Greater Trochanteric Pain Syndrome (GTPS)
What is greater trochanteric pain syndrome?
Greater trochanteric pain syndrome (GTPS) is characterised by pain and tenderness over the lateral aspect of the hip, typically reproduced by lateral pressure over the greater trochanter, weight-bearing, or resisted hip abduction. The term encompasses a range of conditions affecting the peritrochanteric space, with the most common cause being abductor tendon pathology, accounting for 15 to 50% of cases. Other contributing factors include trochanteric bursitis, external snapping hip syndrome, and abnormalities of the iliotibial band.
The older term "trochanteric bursitis" is still widely used by patients and GPs, but it is now understood to be inaccurate in most cases.
Research using MRI and ultrasound has shown that isolated trochanteric bursitis — inflammation of the bursa without associated tendon pathology — is relatively uncommon. The majority of GTPS presentations involve gluteal tendinopathy — degeneration of the gluteus medius and minimus tendons at their attachment to the greater trochanter — with bursal involvement typically being secondary to the tendon pathology rather than its primary cause. This distinction matters because anti-inflammatory treatments targeting bursitis are often insufficient when the underlying tendinopathy is not addressed.
For a more detailed breakdown of gluteal tendinopathy specifically, see our dedicated gluteal tendinopathy page.
Who gets GTPS?
GTPS is most prevalent in women between the ages of 40 and 60, with a female-to-male ratio of approximately 4:1. The perimenopausal transition is associated with significantly increased prevalence, likely due to hormonal changes affecting tendon health combined with altered biomechanics. It is also common in runners and other athletes with high hip loading demands, and in people with a history of lower back pain, hip osteoarthritis or leg length discrepancy. Obesity increases the compressive load on the gluteal tendons and is a recognised risk factor.
What are the symptoms?
Pain over the lateral hip — over or just posterior to the greater trochanter — is the hallmark symptom. Patients with GTPS typically experience pain when lying on the affected side, with prolonged sitting, walking, or climbing stairs. The pain may refer into the lateral thigh and occasionally the knee, which can lead to misdiagnosis as hip joint or lumbar spine pathology. Crossing the legs — adducting the hip — and positions of hip internal rotation are characteristic aggravating factors, as both increase the compressive load on the gluteal tendons over the greater trochanter.
Why the old advice was wrong — and what the evidence now says
For years, the standard advice for GTPS included stretching the iliotibial band (foam rolling, cross-leg stretches), prolonged rest, and cortisone injections as the primary interventions. Current evidence has substantially revised this approach.
ITB and hip stretching that involves hip adduction — crossing the leg, or side-lying stretches — actually increases the compressive load on the gluteal tendons over the greater trochanter and frequently worsens symptoms. Patients who have been diligently stretching their "tight hip" and finding their symptoms are getting worse are often experiencing this mechanism.
Targeted physiotherapy offers superior long-term outcomes compared to shock wave therapy and corticosteroid injections. In one study, 60.5% of patients reported symptom resolution at 15 months with physiotherapy. Corticosteroid injection provides faster short-term relief but poorer long-term outcomes than structured physiotherapy, and repeated injections are associated with tendon weakening.
How can physiotherapy help?
The evidence-based approach to GTPS management is built around three principles: load management, progressive tendon loading, and proximal hip strengthening.
Load management — identifying and modifying the positions and activities that compress the gluteal tendons — is the immediate priority. Key modifications include avoiding crossing the legs, sleeping with a pillow between the knees to prevent hip adduction, standing with weight equally distributed rather than shifting onto one hip, and avoiding sitting in low chairs that flex the hip beyond 90 degrees. These simple changes often produce rapid symptom improvement.
Progressive tendon loading — a graduated program that starts with isometric exercises and progresses through isotonic and heavy slow resistance loading — stimulates gluteal tendon remodelling and rebuilds load capacity. This is the cornerstone of long-term recovery and the intervention with the strongest evidence base. The loading program must be carefully progressed to avoid the compressive positions that provoke symptoms while building meaningful tendon strength.
Gluteal and hip abductor strengthening — targeting the gluteus medius and minimus specifically — addresses the muscle weakness that is a consistent finding in GTPS and that both contributes to and results from the tendinopathy. As hip abductor strength improves, the dynamic stability of the hip during walking and single-leg activities reduces the compressive demands on the tendons. Real time ultrasound assists in assessing gluteal tendon structure and guiding deep hip muscle activation retraining.
Lumbopelvic and lower limb biomechanics — including leg length discrepancy assessment, foot pronation, and gait pattern — are evaluated and addressed where they are contributing to increased tendon compression during walking and running. Clinical Pilates provides an excellent environment for progressive hip abductor and gluteal loading in controlled positions that avoid the compression provocations.
Dry needling of the gluteal musculature assists with pain management and muscle activation in the acute phase.
