What GTPS feels like day to day

The pain tends to announce itself in familiar ways. A dull ache or burning sensation over the outer side of the hip — centred on the bony prominence you can feel when you press the side of your thigh — is the most common description. For some people it sharpens during activity; for others it settles into a constant background throb that grinds down daily life over weeks or months.

The discomfort often spreads down the outer thigh but does not usually track below the knee. This helps distinguish it from sciatic or lumbar referred pain, which tends to travel further and behave differently — though that distinction is for clinical assessment to confirm.

Night is when many people first realise something is genuinely wrong. Lying on the affected side becomes impossible; the pressure of the mattress directly over the greater trochanter can wake you repeatedly. Some people also find that lying on the opposite side aggravates symptoms as the top leg falls inward, stretching the outer hip tissues.

During the day, certain movements reliably provoke a flare: walking any distance, climbing stairs, rising from a low chair, or standing with your weight shifted onto one hip. Sitting with your legs crossed is another common trigger. The tenderness on pressing the outer hip is often striking — patients frequently recognise it as exactly where their pain lives, which itself is a clinically useful pointer.

Why GTPS develops

The older label — trochanteric bursitis — pointed to bursal inflammation as the main culprit, and anti-inflammatory treatment followed logically from that. Contemporary clinical consensus, including the 2022 ISHA international agreement, tells a different story: the primary problem in most cases is gluteal tendinopathy — degenerative change or micro-tearing in the gluteus medius and minimus tendons where they attach to the greater trochanter. The bursa may become irritated secondarily, but it is rarely the origin.

What drives this tendon damage is compressive load rather than simple friction or inflammation. When the hip moves into certain positions — thigh crossing the midline, weight shifting onto one side — the gluteal tendons are squeezed between the greater trochanter and the overlying soft tissues. Repeated or sustained compression over time, particularly in tendons that are already weakened, is what tips the tissue toward pathology.

Several factors raise that compressive load or reduce the tendons' capacity to tolerate it:

• Female sex and pelvic width. Women aged 40–60 are most commonly affected, facing roughly 1.79 times the risk compared with men. A wider pelvic structure increases the inward angle of the femur, placing greater compressive force on the tendon attachment.
• Sudden changes in activity. A new walking programme, increased running mileage, or a sharp step up in daily steps can overload tendons before they have adapted.
• Hip and gluteal muscle weakness. Insufficient strength in the abductor muscles shifts mechanical load onto passive structures, including the tendons themselves.
• Altered gait mechanics. A Trendelenburg pattern — where the pelvis drops on the unsupported side during walking — places repeated compressive strain on the tendon with each step.
• Contributing conditions. Higher BMI, co-existing hip osteoarthritis, lumbar referred pain, and a direct fall onto the outer hip are all established contributing factors.

One emerging observation, from a 2025 retrospective study of over 1.3 million patients, found a significant association between systemic hormonal contraception and GTPS risk — though this is observational and does not yet inform clinical guidance.

How GTPS is diagnosed

A clinician assessing suspected GTPS will typically start with questions before touching anything — how the pain began, which positions make it worse, and whether sleep has been disrupted by lying on the affected side. That history, combined with a targeted physical examination, usually provides enough information to reach a diagnosis.

The examination centres on a small number of reproducible tests. Direct palpation of the greater trochanter — pressing firmly on the bony point at the outer hip — typically reproduces the patient's familiar pain immediately. The FABER test (positioning the hip in flexion, abduction, and external rotation) and resisted hip abduction load the gluteal tendons and can provoke lateral discomfort. A Trendelenburg assessment, watching for pelvic drop during single-leg stance, reveals whether the hip abductors are functioning effectively.

Imaging is not a first step for straightforward GTPS. Ultrasound or MRI may be arranged when the diagnosis is uncertain, or when another cause — hip osteoarthritis, femoroacetabular impingement, a labral tear, or lumbar nerve root referral — needs to be excluded. An important caveat applies: tendon changes on MRI can be present in people with no symptoms at all, so a scan finding alone is not a diagnosis. The clinical picture — what provokes the pain, where the tenderness sits — guides management, not the scan in isolation.

GTPS can also arise after hip replacement: roughly 9% of patients develop trochanteric bursal irritation post-operatively, making lateral hip pain an important clinical consideration across the full hip care pathway.

First-line management: load and movement

Recovery from GTPS is an active process, not a matter of resting until the pain fades. Both the 2022 ISHA international consensus and NHS guidance place load management and progressive exercise at the centre of first-line care — and the reasoning matters. Resting a tendon completely can reduce its capacity to handle load over time; the aim is to modify compressive strain intelligently, then rebuild tendon tolerance gradually.

