Greater Trochanteric Pain Syndrome

Lower Limb

Overview

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain arising from pathology of the gluteal tendons, bursa, and associated soft tissues around the greater trochanter. It predominantly affects middle-aged and older adults, particularly women, and is often exacerbated by activities involving hip adduction and internal rotation. The condition results from cumulative microtrauma, muscle weakness, and altered biomechanics rather than a single traumatic event.

Pathophysiology

GTPS develops through chronic irritation and degeneration of the gluteus medius and minimus tendons where they insert on the greater trochanter. The primary mechanism involves excessive hip adduction and internal rotation—often from weak hip abductors, tight hip flexors, or altered pelvic mechanics—creating repetitive tensile and compressive stress on these structures. Secondary inflammation of the trochanteric bursa occurs as a consequence.

Patient Education

GTPS typically improves with graded strengthening of the hip abductors and external rotators combined with activity modification and correction of movement patterns; avoid prolonged sitting, sleeping on the affected side, and repetitive hip adduction movements.

Typical Presentation

Site

Lateral hip at the level of the greater trochanter; may radiate along the lateral thigh to the knee

Quality

Sharp, aching, or burning pain; described as tenderness directly over the bony prominence

Intensity

Mild to moderate, often 4-7/10; varies significantly with activity and time of day

Aggravating

Prolonged standing, walking or running (particularly on slopes or cambered surfaces), climbing stairs, side-lying on the affected side, hip adduction activities, single-leg stance, rising from seated position, crossing legs

Relieving

Rest, avoiding provocative movements, side-lying on the unaffected side, analgesia, application of heat

Associated

Hip weakness on resisted abduction and external rotation; positive single-leg stance test; altered gait mechanics with pelvic drop on contralateral side; tight hip flexors and tensor fasciae latae; reduced hip internal rotation; possible referred symptoms into lateral thigh

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

Grade C
A+ABCDModest value: a small but usable shift in probability (LR 2–5 or 0.2–0.5)
modest, supportive value.

Single Leg Stance (Trendelenburg Test)

Procedure

Patient stands on the affected leg with the other knee lifted, a fingertip on the wall for balance if needed. Watch the pelvis from behind for up to 30 seconds.

Positive Finding

The pelvis drops on the side of the lifted leg, or the patient leans the trunk over the stance leg to stay level.

Sensitivity / Specificity

73% (11 with a gluteus medius tear)/77% (13 with lateral hip pain but no tear)

Reference: Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44(9):2138-45.

Interpretation

Shows weakness or poor control of the hip abductors (gluteus medius and minimus) on the stance side. Common in lateral hip pain and useful to guide strengthening, but not diagnostic on its own. From one study of 24 women with greater trochanteric pain, with MRI as the reference (Bird 2001). The figures are for detecting a gluteus medius TEAR, not for diagnosing the pain syndrome. The comparison group had the same pain without a tear. Small study, so treat the figures as rough; a positive sign supports imaging before any surgical referral.

Sources

No accuracy study

30-Second Single Leg Stance (Pain Provocation)

Procedure

Patient stands on the affected leg with the other knee lifted, a fingertip on the wall for balance, and holds for up to 30 seconds. Ask the patient to report when and where pain starts.

Positive Finding

The patient's own lateral hip pain is reproduced within 30 seconds.

Sensitivity / Specificity

100% (17 patients)/—

Interpretation

Loads the gluteal tendons by compression. Reproduction of the familiar lateral hip pain strongly supports gluteal tendinopathy. Pain is the finding here, not pelvic drop. From one small study of 17 patients with long-standing lateral hip pain, all with gluteal tendon changes or bursitis on MRI (Lequesne 2008). Only sensitivity is shown: the comparison group had no hip pain, which makes specificity look better than it is in clinic. A larger study of 65 people with lateral hip pain (Grimaldi 2017) found that pain within 30 seconds of standing on one leg made gluteal tendinopathy on MRI very likely; that figure is not shown until the full paper is checked.

Sources

No accuracy study

Ober Test

Procedure

Patient lies on the unaffected side with the bottom hip and knee bent. Hold the pelvis steady, bring the top leg (knee bent or straight) into abduction and slight extension, then let it lower towards the plinth.

