If you experience persistent pain along the outside of your hip or down the side of your thigh, it could be more than just muscle soreness or aging – you might be suffering from Greater Trochanteric Pain Syndrome (GTPS). Also known as hip bursitis or gluteal tendinopathy, GTPS is a common but often misunderstood condition that affects many adults, especially women over 50.
In this comprehensive guide, we’ll break down what GTPS is, what causes it, how it relates to other pain conditions like lower back pain, and what the latest research recommends for effective treatment. If lateral hip and thigh pain is interfering with your sleep, movement, or quality of life, understanding GTPS is your first step toward relief.
What Is Greater Trochanteric Pain Syndrome (GTPS)?
GTPS is a clinical term for pain and tenderness over the greater trochanter, which is the bony prominence on the outer side of your hip. This area serves as the attachment point for several key muscles, including your gluteus medius and minimus, which are responsible for stabilising the pelvis and moving the hip.
Pain often starts at the side of the hip and can radiate down the lateral thigh, sometimes making it uncomfortable to lie on that side at night. In fact, GTPS can significantly interfere with sleep and day-to-day activities like walking, standing, or climbing stairs.
How Common is GTPS?
GTPS affects 10–25% of the general population, and approximately one in four women over 50 will experience this condition at some point. The higher prevalence in women is partly due to anatomical differences such as a wider pelvis, which alters biomechanics and increases strain on the hip stabilising muscles.
Causes of GTPS: Why Does It Happen?
There isn’t a single cause of GTPS. Instead, it typically develops due to a combination of factors, including:
- Trauma or injury, like falling directly on the hip, which can irritate the bursa or damage the gluteal tendons
- Sedentary lifestyles, which weaken the hip abductors and glute muscles, leading to instability and overloading of tendons
- Muscle imbalances, where tight or weak muscles create abnormal forces across the hip joint
- Repetitive strain, such as long-distance walking, running, or prolonged standing, which can overload the hip structures
- Shearing or friction forces over the tendons that can lead to micro-tears or secondary bursitis
What Is a Bursa? What is Bursitis?
A bursa is a small, fluid-filled sac that sits between bones and soft tissues (like tendons or muscles) to reduce friction and help joints move smoothly. There are many bursae in the body, including one over the greater trochanter.
When the bursa becomes irritated or inflamed, it can cause bursitis, leading to:
- Sharp or throbbing pain
- Night pain that disrupts sleep
- Morning stiffness
- Local tenderness
- Weakness and reduced physical function
But here’s the important part: studies suggest true bursitis is present in only 10–20% of GTPS cases. Most often, pain comes from the gluteal tendons themselves (gluteal tendinopathy), not the bursa.
What Is Gluteal Tendinopathy?
Your tendons are like strong ropes connecting muscles to bones. In GTPS, the gluteus medius and minimus tendons become overloaded or degenerate over time, a process called tendinopathy.
Common causes of gluteal tendinopathy include:
- Overuse (repetitive stress or increased activity without conditioning)
- Muscle weakness (from inactivity, injury, or nerve problems)
- Direct trauma
- Poor hip or pelvic biomechanics
This degeneration weakens the tendon structure, causing pain and dysfunction.
Can GTPS and Low Back Pain Happen Together?
Absolutely — and they often do. GTPS is frequently associated with chronic low back pain. Why?
- The L5/S1 nerve roots in the lower back supply the hip abductors. If there’s chronic lumbar disc pathology or nerve dysfunction at these levels, the muscles may weaken due to poor nerve signals.
- Weak hip muscles cause instability and abnormal movement patterns, leading to compensations in other muscles and joints.
- The sacroiliac joint (SIJ) can become irritated by altered forces from hip weakness, contributing to secondary pain.
The Role of the Piriformis and IT Band
When your glute muscles weaken, your body tries to compensate. Two common compensations are:
- Piriformis muscle compensation: The piriformis, a small muscle deep in the buttock, may work overtime to stabilise the pelvis. But it’s not designed for prolonged load and can spasm, tighten, and cause piriformis syndrome (pain deep in the glute, sometimes radiating down the leg).
- Iliotibial Band (ITB) compensation: The ITB runs along the outer thigh from the hip to the knee. Weak glutes can cause the ITB to move or tighten excessively, leading to increased friction over the hip bursa or greater trochanter, worsening pain.
What Does Research Say About GTPS?
A large body of evidence shows most people with GTPS don’t have true bursitis, and the primary driver of pain is gluteal tendinopathy. Additionally, studies reveal:
- Women and female athletes are more susceptible due to anatomical factors (wider pelvis, increased Q-angle).
- Corticosteroid injections are commonly used, but while they may offer short-term relief, they don’t address the underlying cause and carry significant health risks with repeated use, such as:
- Bone weakening
- Hormonal imbalances
- Hypertension
- Sleep and mood disturbances
- Increased appetite
- Elevated blood sugar levels
Exercise vs. Corticosteroid Injections: What’s Better?
A randomised controlled trial (RCT) compared three approaches in people diagnosed with GTPS:
- Education and targeted exercise strengthening
- Corticosteroid injection therapy
- Wait-and-see approach (no active treatment)
At 8 weeks, both the exercise + education group and the corticosteroid group improved more than the wait-and-see group. But by the 52-week mark, education plus exercise led to better overall improvements than corticosteroid injections.
This supports exercise-based rehabilitation as the gold standard for long-term outcomes.
Evidence-Based Treatment for GTPS
Effective management of GTPS involves more than pain relief — it should target the underlying cause:
- Progressive strengthening programme: Exercises designed to activate and strengthen weakened muscles, particularly the hip abductors, gluteus medius/minimus, hip extensors, and back extensors.
- Stretching: Loosening tight muscles like the piriformis and ITB, which often become overactive to compensate for weak glutes.
- Education: Teaching patients about tendon loading, proper movement patterns, and avoiding aggravating activities can prevent re-injury and reduce fear of movement
- Manual therapy: Soft tissue work and joint mobilisation can help relieve acute pain in the lower back and hip region.
- Activity modification: Avoiding excessive side-lying on the affected side, sudden increases in walking or running, or prolonged standing can help manage symptoms while starting rehabilitation.
Key Takeaway: GTPS Is Not Just Bursitis
Despite being commonly called “hip bursitis,” Greater Trochanteric Pain Syndrome is primarily a problem of gluteal tendinopathy and muscle weakness, not inflammation of the bursa alone.
Addressing biomechanical and muscular imbalances is the most effective, evidence-based approach to long-term recovery. Relying solely on passive treatments like corticosteroid injections may delay proper healing and increase health risks.
Need Help with Lateral Hip Pain?
At Logan Physio, our experienced team can accurately diagnose your hip pain, identify contributing factors, and guide you through a personalised strengthening and rehabilitation program to restore your function and quality of life.
