What is GTPS?

GTPS is short for Greater Trochanteric Pain Syndrome. Say that 5 times fast!  The term “greater trochanteric pain syndrome” (GTPS) describes a collection of overlapping conditions that cause lateral-sided hip pain, including greater trochanteric bursitis, iliotibial band syndrome, and strain or tendinopathy of the hip abductor muscles (1-4).

greater trochanteric pain syndrome

Bursitis and GTPS

The typical hip has six bursa, which are positioned beneath tendons to reduce friction over the bone (5).  Any of these bursae may become painfully inflamed (6). Bursitis, or bursa inflammation may occur in response to acute trauma, but more commonly develops from repetitive mechanical overloading.

What are the risk factors for GTPS?

Tensor fascia lata hypertonicity and iliotibial band tightness generate excessive lateral hip compression and are predisposing factors for greater trochanteric pain syndrome. Hip abductor weakness, foot hyperpronation, pes planus, or leg length inequality are also contributing factors (8,9). Approximately 1/3 of patients with GTPS demonstrate leg length discrepancies (8).

Hip Abductors and GTPS

The hip abductors (i.e. gluteus medius and minimus) are central to GTPS as a source of ongoing symptoms.  Weakness in the abductors causes excessive thigh adduction and medial rotation, creating  biomechanical disadvantages at the knee and hip, particularly increased tension of the iliotibial band and compression of the greater trochanteric bursa (8).

Who is affected by GTPS?

Greater trochanteric pain syndrome affects a wide spectrum of people, but is most common in middle-aged to elderly adults (8,17). The condition affects both active and sedentary populations (10). GTPS is two to four times more common in females, affecting up to 15% of women (10,17). The condition is present on both sides in up to one-third of GTPS patients (10). 20-35 percent of patients affected with GTPS suffer with concurrent lower back pain (8). 

How long can GTPS last?

The chronicity of GTPS is impressive, unfortunately. Thirty-six percent of patients will be symptomatic at one year, and 29% have ongoing complaints after five years. (17) Those with lower extremity osteoarthritis as well as GTPS have nearly a five times greater risk of persistent symptoms (17).

What are the symptoms of GTPS?

Greater trochanteric pain syndrome presents as chronic, persistent pain in the lateral hip, buttock, and thigh (8,19). Tif there is numbness or pain radiating significantly beyond the knee, alternate diagnosis is likely (20).  Groin crease pain could indicate acetabular pathology, particularly osteoarthritis (21). 

What aggravates GTPS?

GTPS symptoms are often provoked by sitting with the affected leg crossed, transitioning to a standing position, prolonged standing, climbing stairs, and high-impact activities, such as running (8,22). Patients may limit activity as a result of pain, and an antalgic gait is possible. Sleep disturbances are common, since lying on the affected side often increases symptoms.

Are X-rays or imaging necessary for GTPS?

In many cases, X-rays are unnecessary for the initial assessment of GTPS (30). Radiographs may be warranted in cases of trauma or when needed to rule out other pathology. Radiographs should be performed on all patients presenting with significant loss of motion or the inability to bear weight. Children and pre-pubescents with hip pain will likely require radiographs to exclude Legg-Calve-Perthes disease and slipped capital femoral epiphysis (SCFE), respectively. Cases that are unresponsive to a trial of conservative care require further diagnostic work-up. In cases where the diagnosis cannot be confirmed clinically, MRI is the current standard of imaging for GTPS and hip abductor tendon tears (32,52).

GTPS Treatment

Most of the problems with GTPS are from common biomechanical deficits. The goal of treatment should be correct faulty mechanics and to prevent future overload. Conservative treatment of GTPS can exceed a 90% success rate (33).

Rest, activity modification and pain relief are the first lines of defense(34). Patients with acute pain may need to temporarily limit or discontinue aggravating activities. Anti-inflammatory treatments include ice, ultrasound, or electrical stimulation. Patients may apply ice or use ice massage at home. The use of counter-irritant creams (Biofreeze, icy hot, etc.) may provide symptomatic relief.

Stretching and myofascial release techniques such as A.R.T. may be needed for the TFL/ ITB, external hip rotators, hip flexors, gluteus maximus, quadriceps, and hip abductors (8,27). Performing deep soft tissue massage and myofascial release prior to stretching may improve treatment outcomes (36-38).

