What it is

Greater trochanteric pain syndrome (GTPS) refers to pain on the outer hip around the greater trochanter. The main driver is irritation of the gluteal tendons and the nearby bursa where they pass over the bone.

People notice pain when lying on the side, climbing stairs, standing with weight on one leg, or after long walks.

Symptoms often build over weeks. Ignoring them encourages a cycle of tendon irritation and poor sleep.

A plan that reduces compressive positions and rebuilds tendon strength restores tolerance and sleep.

What happens when it occurs

Compression of the gluteus medius and minimus tendons against the greater trochanter irritates the tendon and bursa.

Reducing time in compressed positions and loading the tendon in a graded way improves symptoms.

Common causes and risk factors

  • Prolonged standing with the hip adducted or crossed legs
  • Rapid increases in walking or hill work
  • Weak hip abductors and reduced control in single-leg tasks
  • Lumbar or pelvic mechanics that bias the hip into adduction

Who is most affected

Adults in midlife, especially women, walkers, runners returning after time off, and people who stand for long periods at work.

Typical symptoms

  • Outer hip pain and tenderness over the greater trochanter
  • Pain when lying on the side or with crossed legs
  • Pain on stairs, hills, or long walks

When to seek care

Seek care if pain persists beyond two weeks, disturbs sleep, or limits walking and stairs.

How we diagnose

History and examination including resisted hip abduction and palpation over the greater trochanter.

Ultrasound or MRI is used when a tear is suspected or if progress stalls.

Management

  • Avoid side-lying on the painful side and deep hip adduction positions
  • Progressive strengthening for gluteus medius and minimus
  • Stride and hill load management
  • Shockwave therapy for persistent cases, injections used selectively

Rehabilitation milestones

Phase 1 weeks 0 to 2: reduce compression, isometrics for hip abduction, short flat walks.

Phase 2 weeks 2 to 6: heavy slow resistance for hip abduction and extension, gait control.

Phase 3 weeks 6 to 12: step-downs, hills, longer walks or return to run plan.

Phase 4 weeks 12 to 16: full activity and plyometric preparation if needed.

Readiness to progress

  • No pain when lying on the previously painful side
  • Hip abduction strength within 90 percent of the other side
  • Step-downs and hill walking completed without next-morning flare

Prevention

  • Maintain hip abductor strength
  • Limit prolonged hip adduction postures
  • Progress walking and hills gradually

Australia snapshot

  • Common in primary care and musculoskeletal clinics
  • Women present several times more often than men
  • Standing occupations and walkers make up a large share of cases

Latest insights

Reduce compressive positions first, then load the tendon in a progressive plan.

Strength plus movement retraining outperforms rest alone.

Frequently Asked Questions

Many cases improve over 6 to 12 weeks with compressive-load reduction and progressive strengthening. Night pain is often the last symptom to clear.

Yes, keep flat walks within a pain target of 3 out of 10 and avoid long hills early. Build distance in small steps and stop side-lying on the painful side.

Only if a tear is suspected or if progress stalls after a structured trial. Ultrasound or MRI can show tendon changes and bursal swelling.

Use a pillow between the knees in side-lying and avoid adduction postures. Braces are rarely required.

When you can perform pain-free step-downs, have 90 percent hip abduction strength, and morning pain is minimal after a hill trial.

Shorten the next walk by 20 to 30 percent, remove hills, and repeat isometrics. Resume progression when the next morning is comfortable.

Most people continue working with standing breaks and posture changes. Driving is fine when you can load the hip to press pedals without pain.