What is greater trochanteric pain syndrome?

Greater trochanteric pain syndrome is a condition that causes pain over the outside of your upper thigh (or thighs). The cause is usually due to a problem with some of the tissues that lie over the bony prominence (the greater trochanter) at the top of the thigh bone (femur). Tissues that lie over the greater trochanter include muscles, tendons, fascia (strong fibrous tissue), and bursae(thin fluid sacs).

Greater trochanteric pain syndrome used to be called trochanteric bursitis. This was because the pain was thought to be coming from an inflamed bursa that lies over the greater trochanter. A bursa is a small sac filled with fluid which helps to allow smooth movement between two uneven surfaces.

However, research suggests that most cases of greater trochanteric pain syndrome are due to minor tears or damage to the nearby tendons and an inflamed bursa is an uncommon cause. So, rather than the term trochanteric bursitis the more general term greater trochanteric pain syndrome is now preferred.

How common is greater trochanteric pain syndrome?

It is a common condition. It is more common in women than in men. It most often occurs in people who are aged over fifty and those who are overweight.  However, it can also occur in younger people.  It often comes along with people who suffer from low back pain (usually occurring on the same side as the back pain)

What causes greater trochanteric pain syndrome?

Causes of greater trochanteric pain syndrome include:

•An injury such as a fall onto the side of your hip area.

•Repetitive movements involving your hip area such as excessive running or walking.

•The presence of surgical wire, implants or scar tissue in the hip area (for example, after hip surgery).

•Having a one leg longer than the other

•It most often comes with low back pain on the same side. This is because people suffering from back pain are unable to properly exercise their back and hip muscles. As a result of this the hip muscles become weak putting excess strain on the tendons connecting muscle to bone. The tendon pain often becomes secondary to a person with back pain.

•Any problem that stops a person from being able to exercise can leave supporting hip muscles weak which can result in tendon pain at the site

What are the symptoms of greater trochanteric pain syndrome?

The most common symptom is pain in your outer thigh and hip area. Many people find this pain to be a deep pain which may be aching or burning. The pain may become worse over time.  The pain may be more intense when you are lying on your side, especially at night. The pain may also be made worse by doing exercise. You may find that you walk with a limp. While it is usually focused on the side of the leg some people experience it radiating down the leg.

How is greater trochanteric pain syndrome diagnosed?

The diagnosis is usually made based on your symptoms and an examination by a doctor. Your doctor will usually examine your hip and legs. You may find it be to be very tender when your doctor presses over the trochanter area. Investigations (tests) are not normally needed unless the diagnosis is not clear. For example, an X-ray of your hip or an MRI scan may be advised if the diagnosis is unclear.

What is the treatment of greater trochanteric pain syndrome?

Greater trochanteric pain syndrome can be self-limiting or chronic. However, it often takes weeks to months for the pain to ease. Symptoms can persist for months, and sometimes longer in some people. However, persistence does not mean that there is a serious underlying condition or that the hip joint is being damaged.

Summary Approach to Treatment of Greater Trochanteric Bursitis

1. AVOID postures that put excess strain on the tendon which increases pain (Tendon Protection)

• Avoid pressure to the hip area (e.g, sitting for prolonged periods in a car with low seats or lying on one side only)
• Avoid positions where knees are brought together. This position increases pressure on the greater trochanter. Always have knees apart whether standing, sitting, lying or walking. 
• Activities that keep the knees together (adducted) increase the compressive forces on the outside hip area (greater trochanter). Always be aware of your leg position whether standing, sitting, or lying.  Always keep legs 2 to 3 handwidths apart.
• When standing avoid tilting to one side as that will increase the compression forces. 
• When lying down use a pillow to support the legs or in between the legs in side lying.

2. Analgesics (pain killers). Taking acetaminophen (Tylenol) or non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen may help to reduce the pain. This is most beneficial when taken before an activity like exercising or going for a long walk.

3.  Applying an ice pack (wrapped in a towel) for 10-20 minutes several times a day may improve your symptoms.

4. Injections: Injection of corticosteroid (cortisone) and local anaesthetic. This is usually only done if someone has so much pain that they can’t tolerate the exercises. Steroid injection of tendons while helpful in improving pain in the short term, hinders tendon healing in the long term. Repeated steroid injections are NOT advised. An injection must be undertaken with tendon protection and exercise to make long term gains.

5. Weight loss for those that are obese

EXERCISE PROGRAM – This is the long term pathway to recovery. It is the most important treatment.

1. First pay attention to positions and postures that aggravate the pain and AVOID them

2. When possible exercises are best when prescribed and coached by an exercise specialist. Usually a phyiotherapist, athletic therapist, or an exercise minded chiropractor.

Follow this link to one program that promotes strengthening and endurance of the hip and back muscles.

3. Many patients with greater trochanteric pain syndrome also have low back pain.  If you also have significant low back pain there are other exercises that should be added to your exercise program.

4. If you are unable to tolerate the exercises you may benefit from some injections to temporarily improve your pain.