Greater Trochanteric Pain Syndrome (GTPS)

Uncategorized

25 Apr

Written By

Your healthcare professional has diagnosed you with lateral hip pain also known as greater trochanteric pain syndrome (GTPS). What now? This information page, along with research proven exercises, is designed to help you in addition to the advice given by your healthcare professional. We will guide you through each step on your return to activities of daily living or any sporting goals you may have.

What is GTPS

https://youtu.be/eSc2IzZWeiE

Mr Ibrahim Malek FRCS (Orthopaedic Consultant).

GTPS is a painful condition affecting the outer hip and thigh region. This usually occurs when the soft tissues that lie over the bony prominence (greater trochanter) at the top of the thigh bone become irritated and sore. These can include muscles, tendons or the bursae (small fluid filled sacs that allow smooth movement between muscle and bone). Sometimes it may travel down as far as the outside of the knee.

This irritation can occur for numerous reasons, however it is most commonly due to OVERLOAD, where the structures around the greater trochanter are unable to tolerate the strain applied to them.

What are the symptoms of GTPS.

These can vary from person to person depending on the initial factors that are causing the condition. You may experience

Pain at the outer hip and thigh area. This may feel like a burning or aching pain.
The pain may be more intense when lying on your side, especially at night.
Pain increases with exercises and you may walk with a limp.

What Causes GTPS ?

Although the exact causes of GTPS are not fully understood, it is most common in middle aged females. There are many factors that can contribute to it including:

Direct fall or impact to the outside edge of the hip.
Weakness of the muscles surrounding the hip, especially the Gluteus medius muscle, which is on the outside of the hip.
OVERLOAD or excessive loading through the hip without adequate recovery. For example prolonged walking and running. (Poor running style can also lead to increased load on this area of the hip.)
Being overweight.
Certain postural habits: for example, standing on one leg for long periods of time, crossing legs when sitting, or lying on affected side for long periods.

How is GTPS Managed?

Research shows that a graded exercise program is the best management plan for patients with GTPS. Through appropriate exercises, we aim to ‘optimally load’ the affected area, which will reduce pain and improve your general function. Exercise needs to be challenging, approximately 7 – 8 out of 10 on a scale of perceived exertion, to achieve the optimal expected muscle adaptations. Whilst the exercises should be challenging, there may be a slight increased ache but this should not exceed 5/10 on a pain score. You may need to reduce some of your aggravating activities such as running or walking. However, you can still exercise using a bike, swimming or by doing gentle lower limb strengthening activities, as this will put less strain on the affected area whilst remaining healthy, which is in definition optimal load.

https://www.youtube.com/watch?v=pl0XrDgDm-k&feature=youtu.be

Jack Challoner (Clinical specialist Physiotherapist).

The Impact of Diet

One other feature of GTPS is that if you are overweight your pain is generally worse. In fact, evidence shows that weight loss through exercise and a healthy balanced diet may reduce your pain and improve your general lifestyle. Losing weight also helps improve your mood, reduces inflammation in the body, can lead to improved sleep and reduces the risk of other diseases, such as a heart conditions.

https://www.youtube.com/watch?v=30dfc2KLkgM&feature=youtu.be

Kate Harrod Wild (Specialist Dietician).

Avoid activities that provoke pain during or after the activity. Often ceasing the most provocative parts of an activity will allow continuation of modified activity.

Standing posture- stand on both legs, legs slightly apart, perch on stool or lean on wall. Avoid standing with hips swayed forwards or standing on one leg.

Walking- think tall. Reduce speed and distance, walk with shorter strides with feet a little wider and avoid hills until pain settles.

Stairs: place feet a little wider so they are hip width apart. Use rail on opposite side if possible to share the load.

Sitting posture: Do Not cross your legs, Do Not sit with knees together (place a cushion between knees), Do Not side sitting, Avoid low seats, use a wedge cushion so hips are higher than knees.

Sleeping posture: Use a soft mattress overlay or lie ¼ turned. If lying on the opposite side- use two pillows in one pillow case to keep hip and knee horizontal.

