Gluteal Tendinopathy, Trochanteric Bursitis, Greater Trochanteric Pain Syndrome (GTPS)

What is gluteal tendinopathy, trochanteric bursitis & GTPS?

Pain over the side of the hip is commonly related to changes in the health of the tendons that join the gluteal (buttock) muscles to the hip, and sometimes of the nearby bursae (fluid filled sacks that help reduce friction between tendons and bones). The condition may be diagnosed as gluteal tendinopathy or tendinitis, trochanteric bursitis or Greater Trochanteric Pain Syndrome (GTPS) which encompasses both. The good news is, that regardless of the diagnostic term and whether in your case the tendons or bursae seem to be most affected, the underlying cause appears to be the same and strategies to improve health of one, will help the other as well.

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Do you have hip bursitis or gluteal tendinopathy? Not sure where to start on your road to recovery? Or what your next steps should be?

This FREE resource provides a suggested treatment pathway, based on the available scientific evidence and Dr Alison Grimaldi's 30+ years of clinical practice as a physiotherapist and 20+ years as a researcher and educator in this field.

Download FREE Resource

What are the usual symptoms of gluteal tendinopathy and trochanteric bursitis?

area-of-pain-experienced-with-gluteal-tendinopathy

The main symptom is pain and tenderness over the bony prominence (bump) at the side of the hip, called the greater trochanter (As shown in the figure to the left).

Pain may also spread down the outer surface of the thigh towards the knee and sometimes just below the knee (As shown in the figure to the left). Pain that extends all the way to the foot is more likely to be related to a problem in the lower back.

The pain of gluteal tendinopathy (+/- bursitis) is often worst at night, particularly when lying on either side and may result in substantial sleep disturbance.

The pain may also have a significant impact on activity levels due to pain experienced when walking & standing on one leg, particularly walking uphills/slopes.

Wondering if you have gluteal tendinopathy or trochanteric bursitis?

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Usual symptoms of gluteal tendinopathy/ trochanteric bursitis /GTPS

Pain over the side of the hip experienced when:

  • Lying on the side at night
  • Walking uphills and stairs
  • Standing on one leg, for example when dressing
  • Sitting in low chairs especially with crossed legs
  • Getting up from chairs and during the first steps

What causes gluteal tendinopathy and bursitis and who is most likely to develop the problem?

common-walking-patterns-in-those-with-gluteal-tendinopathy

Many factors influence the health of the tendons and bursae at the side of the hip, but either too much or too little stimulus may result in tissue changes. Poor postures or movement patterns may over time contribute to reduced tendon health.

Recent Australian research has shown that the gluteal (buttock) muscles (gluteus medius and minimus) of those with painful gluteal tendinopathy are weaker¹ and activate in different ways to those with painfree hips.²

Those with lateral hip pain also tend to move in ways that result in higher than normal loads passing across their gluteal tendons.³ Those with painful gluteal tendinopathy tend to walk with greater pelvic tilt (as demonstrated by the dotted line) or side-shift or lean their body a little more to the side (as shown in the figure to the left).

Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica-2

Recovering from Gluteal Tendinopathy, Trochanteric Bursitis or GTPS

This rehab course offers an evidence-based program developed by a world leading expert, Dr Alison Grimaldi. It helps you understand your condition, and provides powerful self-help tips and exercises to help you recover from Gluteal Tendinopathy and Trochanteric Bursitis.

Find out more!
First lesson is FREE!

Changes in tendons and bursae are not necessarily painful, but if weakened tendons are unable to cope with their workload, pain may develop.

Pain is often triggered by sudden increases in activity levels, where the tendons have not been given adequate time to adapt to the new loads, such as taking up a new sport or activity or returning to activity after illness, injury or pregnancy. For example, going on holidays and walking lots of hills or stairs or for long distances along the beach may cause a painful reaction.

Sudden loads on the tendon during a slip or fall can also result in pain and injury or a gain in weight may add more load to these tendons that support your bodyweight when standing on one leg.

