WHAT IS GREATER TROCHANTERIC PAIN SYNDROME?
GTPS is a musculoskeletal condition that causes pain on the outside of client’s hip and thigh. This condition encompasses common diagnosis including gluteal tendinopathy and trochanteric bursitis.
It is often caused by stress on the structures in the outside of their hip by such activities as running/walking or by direct trauma/pressure to the region.
Anatomy of Hip GTPS
There is a number of structures on the outside of your hip that are irritated in this classification of injury. The most common are the muscles of gluteus medius/minimus, their tendinous insertion and the trochanteric bursa. The iliotibial band sits on top this area and can also contribute to a client’s pain presentation.
These muscles play a major role in stabilising the pelvis during gait. The higher the load (distance, speed, power) the more stress they are under and hence client’s symptoms tend to increase accordingly. For example, it is likely that running will cause a higher level of discomfort compared to leisurely walk.
Contributing Factors and Features of GTPS
What will a client with GTPS likely present with? (but not limited to):
- Recent increase in training load
- Weakness in glutes (especially gluteus medius and minimus)
- Pain on the outside of hip/thigh
- Pain with compression on the outside of hip/thigh
- Pain with single leg activities
- Age greater than 40 years’ old
Management of Hip GTPS?
In the initial stages of GTPS management, the goal is often to reduce and control client’s symptoms. This is done by unloading the outside of the hip and hence the structures that are irritated.
Educating clients to effectively make changes to limit provocative activities is important during this time. This enables the source of symptoms to settle and for patients to start working these structures in a positive way.
Therapeutic treatment techniques will help facilitate this process and should be accompanied by exercises to start the rehabilitation process as soon as possible.
Rehabilitation of GTPS
Restoring optimal performance at the hip joint can be achieved through effective rehabilitation with your physiotherapist.
In the early stages of rehab, restoring strength in the effected muscle groups (gluteus medius/minimus) is one of the primary goals. As their capacity improves client’s ability to perform higher load activities in the effected region will increase. This enables clients to reintegrate the things that they love to do into their routine.
During rehab all factors that contributed to the onset of the condition should be addressed including hip mobility, hip control, training technique and training load.
Following this systematic approach enables clients to continue doing the things they love and stay active into the future.
Examples of GTPS Rehabilitation Exercises
Resisted Hip Abduction Single Leg Bridge
Resisted Crab Walk Single Leg Hip Hinge