Physical Therapy for Greater Trochanteric Pain Syndrome / Gluteal Tendinopathy / Hip Bursitis
What is Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome (GTPS) is a condition that causes pain over the outer side of the hip, specifically near the greater trochanter, which is the bony prominence you can feel on the side of your upper thigh.
GTPS is sometimes referred to as gluteal tendinopathy or hip bursitis.
GTPS is an umbrella term for several conditions that cause lateral hip pain, most commonly involving:
Gluteus medius or minimus tendinopathy or tears
Gluteal tendinopathy is a condition where the tendons of the gluteal muscles become irritated, weakened, or damaged, typically due to overuse, poor biomechanics, or aging.
Trochanteric bursitis (inflammation of the bursa near the greater trochanter)
Trochanteric bursitis is a condition where the trochanteric bursa—a small, fluid-filled sac located on the outer part of the hip near the greater trochanter—becomes inflamed, leading to pain and tenderness in that area.
You can read more about GTPS in this article.
Greater Trochanteric Pain Syndrome symptoms
Greater Trochanteric Pain Syndrome typically presents with pain and tenderness on the outside of the hip. The symptoms can range from mild discomfort to more persistent, aching pain that interferes with daily activities.
Common Symptoms Include:
Lateral hip pain: Usually located over the greater trochanter (bony bump on the outer thigh)
Pain when lying on the affected side, especially at night
Pain with activities involving hip movement, such as:
Walking
Climbing stairs
Standing up from a seated position
Tenderness to touch on the outer hip area
Radiating pain down the thigh (but typically not past the knee)
Stiffness or tightness in the outer hip or buttock
Pain worsens with prolonged standing or walking
Mild swelling or warmth in some cases (if bursitis is present)
If symptoms persist or significantly impact your movement, it's a good idea to consult a healthcare provider to confirm the diagnosis and rule out other conditions like hip osteoarthritis, lumbar spine issues, or gluteal tendon tears.
Who is at risk to develop Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome can affect anyone, but certain factors and populations are more prone to developing it due to biomechanics, activity levels, or underlying health conditions.
People at Higher Risk Include:
Middle-aged women (especially between ages 40–60)
Women are up to 4 times more likely to develop GTPS than men.
This may be due to differences in pelvic structure, hormonal factors, or muscle imbalances.
People with weak hip muscles
Particularly weakness in the gluteus medius and minimus (hip abductors), which can lead to increased strain on tendons and bursae.
Individuals with leg length discrepancy
Unequal leg lengths can change the way weight is distributed through the hip during walking or standing.
People with gait abnormalities
Improper walking mechanics, often due to flat feet, knee arthritis, or spinal issues, can overload the lateral hip.
Athletes or active individuals
Runners, cyclists, or hikers are at risk due to repetitive hip movement and overuse.
People with low back pain or spinal disorders
Lumbar spine pathology can alter movement patterns or cause referred pain, contributing to GTPS.
Individuals with obesity or high BMI
Excess weight increases pressure on the hip structures, particularly during movement or prolonged standing.
Sedentary lifestyle
Lack of physical activity can weaken key stabilizing muscles in the hip, leading to dysfunction when the person becomes more active.
How do we diagnose Greater Trochanteric Pain Syndrome?
At The Game Plan PT, we diagnose Greater Trochanteric Pain Syndrome through clinical exam findings that typically include:
Tenderness directly over the greater trochanter or gluteal tendons
Pain with resisted hip abduction
Pain on single-leg stance (e.g., Trendelenburg test)
Gait abnormalities
Range of motion testing to rule out hip joint problems
Tests to differentiate GTPS from referred pain (e.g., from the lower back)
Imaging is usually not necessary but may be used if the diagnosis is unclear or symptoms persist despite treatment.
Ultrasound: Can show bursitis, gluteal tendon pathology, or inflammation.
MRI: Useful for detecting gluteus medius/minimus tendinopathy or tears, and ruling out other causes like labral tears or hip joint arthritis.
How long does Greater Trochanteric Pain Syndrome take to heal?
The healing time for Greater Trochanteric Pain Syndrome can vary depending on several factors, including the severity of the condition, how early treatment begins, and how consistently it's managed.
Typical Recovery Timeline
Mild cases:
Often improve within 4 to 6 weeks with conservative care (rest, NSAIDs, and physical therapy).