Eighteen percent of the population aged over 50 suffers with lateral hip pain and women are 3 times more likely to develop greater trochanteric pain syndrome.4 Change in hormones are thought to contribute to the development of tendon changes, but there are usually a number of casual factors. The onset of pain associated with a combination of hormonal change during menopause, weight gain during this time and a sudden increase in activity levels to deal with this, is a common story related to health professionals.

Read more about causes of gluteal tendinopathy and trochanteric bursitis in our associated blog.

Common Triggers for the Development of Lateral Hip Pain:

  • Fitness Kick
  • Unaccustomed activity on holiday
  • Returning to activity too quickly after injury, illness or pregnancy
  • Slip or Fall
  • Hormonal change during menopause
  • Weight gain
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Do you have hip bursitis or gluteal tendinopathy? Not sure where to start on your road to recovery? Or what your next steps should be?

This FREE resource provides a suggested treatment pathway, based on the available scientific evidence and Dr Alison Grimaldi's 30+ years of clinical practice as a physiotherapist and 20+ years as a researcher and educator in this field.

Download FREE Resource

Getting Help. What is the treatment for gluteal tendinopathy, trochanteric bursitis & GTPS?

A high-quality research study recently published in the British Medical Journal5 compared three common treatment approaches: Education and Exercise provided by physiotherapists, Cortisone Injection and adopting a Wait-and-See approach with simple advice. They found:

  1. Education and exercise was superior to wait-and-see in both the short (8 weeks) and long term (12 months)
  2. Education and exercise was superior to injection in both the short (8 weeks) and long term (12 months)
  3. Injection is no more successful than wait and see in the long term (12 months)
outcomes-of-the-LEAP-clinical-trial-for-gluteal-tendinopathy
outcomes-of-the-LEAP-clinical-trial-for-gluteal-tendinopathy

The education and exercise approach provided information to participants regarding minimising provocative tendon loads in everyday life and an exercise programme that focusses on improving movement patterns and load tolerance of the tendons (the ability of the tendons to accept load without pain). Comparison with other research outcomes suggests that all programs are not equally effective, so finding a Hip Pain Professional who is up to date with the latest research will help ensure you get the best possible outcome.

Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica-2

Recovering from Gluteal Tendinopathy, Trochanteric Bursitis or GTPS

This rehab course offers an evidence-based program developed by a world leading expert, Dr Alison Grimaldi. It helps you understand your condition, and provides powerful self-help tips and exercises to help you recover from Gluteal Tendinopathy and Trochanteric Bursitis.

Find out more!
First lesson is FREE!

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Authors

This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.

Dr Alison Grimaldi - Hip Pain Professional

Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD, FACP is a fellow of the Australian College of Physiotherapists, Practice Principal of PhysioTec Physiotherapy, an Australian Sports Physiotherapist , an Adjunct Senior Research Fellow at the University of Queensland, as well as an author and global educator

Kirsty McNab hip pain professional and hip physio
Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.

References

  1. Allison, K., Vicenzino, B., Wrigley, T., Grimaldi, A., Hodges, P. and Bennell, K. (2016). Hip Abductor Muscle Weakness in Individuals with Gluteal Tendinopathy. Medicine & Science in Sports & Exercise, 48(3), pp.346-352.
  2. Allison, K., Salomoni, S., Bennell, K., Wrigley, T., Hug, F., Vicenzino, B., Grimaldi, A. and Hodges, P. (2017). Hip abductor muscle activity during walking in individuals with gluteal tendinopathy. Scandinavian Journal of Medicine & Science in Sports, 28(2), pp.686-695.
  3. Allison, K., Wrigley, T., Vicenzino, B., Bennell, K., Grimaldi, A. and Hodges, P. (2016). Kinematics and kinetics during walking in individuals with gluteal tendinopathy. Clinical Biomechanics, 32, pp.56-63.
  4. Segal, N., Felson, D., Torner, J., Zhu, Y., Curtis, J., Niu, J. and Nevitt, M. (2007). Greater Trochanteric Pain Syndrome: Epidemiology and Associated Factors. Archives of Physical Medicine and Rehabilitation, 88(8), pp.988-992.
  5. Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H. and Vicenzino, B. (2018). Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ, May 2;361:k1662.
Recovering-from-Piriformis-Syndrome-Deep-Gluteal-Syndrome-or-Hip-Related-Sciatica

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