Greater Trochanteric Pain Syndrome: Causes, Symptoms, Treatment, Exercises, Physical Therapy, Prognosis

In between tendons and bones all over the body, small sacs of fluids called bursae are present. These fluid sacs provide necessary cushion to the tendons and protect them from sudden damage. The trochanteric bursa is one such fluid sac present in the back of the thigh separating the muscles and tendons of the thighs and buttock from the greater trochanter of the hip. The greater trochanter or great trochanter of femur is the part of the skeletal system of the femur that is irregular in shape, with coarse surface, but to some extent looks quadrilateral. Greater Trochanteric Pain Syndrome or GTPS is also known as Trochanteric Bursitis that is symptomized by a pain in the upper surface of the hip and thigh.^[1]

Due to any injury to the greater trochanter or the adjoining parts and trochanteric bursa, pain on the upper surface of the upper thigh and the hip may occur, which is known as Greater Trochanteric Pain Syndrome. The main cause of the pain is the inflammation or injury to the trochanter bursa, which is why it is also called Trochanteric Bursitis.^[2] In the adjoining area of the Greater Trochanter, several other small fluid sacs are present, but trochanter bursa is the largest fluid sac in that part, and it faces the maximum damage during an injury.

In contrary, some recent research shows that inflammation of the trochanter bursa is not the sole cause of the pain; minor damages to the adjoining muscles and tendons also add to that pain along with an inflamed trochanter bursa. So, these days, experts call the condition as greater trochanteric pain syndrome.

Following are the most known symptoms of Greater Trochanteric Pain Syndrome^[3] –

• Mild to severe hip and upper thigh pain. The pain may spread up to the knee area. The pain intensifies while walking, running, carrying heavy weights, and sitting cross legged.
• Tenderness in the affected areas.
• Painful walking or normal movements is also a symptom of Greater Trochanteric Pain Syndrome.
• Swelling of the affected area, with a sensation of warmth.
• In severe situations, the affected area may be discolored or look reddish.

The main causes of greater trochanteric pain syndrome include the following –

• Sudden fall with the hip area facing the ground and the maximum body weight concentrates on the hip and upper thigh area mainly.
• Excessive pressure on the hip and thigh muscles and bones for a long time for many days may also cause greater trochanteric pain syndrome. This is the main reason of occurrence of the condition in athletes, weight lifters, and bodybuilders.
• Some other problems like osteoarthritis, leg gait disturbances, and problems in the spinal cord may also lead to greater trochanteric pain syndrome.
• In some small number of cases, it is found that greater trochanter pain syndrome has been formed after an arthroscopic surgery on the hip.
• Infection due to any other reason like tuberculosis may also cause inflammation in the trochanter bursa leading to greater trochanteric pain syndrome.^[4]

It is found through several studies that Greater Trochanteric Pain Syndrome is comparatively common among physically active persons, sportsman, and aged people. It is also revealed through studies that women get this disease more than men. Almost 2 per 1000 patients with hip and thigh pains or other related problems are found to suffer with greater trochanter pain syndrome every year worldwide. Among these, almost 80% are females. Studies have not found any specific age group of people to suffer from this disease. However, it is mostly found in middle-aged people.

Greater trochanteric pain syndrome is diagnosed through thorough checkup, understanding the symptoms of the problem, and differential diagnosis. An expert will at first rule out the other possibilities of the pain. Then, he will ask for a physical examination to confirm the cause. Normally, X-ray or USG is advised. If that seems insufficient, the doctor may ask for MRI or CT scan. He may also ask for a pathological test to rule out the possibility of infection in the trochanter bursa.^[5]

The treatment of Greater Trochanteric Pain Syndrome includes the following –

• Application of ice pack can help relieve greater trochanteric pain syndrome
• Giving rest to the legs
• Application of corticosteroid injections
• Administration of non-steroidal anti-inflammatory drugs (NSAID)
• If required, application of local anesthetic
• Physical Therapy

If the patient’s condition doesn’t improve much, attending doctor may advise for Extracorporeal Shock Wave Therapy (ESWT). In most of the cases, greater trochanter pain syndrome symptoms improve with these treatment procedures. In some rare cases, the symptoms may be found to be refractory and unresponsive to traditional treatment procedures and ESWT. In those cases, surgical intervention may be needed.

Physiotherapy and exercise have immense importance in the management of Greater Trochanteric Pain Syndrome. An expert physiotherapist uses numerous tools like ice packs, electrotherapy, acupuncture, and also advices the use of temporary supporting aids for walking. As the pain comes under control and the patient feels better, the physiotherapist will teach some exercises for regular practice. These exercises or stretching are given for the better performance of the tensor fascia lata (TFL), iliotibial band (ITB), the hip rotators, the hip flexors and the quadriceps.

Two most important and effective exercises for greater trochanteric pain syndrome are –

• Champshell Exercise for Greater Trochanteric Pain Syndrome: The exercise is to be done in the below mentioned way:
  • The patient needs to lie on one side with the head on the pillow and the hand in the lower side bent with the head resting on the palm.
  • The two legs will remain one over the other. The feet will also touch one another.
  • In this posture, the patient needs to lift his or her leg up as much as possible without separating the two feet.
  • Remain in this position as long as possible and when tired bring down the leg to the normal position once again.
  • This exercise is to be practiced for 30 minutes, at least two times a day.
• ITB Exercise for Greater Trochanteric Pain Syndrome: ITB stands for Iliotibial Band. In this exercise, a foam roller is required. In absence of a foam roller, a folded and rolled towel can be used.
  • To do this exercise, the patient needs to lie on one side, placing the foam roller or towel under the lower thigh.
  • Resting the upper part of the body slightly above the ground, and stretching the upper leg just vertical to the waist, the roller is to be moved from the hip area up to the knee. This exercise may seem quite tough initially. At the initial stages, it shouldn’t be practiced for more than 30 seconds at a stretch. Taking rest in between the two exercises, it can be practiced 3-4 times in each session.

Most of the patients with Greater Trochanteric Pain Syndrome respond well to the traditional treatment procedures as stated above. With the help of physiotherapy and exercise, they come back to normal life within a few months. Corticosteroid injections also play a vital role in the treatment procedures of greater trochanter pain syndrome. Studies have shown that on timely treatment of Greater Trochanteric Pain Syndrome, no chronic pain occurs in the same part for the next 5 years at least.

Greater Trochanteric Pain Syndrome mostly occurs in middle-aged and old aged people. This disease is also found in sports persons. Due to significant damage in the greater trochanter and adjoining region, along with some damage in trochanter bursa, Greater Trochanteric Pain Syndrome occurs. Most patients with the condition respond positively to the traditional treatments. However, in some rare occasions, surgical intervention may be inevitable. Patients take a few months to come back to their normal lifestyle, and start to perform all previous activities without any issue.

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Also Read:

• Massage Therapy for Trochanteric Bursitis: Benefits, Soft Tissue Massage