Moderate to chronic cases:
May take 3 to 6 months for significant improvement, especially if the condition has persisted for a long time or involves gluteal tendinopathy.
Severe or stubborn cases (e.g., with tendon tears or persistent bursitis):
Can take 6 months or longer to fully resolve, and may require injections or other interventions like shockwave therapy or PRP.
Greater Trochanteric Pain Syndrome treatment
Conservative management including physical therapy is the gold standard treatment for GTPS with a success rate over 90% according to this article.
Physical therapy for GTPS typically includes:
1. Pain Management and Activity Modification
Education: Avoid positions or movements that compress the lateral hip (e.g., crossing legs, side-lying on affected side)
Temporary activity modification: Reduce walking or running, particularly on inclines or uneven surfaces
2. Manual Therapy Techniques
Soft tissue mobilization of the gluteal muscles
Myofascial release and trigger point therapy
Joint mobilizations to improve hip mobility
3. Therapeutic Exercise
A. Stretching Exercises
Gluteus maximus and piriformis stretches
Hip flexor and quadriceps stretches
B. Strengthening Exercises (focus on hip abductors, core, and pelvic stability)
Progressive loading of gluteus medius and minimus that starts with isometrics (holding a muscle contraction without movement) in the early phase and progressing to isotonics (holding a muscle contraction with movement)
Progressing hip/glute strength from exercises done laying down to exercises done in standing
Progressing hip/glute strength from bilateral or split-stance to single leg
4. Neuromuscular Re-education
Training for pelvic and trunk control
Gait training to reduce compensatory patterns
Proprioceptive exercises (e.g., single-leg stance)
5. Functional Training
Gradual return to activities such as walking, stair climbing, or sports
Focus on proper form and body mechanics during movement
When treating our runners with GTPS, we perform a biomechanical running analysis to correct any habits that may be contributing to the condition. For example, runners with GTPS tend to demonstrate a crossover gait, pelvic drop, and lateral trunk lean during their running analysis.
Greater Trochanteric Pain Syndrome Stretches: What are the best glute / hip rotator stretches?
Piriformis Stretches
Half Kneeling Quad/Hip Flexor Stretch
Greater Trochanteric Pain Syndrome exercises: What are the best gluteal tendon strengthening exercises?
Abductor Isometric with Band
Side-lying Clamshell
Side-lying Reverse Clamshell
Glute Bridge Progressions
Single Leg Hip Thrust
Side Plank Variations
Step Up with March
Lateral Step Down
Single Leg RDL
The best exercises for GTPS will depend on which specific tendon is involved but generally, progressing to single-leg hip strength and stability will be a priority for these patients.
Greater Trochanteric Pain Syndrome exercises to avoid
Early in the rehab process, you’ll want to avoid single-leg activities and exercises that load the gluteal tendons such as running, sprinting, bounding, kicking, skating, step ups, step downs, single leg squats, single leg RDL, etc. These exercises can place too much tension or strain on the gluteal tendons while the tissue is healing.
Pain Monitoring Model for Greater Trochanteric Pain Syndrome
For Greater Trochanertic Pain Syndrome, our therapists use the classic tendinopathy pain monitoring scale:
1. Pain is allowed to reach 5 on the Numeric Pain Rating Scale (NPRS) during activity
2. Pain immediately after activity is allowed to reach 5 on the NPRS
3. Pain the next morning after activity should not exceed a 5 on the NPRS
4. Pain should not increase from week to week
Tendons need loading to heal. However, too much load prevents proper collagen fiber healing. And too little loading doesn’t stimulate the formation of collagen fibers (and therefore the tendon does not get more resilient to loads/demands placed on it through running).
How to prevent Greater Trochanteric Pain Syndrome
The best way to prevent Greater Trochaneteric Pain syndrome is to incorporate strengthening of the abductors, hip rotators, and core muscles. These muscles work together to stabilize the hip. They also work together on movement coordination and muscle firing timing. Some of the recommended exercises videos can be referenced above.
Closing Remarks
If you are dealing with Greater Trochanteric Pain Syndrome or hip pain with exercise, contact us below to speak with a physical therapist.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioner. Please consult with a trusted provider.
Dr. Vincent Liu, PT, DPT
Doctor of Physical Therapy
The Game Plan Physical Therapy