Our physiotherapists Eliane Machado and Bethany Kippen both have experience in GTPS and hip tendinopathy management and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait analysis and hip loading assessment that underpins GTPS rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Greater trochanteric pain syndrome (GTPS) is characterised by pain and tenderness over the lateral aspect of the hip, typically reproduced by lateral pressure over the greater trochanter, weight-bearing, or resisted hip abduction. The term encompasses a range of conditions affecting the peritrochanteric space, with the most common cause being abductor tendon pathology, accounting for 15 to 50% of cases. Other contributing factors include trochanteric bursitis, external snapping hip syndrome, and abnormalities of the iliotibial band.
The older term "trochanteric bursitis" is still widely used by patients and GPs, but it is now understood to be inaccurate in most cases.
Research using MRI and ultrasound has shown that isolated trochanteric bursitis — inflammation of the bursa without associated tendon pathology — is relatively uncommon. The majority of GTPS presentations involve gluteal tendinopathy — degeneration of the gluteus medius and minimus tendons at their attachment to the greater trochanter — with bursal involvement typically being secondary to the tendon pathology rather than its primary cause. This distinction matters because anti-inflammatory treatments targeting bursitis are often insufficient when the underlying tendinopathy is not addressed.
For a more detailed breakdown of gluteal tendinopathy specifically, see our dedicated gluteal tendinopathy page.
Who gets GTPS?
GTPS is most prevalent in women between the ages of 40 and 60, with a female-to-male ratio of approximately 4:1. The perimenopausal transition is associated with significantly increased prevalence, likely due to hormonal changes affecting tendon health combined with altered biomechanics. It is also common in runners and other athletes with high hip loading demands, and in people with a history of lower back pain, hip osteoarthritis or leg length discrepancy. Obesity increases the compressive load on the gluteal tendons and is a recognised risk factor.
What are the symptoms?
Pain over the lateral hip — over or just posterior to the greater trochanter — is the hallmark symptom. Patients with GTPS typically experience pain when lying on the affected side, with prolonged sitting, walking, or climbing stairs. The pain may refer into the lateral thigh and occasionally the knee, which can lead to misdiagnosis as hip joint or lumbar spine pathology. Crossing the legs — adducting the hip — and positions of hip internal rotation are characteristic aggravating factors, as both increase the compressive load on the gluteal tendons over the greater trochanter.
Why the old advice was wrong — and what the evidence now says
For years, the standard advice for GTPS included stretching the iliotibial band (foam rolling, cross-leg stretches), prolonged rest, and cortisone injections as the primary interventions. Current evidence has substantially revised this approach.
ITB and hip stretching that involves hip adduction — crossing the leg, or side-lying stretches — actually increases the compressive load on the gluteal tendons over the greater trochanter and frequently worsens symptoms. Patients who have been diligently stretching their "tight hip" and finding their symptoms are getting worse are often experiencing this mechanism.
Targeted physiotherapy offers superior long-term outcomes compared to shock wave therapy and corticosteroid injections. In one study, 60.5% of patients reported symptom resolution at 15 months with physiotherapy. Corticosteroid injection provides faster short-term relief but poorer long-term outcomes than structured physiotherapy, and repeated injections are associated with tendon weakening.
How can physiotherapy help?
The evidence-based approach to GTPS management is built around three principles: load management, progressive tendon loading, and proximal hip strengthening.
Load management — identifying and modifying the positions and activities that compress the gluteal tendons — is the immediate priority. Key modifications include avoiding crossing the legs, sleeping with a pillow between the knees to prevent hip adduction, standing with weight equally distributed rather than shifting onto one hip, and avoiding sitting in low chairs that flex the hip beyond 90 degrees. These simple changes often produce rapid symptom improvement.
Progressive tendon loading — a graduated program that starts with isometric exercises and progresses through isotonic and heavy slow resistance loading — stimulates gluteal tendon remodelling and rebuilds load capacity. This is the cornerstone of long-term recovery and the intervention with the strongest evidence base. The loading program must be carefully progressed to avoid the compressive positions that provoke symptoms while building meaningful tendon strength.
Gluteal and hip abductor strengthening — targeting the gluteus medius and minimus specifically — addresses the muscle weakness that is a consistent finding in GTPS and that both contributes to and results from the tendinopathy. As hip abductor strength improves, the dynamic stability of the hip during walking and single-leg activities reduces the compressive demands on the tendons. Real time ultrasound assists in assessing gluteal tendon structure and guiding deep hip muscle activation retraining.
Lumbopelvic and lower limb biomechanics — including leg length discrepancy assessment, foot pronation, and gait pattern — are evaluated and addressed where they are contributing to increased tendon compression during walking and running. Clinical Pilates provides an excellent environment for progressive hip abductor and gluteal loading in controlled positions that avoid the compression provocations.
Dry needling of the gluteal musculature assists with pain management and muscle activation in the acute phase.
Our physiotherapists Eliane Machado and Bethany Kippen both have experience in GTPS and hip tendinopathy management and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait analysis and hip loading assessment that underpins GTPS rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
