals-ahps/musculoskeletal-service/

• Corticosteroid injections can be helpful for pain management but will not resolve the cause of the problem and are never the first treatment. This can be discussed with your GP or physiotherapist.

Other signs If:

• your symptoms have not improved or are getting worse after treating it yourself • you have a very high temperature, or you feel hot and shivery • you cannot move the affected joint • you have very severe, sharp or shooting pains in the joint Then please review this with your GP.

Prognosis Research shows that six out of ten people get better within one year; however, some people can take longer.

10 Further advice If you are still having difficulty please contact your GP, NHS inform on 0800 22 44 88 for more information, or you can access the MSK NHS Ayrshire & Arran website on http://www.nhsaaa.net/allied-health-professionals- ahps/musculoskeletal-service/

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Last reviewed: March 2018 Leaflet reference: MIS18-032-GD PIL code: PIL18-0019