Hip Pain (Greater Trochanteric Pain Syndrome)
Hip pain can greatly affect our ability to function as the hip is a vital joint involved in most day to day activities such as walking and squatting.
Hip pain can be caused from a variety of different injuries and pathologies which is why there are a lot of different terms used to describe it such as Trochanteric Bursitis, Gluteal tendinopathy and Gluteal tendinitis. Because these conditions are all talking about symptoms in the same area, we now often refer to Hip pain as being "Greater Trochanteric Pain Syndrome" which also reflects the fact that hip pain is often not just one, but a combination of factors.
The name comes from the area affected. The Greater Trochanter is a bony structure that is part of the femur (thigh bone). This area is an attachment point for several hip muscles that are important for movement and stabilisation. In the past, bursitis was thought to be the main source of pain, however recent research indicates the tendons of the gluteal complex are the primary local sources of lateral hip pain.
Greater Trochanter Pain Syndrome (GTPS) affects approximately 10-25% of the general population. There is increased prevalence in females, and mostly strikes around the ages of 40-60. There is also increased risk in long distance runners.
Some classic features of Greater Trochanteric Pain Syndrome are:
*Pain at night when laying on the affected side
*Pain rolling over in bed
*Pain with sitting in chairs
*Pain after running / walking activities
*Tenderness on palpation over the greater trochanter
Ultrasound and MRI are sometimes used to confirm your diagnosis but often as physiotherapists we can see clinical signs on assessment that allow us to diagnose the condition. Conservative management is highly successful in the management of Greater Trochanteric Pain Syndrome. Injections are required at times to help reduce any pain that is coming from bursas however being a largely tendon related issue your physio will guide you through a plan that reduces pain and then aims to gradually and appropriately re-load the affected tendons. This condition can take months to settle in some cases and at times as a patient it will test your patience however complete resolution of symptoms shoulder occur in a majority of cases. Your physiotherapy program for Greater Trochanteric Pain Syndrome will be broken into three phases. Phase 1 - reduce pain
This will involve a combination of resting and refraining from aggravating activities (such as stretching and prolonged sitting) as well as hands on physiotherapy techniques. Phase 2 - rehabilitating the tendon This phase will be exercise based and will gradually re-introduce progressive load back into the glute tendons. It is important to get this phase correct as it is often at this point where too much load too soon can cause re-lapse. Phase 3 - addressing weakness to prevent recurrence
In this phase a more holistic exercise program will be developed to address underlying weaknesses that may have predisposed you to the condition in the first place. Such as overall strength and function of the gluteals and hamstrings.
If you think you are suffering from Greater Trochanteric Pain Syndrome then the first thing to do is to consult your physiotherapist who can provide a diagnosis and assist with settling down your pain. They will also be able to help guide you on the likely time frame for recovery (which can vary greatly from case to case).