Greater trochanteric pain syndrome is a very common condition that causes pain over the outside part of your hip and thigh. This condition previously known as “trochanteric bursitis” tends to come on slowly and is mainly aggravated by standing and movement activities. Common symptoms of greater trochanteric pain syndrome include:
- Pain over the outside part of the bottom/hip area
- Pain may radiate down towards the outside thigh towards your knee
- Tenderness to touch over the bony part of your hip
- Pain with weight bearing activities such as walking, standing, running. Especially with stairs
- Lying on the painful hip can increase the pain
- Sitting with your legs crossed can aggravate the pain
Anatomy lesson time! Stand up and put both of your hands on your hips - The fashion industry would have you believe that this bony part of the top of your pelvis is your hips. Not true! (I know, shock horror). With the palm of your hand on your hips (aka your pelvis!) and your fingers pointing towards the ground, the bony prominence underneath your fingertips is called the greater trochanter – This is the outside part of your hip joint. Our hip joint is where we hinge to lift our knee to our chest or sit on a seat.
The Greater Trochanter is an important location because two muscles the Gluteus Medius and Gluteus Minimus (smaller than the famous Gluteus Maximus) attach to this bony part. These two muscles rotate the thigh and also activate to stabilise the whole hip joint during activities. The part of the muscles that attaches to the bony prominence are called tendons. When tendons are damaged or unhealthy it is called tendinopathy. Research has shown us that the largest factor causing greater trochanteric pain syndrome is tendinopathy in these gluteal tendons.
What causes Gluteal Tendinopathy?
Gluteal tendinopathy is primarily caused by degeneration of your tendons most commonly from repetitive overloading or when the load being applied to the tendon is too great for it to withstand. Overloading your tendons might lead to more breakdown of the tendon tissue than it can repair. For example if your gluteal tendons are used to walking for approximately 30 minutes a day and then you decide to do a three day hilly overland hike without training this can lead to more breakdown in the tendon tissue than it can repair. Another common cause of gluteal tendinopathy is a result of compression loading going through the tendon. Examples of compression loading include doing the pigeon pose in yoga or lying on your hip at night while sleeping (this compresses the tendon at the greater trochanter).
How does Physiotherapy help with Gluteal tendinopathy?
Physiotherapists are the tendinopathy masters. We’ve spent tonnes of time treating temperamental tendons. Like most tendon injuries the treatment can be thought of as being in two key parts. The first part is to offload the tendon and get your pain under control. The next stage involves incrementally strengthening the gluteal tendon to build capacity allowing the tendon to tolerate all the activities you want to do in your life.
Part one will involve reducing the pain in your hip. This is primarily done by reducing the load going through your gluteal tendons. In practical terms this will mean avoiding common aggravating symptoms. For instance if you love yoga we might need to take out pigeon pose and other positions where your problematic hip crosses over the midline. We can also use massage, dry needling and mobilisation to help with any surrounding areas of muscle tightness.
Once the pain is under control the next step is to start a gradual and incremental strengthening glute strengthening program. This will help the tendon’s ability to withstand load and allow you to get you back to doing the things you love. During this stage it is important to follow our expert physios instruction and avoid pushing into pain and follow the sets, reps and the speed of each exercise so we can be consistent and get you back to what you love faster!