The addition of IASTM may stimulate remodeling of the gluteus medius and gluteus minimus tendons (39,40).

A specific emphasis should be placed on strengthening the hip abductors and external rotators (41,45,46). Patients should be taught proper squatting and hip hinge techniques to limit hip internal rotation. 

While isolated hip stretching and strengthening exercises may be necessary to improve mobility and strength, those exercises and their associated gains do not necessarily translate to improved functional movement patterns. For lasting improvement, patients must be subsequently taught to ‘groove” new movement patterns, via activity-specific exercises (48).

Other insights on GTPS

Athletes should avoid running on a banked surface, like the crown of a road or indoor track. Running on a small circular track causes the inner leg’s ITB to work harder to prevent it from swinging medially. Runners should reverse directions on a circular track each mile. 

Patients should avoid running on wet or ice surfaces, as these require greater TFL activation for stabilization. Patients with a “lazy” narrow-based running gait should be encouraged to increase step width to minimize stress on the iliotibial band. (42) 

Runners may need to consider new training shoes, particularly if the current shoes have in excess of 300 miles or show any signs of wear on the lateral heel. Cyclists should make certain that their seat is not positioned “too high”. 

Overweight or obese patients should consider weight reduction programs to decrease overall biomechanical tension on the area.

Other treatment options for GTPS

The medical co-management of GTPS includes NSAIDs and the injection of local anesthetics or corticosteroids (43). Some researchhas shown benefit for combined corticosteroid and lidocaine injections (44,47). 

At Creekside Chiropractic & Performance Center, we are highly trained to treat GTPS.  We are the only inter-disciplinary  clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.

Evidence Based-Patient Centered-Outcome Focused


1. Grumet RC, Frank RM, Slabaugh MA, Virkus WW, Bush-Joseph CA, Nho SJ. Lateral Hip Pain in an Athletic Population Differential Diagnosis and Treatment Options Sports Health. 2010 May; 2(3): 191–196. 

2. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. May 2009;108(5):1662-70. 

3. McGee DJ. Hip. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:333-71. 

4. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. Dec 2008;24(12):1407-21. 

5. Kingzett-Taylor A, Tirman PF, Feller J, McGann W, Prieto V, Wischer T, Cameron JA, Cvitanic O, Genant HK. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR Am J Roentgenol. 1999 Oct;173(4):1123-6. 

6. Woodley SJ, Mercer SR, Nicholson HD. Morphology of the bursae associated with the greater trochanter of the femur. J Bone Joint Surg Am. 2008;90(2):284-294. 

7. Silva F, Adams T, Feinstein J, et al. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. Apr 2008;14(2):82-6. 

8. Markley G. Greater Trochanteric Pain Syndrome. Presentation- Illinois Chiropractic Society National Convention. September 2013, Chicago, IL. 

9. Smart GW, Taunton JE, Clement DB. Achilles tendon disorders in runners – a review. Med Sci Sports Exerc 1980;12(4):231-243. 

10. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. Aug 2007;88(8):988-92. 

11. Robertson WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DG, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy. 2008;24(2):130-136. 

12. Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). J Bone & Jt. Surg 1999. 81-A(2):259-278. 

13. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 1992;11(3):568-569 

14. Bunker T, Esler C, Leach W. Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997;79:618–620. 

15. Connell DA, Bass C, Sykes CA, Young D, Edwards E. Sonographic evaluation of gluteus medius and minimus tendinopathy. Eur Radiol. 2003;13(6):1339-1347. 

16. Kagan A., II Rotator cuff tears of the hip. Clin Orthop Relat Res. 1999;368:135-140

17. Lievense A, Bierma-Zeinstra S, Schouten B, et al. Prognosis of trochanteric pain in primary care. Br J Gen Pract. 2005;55:199–204. 

19. Snider RK, Trochanteric bursitis. In: Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:299- 303. 

20. Jennings F, Lambert E, Fredericson M. Rheumatic diseases presenting as sports-related injuries. Sports Med. 2008;38(11):917-930. 

21. Ho GW, Howard TM. Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction. Curr Sports Med Rep. Sep-Oct 2012;11(5):232-8. http://reference.medscape.com/... 

22. Douglas DD. Trochanteric Bursitis Clinical Presentation. Medscape, Referenced 12/21/13 23. 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. Sep 2001;44(9):2138-45. 

