Greater Trochanteric Pain Syndrome - Causes and Treatment

Introduction

Greater Trochanteric Pain Syndrome (GTPS) is a common and often debilitating condition that affects many individuals, particularly women and athletes. It is characterized by pain and tenderness on the outer part of the hip, specifically around the greater trochanter, which is the bony prominence at the top of the femur. GTPS can significantly impact one's quality of life, making everyday activities and even walking painful. However, there is hope for relief through physical therapy.

What Is Greater Trochanteric Pain Syndrome?

GTPS encompasses two primary conditions: trochanteric bursitis and external snapping hip syndrome. Trochanteric bursitis entails the inflammation of a bursa, which is a sac filled with fluid serving as a protective cushion between the greater trochanter and the nearby soft tissues. The external snapping hip syndrome is characterized by the snapping sensation or noise when the hip moves, often caused by the iliotibial band (IT band) rubbing against the greater trochanter.

Common Symptoms of GTPS:

• Pain on the outside of the hip may radiate down the thigh.

• Tenderness over the greater trochanter.

• The pain is worsened by activities like walking, running, or climbing stairs.

• Audible snapping or popping sensation during hip movement.

What Causes Greater Trochanteric Pain Syndrome?

Some common factors that may lead to the development of GTPS are:

• Repetitive Stress or Overuse: Overuse or repetitive stress on the hip, such as from activities like running, cycling, or standing for extended periods, can cause irritation and inflammation of the tissues surrounding the greater trochanter.

• Muscle Weakness or Imbalance: Weakness or imbalances in the muscles that stabilize the hip joint, particularly the gluteus medius and minimus, can increase stress on the greater trochanter and surrounding structures.

• Tight Muscles: Tightness in the iliotibial band (IT band), hip flexors, or other hip muscles can cause friction and irritation as they rub against the greater trochanter during movement.

• Trauma: A direct injury to the hip or a fall onto the hip can lead to inflammation and pain in the greater trochanteric area.

• Biomechanical Issues: Abnormalities in gait or walking patterns can place excessive stress on the hip joint and contribute to GTPS.

• Obesity: Carrying excess body weight can amplify the stress on the hip joint and worsen GTPS.

• Age: GTPS is more common in middle-aged and older adults, as the tendons and bursae around the hip can degenerate, making them more prone to irritation and inflammation.

• Systemic Diseases: In some cases, underlying medical conditions like rheumatoid arthritis or diabetes may contribute to hip pain and inflammation.

• Anatomical Factors: Certain anatomical variations, such as a prominent greater trochanter or a discrepancy in leg length, can predispose individuals to GTPS.

What Is the Treatment of Greater Trochanteric Pain Syndrome?

Treating greater trochanteric pain syndrome typically involves a combination of conservative approaches to reduce pain inflammation and improve hip function. The individualized treatment approach may differ based on the person's symptoms, root causes, and how they respond to therapy.

Here are some common treatment options for GTPS:

1. Pain Management: Various modalities may be used to manage pain and inflammation, including:

• Ice or heat therapy.

• A healthcare provider prescribes non-steroidal anti-inflammatory drugs (NSAIDs).

• Corticosteroid injections into the trochanteric bursa to reduce inflammation (administered by a qualified healthcare professional).

2. Biomechanical Corrections: In some cases, orthotic devices, such as shoe inserts, may be recommended to correct gait abnormalities and improve hip function.

3. Activity and Lifestyle Modification: Teaching patients about correct body mechanics, posture, and ergonomics can be instrumental in reducing hip joint strain and preventing potential recurrences of GTPS.

4. Weight Management: For individuals who are overweight or obese, weight loss may be advised to reduce the load on the hip joint.

5. Patient Education: Understanding the condition, its causes, and the importance of adhering to the treatment plan is crucial for managing GTPS effectively.

6. Surgical Intervention: In rare cases when conservative treatments do not provide relief, surgical options may be considered. These include procedures to remove damaged tissue or address anatomical abnormalities. Surgery is generally regarded as a final option, and it is typically suggested only after a comprehensive assessment and unsuccessful trials of conservative treatments.

What Is the Role of Physical Therapy in Greater Trochanteric Pain Syndrome?

Physical therapy is a highly effective method to manage GTPS. Here is how physical therapy can help:

• Assessment and Diagnosis: The first step in physical therapy is a thorough assessment to determine the underlying causes and contributing factors of GTPS. This may involve analyzing posture, gait, muscle imbalances, and joint mobility.

• Pain Management: Physical therapists utilize diverse modalities to alleviate pain and inflammation, including ice, heat, ultrasound, and electrical stimulation. Additionally, manual therapy methods such as soft tissue and joint mobilization can provide relief from pain.

• Strengthening Exercises: Weakness in the hip muscles is a common contributing factor to GTPS. A physical therapist will create a tailored exercise regimen aimed at strengtening the muscles surrounding the hip joint, which includes the gluteus medius and minimus.

• Stretching and Flexibility: Tight muscles, particularly the IT band and hip flexors, can exacerbate GTPS symptoms. Stretching exercises can improve flexibility and reduce tension in these areas.

• Postural Education: Poor posture can contribute to hip pain. A physical therapist will educate patients on proper body mechanics and posture to reduce strain on the hip.

• Home Exercise Program: Patients are typically given a set of exercises to continue at home to maintain progress and prevent recurrences.

With consistent physical therapy, many individuals with GTPS experience significant pain relief and functional improvement. However, it is crucial to remember that GTPS can be a recurrent condition, and long-term management is often necessary. This may involve periodic check-ins with a physical therapist, ongoing home exercises, and lifestyle modifications to prevent flare-ups.

Conclusion

Greater Trochanteric Pain Syndrome can be a challenging condition to live with, but physical therapy offers a promising path to relief. Effective management of GTPS typically involves a combination of conservative approaches, including physical therapy, pain management, and lifestyle modifications. These interventions can provide relief, improve hip function, and help individuals return to their daily activities. While GTPS can be challenging, with the right approach and support, individuals can manage their symptoms and enjoy a higher quality of life.