Positive Finding

The leg stays up and does not lower to the horizontal, or lateral hip pain is reproduced.

Interpretation

Tests tensor fasciae latae and iliotibial band tightness. Pain in the adducted position may reflect compression of the gluteal tendons, which supports tendinopathy. Tightness alone is not diagnostic, and stretching into adduction may aggravate gluteal tendinopathy.

Sources

Performance measure

Lateral Hop Test / Single-Leg Hop for Distance

Procedure

Ask the patient to hop on the affected leg, repeatedly on the spot or for distance, and compare with the other leg.

Positive Finding

Lateral hip pain, or clearly less distance or control than on the other side.

Interpretation

A functional test for active or younger patients, used to guide rehabilitation. Not a diagnostic test.

Sources

No accuracy study

Palpation of the Greater Trochanter (Tender Point)

Procedure

Patient lies on the unaffected side. Palpate over and around the greater trochanter, including just above it and at its back edge, and compare with the other side.

Positive Finding

Tenderness over the greater trochanter that reproduces the patient's pain.

Sensitivity / Specificity

80% (65 people with lateral hip pain)/—

Interpretation

No tenderness makes gluteal tendinopathy unlikely. Tenderness is common and occurs in other conditions too, so combine it with a loading test such as the 30-second single leg stance. Groin pain, loss of hip rotation or night pain point to the hip joint instead. From one study of 65 people with lateral hip pain, with MRI as the reference (Grimaldi 2017). Specificity is not shown: the number of people without tendinopathy is not given in the abstract. No tenderness over the greater trochanter made gluteal tendinopathy on MRI unlikely.

Sources

No accuracy study

Resisted Hip Abduction (Sidelying)

Procedure

Patient lies on the unaffected side. Ask the patient to lift the top leg slightly and hold against your resistance at the knee or ankle. Compare with the other side.

Positive Finding

Reproduction of the lateral hip pain, or weakness.

Interpretation

Loads the gluteus medius and minimus tendons. Pain supports gluteal tendinopathy. Other loading tests (resisted external derotation, FABER) can add to the picture.

Sources

⚠ Red Flags

  • •Acute traumatic onset with severe pain or inability to weight-bear suggesting fracture or acute bursitis
  • •Unintentional weight loss, fever, or systemic symptoms suggesting systemic disease or infection
  • •Night pain at rest unrelated to movement suggesting malignancy or severe inflammation
  • •Progressive neurological deficit, saddle anesthesia, or bowel/bladder changes suggesting cauda equina syndrome
  • •Hip pain associated with significant swelling, erythema, or warmth suggesting septic arthritis
  • •History of inflammatory arthropathy with morning stiffness >1 hour suggesting rheumatological condition

⚡ Yellow Flags

  • •Catastrophizing beliefs about pain or movement ('my hip is permanently damaged')
  • •High pain-related kinesiophobia leading to activity avoidance and deconditioning
  • •Prolonged work absence or social withdrawal secondary to pain
  • •Significant psychological distress, anxiety, or depression concurrent with symptom onset
  • •Frequent healthcare seeking with poor response to multiple interventions suggesting illness anxiety
  • •Litigation or compensation claims related to the hip condition
  • •Discordance between reported pain severity and functional limitations observed during examination

Osteopathic Techniques

Education with exercise (load management) has the best evidence: in the LEAP trial it beat a steroid injection and wait-and-see at 8 weeks. No trials of osteopathic or manual techniques for GTPS were found.

Region

Gluteal and deep hip muscles

Technique

Soft tissue, lumbar and glutealNo trials found

Rationale

Eases tension in the gluteal and deep hip muscles. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Hands-on soft-tissue work (kneading, stretching and sustained pressure) to the lumbar paraspinals, quadratus lumborum and gluteal muscles, usually prone or side-lying.

Cautions

Only minor side effects have been reported in trials.

Evidence in Greater Trochanteric Pain Syndrome

Searched 24 Oct 2026: no trials of gluteal soft tissue technique in GTPS.