25. Stecco Antonio, Gilliar Wolfgang, Hill Robert, Brad Fullerton, Stecco Carla, The anatomical and functional relation between gluteus maximus and fascia lata Journal of Bodywork and Movement Therapies Volume 17, Issue 4 , Pages 512-517, October 2013 

27. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. Sep 2011;21(5):447-53. 

28. Bartlett MD, Wolf LS, Shurtleff DB, Stahell LT. Hip flexion contractures: a comparison of measurement methods. Arch Phys Med Rehabil. 1985;66(9):620-625. 

29. Gautam VK, Anand S. A new test for estimating iliotibial band contracture. J Bone Joint Surg Br. 1998;80(3):474-475. 

30. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 2005 Apr 15;71(8):1545-50. 

31. Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;23(11):1246, e1241-e1245. 

32. McMahon SE, Smith TO, Hing CB. A Systematic Review of Imaging Modalities in the Diagnosis of Greater Trochanteric Pain Syndrome. Musculoskeletal Care. Jul 4 2012; 33. Brooker AJ. The surgical approach to refractory trochanteric bursitis. Johns Hopkins Med J. 1979;145:98–100. 

34. Rowand M, Chambliss ML, Mackler L. Clinical inquiries: how should you treat trochanteric bursitis? J Fam Pract. 2009;58(9):494-500. review. Clin J Sport Med. Sep 2011;21(5):447-53. 

36. Hopper D, Deacon S, Das S, et al. Dynamic soft tissue mobilization increases hamstring flexibility in healthy male subjects. Br J Sports Med, 2005;39:594-598. 

37. Guler-Uysl F, Kozanoglu E. Comparison of the early response to two methods of rehabilitation for adhesive capsulitis. Swiss Med Wkly, 2004;134:363-368. 

38. Chang A, Hayes K, et al. Hip abduction moments and protection against medial tibiofemoral osteoarthritis progression. Arth Rheum, 2005;52:3515-3519.jj37. 

39. Davidson CJ, Ganion LR, Gehlsen G, et al. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Medicine & Science in Sports & Exercise 1997;29(3):313-319. 

40. Hammer WI. Graston technique, a necessary piece of the puzzle. Dynamic Chiropractic 2001;19(20) 

41. Fredericson M, Cookingham C, Chaudhari A, et al.. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med, 2000;10:169-175. 

42. Meardon SA, Campbell S, Derrick TR. Sports Biomech. 2012 Nov;11(4):464-72 Step width alters iliotibial band strain during running. 

43. Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;23(11):1246, e1241-e1245. 

44. Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med. May-Jun 2011;9(3):226-34. 4

5. Ferber R, Noehren B, Hamill J, et al. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther, 2010;40:52. 

46. Michaud T. The Real Cause of Iliotibial Band Syndrome Dynamic Chiropractic – November 18, 2012, Vol. 30, Issue 24 

47. Shbeeb MI, O'Duffy JD, Michet CJ, et al. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. Dec 1996;23(12):2104-6. 

48. Moreside JM, McGill SM. Improvements in hip flexibility do not transfer to mobility in functional movement patterns. J Strength Cond Res. 2013 Oct;27(10):2635-43. 

49. Lachiewicz PF (2011) Abductor tendon tears of the hip: evaluation and management. J Am Acad Orthop Surg 19: 385–391. 

50. Jeanneret L, Kurmann PT, van Linthoudt D (2008) [Rotator cuff tear of the hip]. Rev Med Suisse 14: 1226–1229. 

51. Kaltenborn A et al. The Hip Lag Sign - Prospective Blinded Trial of a New Clinical Sign to Predict Hip Abductor Damage. PLOS One March 12, 2014 https://doi.org/10.1371/journa... 

52. Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J (2004) MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). AJR Am J Roentgenol 182: 137–143. 

53. Connell DA, Bass C, Sykes CA, Young D, Edwards E. Sonographic evaluation of gluteus medius and minimus tendinopathy. Eur Radiol. 2003;13:1339-1347. 

54. Ali M, Oderuth E, Atchia I, Malviya A. The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review. J Hip Preserv Surg. 2018;5(3):209-219. Published 2018 Aug 30. doi:10.1093/jhps/hny027


Find us on the map

Office Hours

Our Regular Schedule


8:00 am-6:00 pm


7:00 am-5:00 pm


8:00 am-6:00 pm


7:00 am-5:00 pm


8:00 am-5:00 pm