The compressive positions already identified as symptom triggers — crossed legs, weight-shifted standing — are also the first targets for practical adjustment. Raising seating height so the hips sit above the knees, sleeping with a pillow between the legs, and distributing weight evenly when standing all reduce unnecessary strain on the gluteal tendons while rehabilitation gets under way.

Progressive gluteal strengthening is the main therapeutic driver. A practical starting point is side-lying hip abduction: lying on the unaffected side and slowly raising the upper leg to around 30 degrees before lowering with control. This loads the gluteus medius without compressing the tendon against the trochanter. Clam exercises and single-leg bridges can be introduced as tolerance improves, progressively increasing demand. A 2025 network meta-analysis of 19 RCTs involving 1,701 participants confirmed that exercise therapy produces the most significant improvements in both pain scores and functional outcomes for GTPS — stronger evidence than any other conservative modality tested.

Realistic expectations help sustain the effort. More than 90% of GTPS cases do resolve with conservative care, but the typical timeframe is 6 to 12 months, with some symptom fluctuation along the way being normal rather than a sign of failure.

When to see a hip specialist

Several signals point clearly towards specialist assessment rather than continued self-management.

Consider escalating when:

• Symptoms are severe at onset, substantially limiting daily function or sleep from the start
• Pain persists beyond roughly three months of consistent conservative management — sustained exercise, compressive-load avoidance, and appropriate pacing
• Sleep is disrupted on most nights, or the condition is preventing normal walking, stair use, or the capacity to work
• The diagnosis is uncertain: pain that does not fit the outer-hip pattern, or where hip osteoarthritis, femoroacetabular impingement, or referred lumbar pain cannot be excluded on clinical grounds alone

A hip specialist can confirm or revise the diagnosis using targeted ultrasound or MRI and arrange advanced treatments — ultrasound-guided injections, extracorporeal shockwave therapy, or, in refractory cases, percutaneous tendon procedures — matched to the individual clinical picture.

Lincolnshire Hip is part of the MSK Doctors group and accepts patients without referral for hip assessment, with clinics in Sleaford and Grantham. Patients uncertain whether their situation warrants a formal consultation can arrange a free discovery call in the first instance.

Advanced options when conservative care is not enough

For the minority of patients whose symptoms remain significant after three to six months of structured exercise and load management, a specialist can draw on several additional options, sequenced by evidence strength.

Extracorporeal shockwave therapy (ESWT) has the strongest non-surgical evidence base at this stage. A systematic review found improvement in pain and function in 17 of 18 studies examining ESWT for gluteal tendinopathy, with outcomes superior to corticosteroid injection and sham treatment across multiple trials.

Ultrasound-guided corticosteroid injection can provide meaningful short-term pain relief, particularly where a flare is preventing engagement with rehabilitation. Its role is symptom management rather than tendon repair — it does not alter the underlying tendinopathy, and relief may not persist beyond a few months.

PRP (platelet-rich plasma) injection is sometimes requested, but a 2025 double-blinded RCT of 79 patients found no significant advantage over placebo at any point up to 12 months. Both groups improved from baseline, consistent with GTPS's natural resolution trajectory. Routine PRP is not currently supported for GTPS on this evidence, though research continues.

Ultrasound-guided collagen injection is an emerging option: a 2025 pilot study reported that 60.5% of patients achieved a clinically meaningful pain reduction at ten weeks, with MRI and strength improvements at six months. Larger randomised trials are needed before it enters routine use.

Surgical intervention — endoscopic bursectomy or percutaneous ultrasound-guided tenotomy — is reserved for genuinely refractory cases where all other pathways have been exhausted. Published two-year data suggest approximately 60% of patients treated with combined iliotibial band and gluteus medius tenotomy sustain at least 50% pain reduction at that point. Surgery represents an uncommon endpoint rather than a routine one.

1. [1] Efficacy of Ultrasound-Guided Injections of Type I Collagen-Based Medical Device for Greater Trochanteric Pain Syndrome: A Pilot Study. (2025). https://doi.org/10.3390/life15030366 https://doi.org/10.3390/life15030366
2. [2] The Limited Impact of Randomized Controlled Trials on the Management of Greater Trochanteric Pain Syndrome as Demonstrated by Fragility Indices. (2025). https://doi.org/10.1016/j.jisako.2025.100846 https://doi.org/10.1016/j.jisako.2025.100846
3. [3] Effect of conservative treatment on greater trochanteric pain syndrome: a systematic review and network meta-analysis of randomized controlled trials. (2025). https://doi.org/10.1186/s13018-025-05477-w https://doi.org/10.1186/s13018-025-05477-w
4. [4] Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome. (2025). https://doi.org/10.2106/JBJS.24.00763 https://doi.org/10.2106/JBJS.24.00763