Sources

Region

Tensor fasciae latae and iliotibial band

Technique

Soft tissue, hip and thighNo trials found

Rationale

Eases tension in the hip and thigh muscles. Not tested in trials for this condition.

How it's done & evidence

How it's done

Hands-on kneading, stretching and sustained pressure to the muscles around the hip and thigh: the hip flexors, adductors and hamstrings, and tensor fasciae latae with the iliotibial band.

Evidence in Greater Trochanteric Pain Syndrome

Searched 24 Oct 2026: no trials of TFL and ITB soft tissue technique in GTPS.

Sources

Region

Hip joint

Technique

Articulation, hipNo trials found

Rationale

Gentle, rhythmic movement of the hip joint within its range to ease stiffness. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Rhythmic, low-velocity passive movement of the hip joint within its range, with no thrust, usually with the patient supine. In hip osteoarthritis trials it was given as a course of about 9–10 sessions over 5–12 weeks.

Cautions

Side effects are usually mild and short-lived. In one hip osteoarthritis trial, 41% of the active group (manual therapy plus exercise) reported mild side effects, against 14% with sham.

Evidence in Greater Trochanteric Pain Syndrome

Searched 24 Oct 2026: no trials of hip mobilisation in GTPS.

Region

Psoas and iliacus

Technique

Muscle energy, psoasNo trials found

Rationale

Low-force MET or counterstrain to ease a tight, tender psoas. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

The hip is taken into extension to the barrier (prone, or supine with the leg off the table). The patient pulls the hip toward flexion for 3–5 seconds against equal resistance, relaxes, and the hip is taken further into extension. Repeat 3–5 times, then re-check.

Cautions

Do not use with a fracture in the area, an unstable pelvis or hip, recent surgery, or a patient who cannot contract on request or follow directions.

Evidence in Greater Trochanteric Pain Syndrome

Searched 24 Oct 2026: no trials of hip flexor MET in GTPS.

Region

Lumbar spine and sacroiliac joints

Technique

Articulation, lumbarNo trials found

Rationale

Gentle mobilisation of the lower back and sacroiliac region. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Rhythmic, low-velocity movement of restricted lumbar segments within their passive range, with no thrust, usually side-lying or prone. The amplitude can vary.

Cautions

Side effects reported in trials were mild and short-lived: soreness, tiredness or a flare of existing symptoms.

Evidence in Greater Trochanteric Pain Syndrome

Searched 24 Oct 2026: no trials of lumbar or sacroiliac mobilisation in GTPS.

Sources

Rehabilitation Exercises

Sidelying Hip Abduction

StrengtheningBeginner

Clamshells (Hip External Rotation)

StrengtheningBeginner

Lateral Band Walks

StrengtheningBeginner

Glute Bridges

StrengtheningIntermediate

Single-Leg Glute Bridge

StrengtheningAdvanced

Single-Leg Stance

BalanceIntermediate

Hip Flexor Stretch (Modified Thomas Position)

StretchingBeginner

Tensor Fasciae Latae and ITB Stretch

StretchingBeginner

Pelvic Tilts and Core Activation

PosturalBeginner

Hip Internal and External Rotation in Sidelying

Range of MotionBeginner

Sidelying Hip Internal Rotation with Adduction

StrengtheningIntermediate

Single-Leg Romanian Deadlift

BalanceAdvanced

Referral Criteria

  • •Presentation of red flag features suggesting fracture, infection, or malignancy requiring imaging and medical investigation
  • •Failure to improve after 6-8 weeks of conservative management and structured rehabilitation suggesting need for imaging (ultrasound or MRI) and possible injection therapy
  • •Severe pain limiting function and activities of daily living unresponsive to analgesia; consider physiotherapy intensification or injection
  • •Signs of neurological deficit or nerve entrapment (e.g., superior cluneal nerve or lateral femoral cutaneous nerve) requiring specialist assessment
  • •Suspected underlying inflammatory arthropathy or systemic condition requiring rheumatology referral
  • •Symptoms consistent with labral pathology or intra-articular hip joint pathology requiring orthopedic assessment and imaging
  • •Significant psychological distress, catastrophizing, or suspected chronic pain syndrome requiring pain psychology or multidisciplinary pain management