Persisting main management

It is important with conditions like GTPS that we are aware of practical approaches which can help us in their management and treatment. Obviously, in this case the exercise is the main tool and gradually being able to increase the amount or resistance (load) has positive effects on what we are able to do and the amounts of pain we feel.

As individuals, we are all different, and we are also aware that we can sometimes fall into habits or patterns due to the pain that may not always be useful to our recovery. It is useful to investigate for these patterns. During the course we will look at practices to recognise these patterns and also what we can do about them. We call this pacing. We also advise to plan for Flare ups. These are events when symptoms increase temporally, but can sometimes put a halt to progress. Flare ups are normal and are expected, and if we plan for these, it should limit their impact. When we have symptoms like GTPS they can last for a length of time, due to this it can be difficult to plan for the future or to work out what we could or should be able to do. We may have put things on hold or avoided certain activities. It is important that we try to restart the things that we enjoy. We will look at setting goals whilst attending the course and also look at maintaining these through our Long term plan.

https://www.youtube.com/watch?v=VqQ3KSMcX6w&feature=youtu.be

Grevin Jones (Clinical specialist physiotherapist in pain management).

How Long Does it Take to get better?

Everyone will improve differently, but for most people it will take between 6 and 9 months of focused rehabilitation to make a return to full normal activities without pain. It is normal to have periods of increased pain or flare ups during this time. If this happens, you will need to optimally load your exercises until the pain returns to previous levels.

If symptoms don’t improve within six to nine months, even when you have been completing your exercise program, other treatment options such as extra corporeal shockwave or corticosteroid injection, may be considered. These may not be suitable for all patients and should be discussed with a medical professional as appropriate.

The Exercises

Research shows that a graded exercise program is the best management plan for patients with GTPS. A Nationwide study, called the LEAP trial, in 2018 found that patients responded the greatest to exercise, advice and education with confirmed GTPS. This highlights the importance of gradually increasing your exercise as guided by your symptoms and/or your physiotherapist. The three phase exercise plan is available below starting with level one. Please watch the videos and follow the table for each level. We would recommend doing each level for 4 - 6 weeks. If the exercises are easy and are not causing pain, this is usually a clear sign to progress, however, not all rehabilitation pathways are without setback, so don't worry if you have to go back a level to make progress. If you have any questions or not sure when to progress, have a chat with your physiotherapist about some guidance.

Participating in an exercise program carries a certain element of risk for some people. You should consult with your physiotherapist before initiating this program to ensure your safety.

Level 1.

Exercise	Duration	Repetitions	Sets	Frequency
Supine Gluteal activation +/- band	Hold 5 seconds	5	3	2 x a day
Standing Gluteal activation +/- band	Hold 5 seconds	5	3	2 x a day
Bridge (Crush a nut)	Hold 5 seconds	5 – 10	3	2 x a day
Sit to Stand	Up quick, down slow	8 - 12	3	2 x a day
Side stepping	1 – 2 minutes		3	2 x a day

1. Hip abduction (supine)

https://www.youtube.com/shorts/LEbCJsfm3M0

2. Repeat the same exercise but in standing

https://www.youtube.com/shorts/wJvLbgCuQS4

3. Bridge

https://www.youtube.com/shorts/27_rHVPzGKI

4. Sit to stand

https://www.youtube.com/shorts/E3t-7Vgr6e0

5. side stepping

https://www.youtube.com/shorts/U4ZcTGIylf0

Level 2.

Exercise	Duration	Repetitions	Sets	Frequency
Staggered Bridge	Hold 5 seconds	5 - 10	3	1 - 2 x a day
Staggered Sit to Stand	Up quick, down slow	8 – 12	3	1 - 2 x a day
Step up	Up quick, down slow	8 – 12	3	1 - 2 x a day
Crab walk	10 -15 steps		3	1 - 2 x a day
Hip abduction with band	Hold 5 – 10 seconds	5	3	1 - 2 x a day

1. Staggered Bridge

https://www.youtube.com/shorts/j8NlGfM6WtQ

2. Staggered sit to stand

https://www.youtube.com/shorts/AeS5fV1dLbc

3. Step up

https://www.youtube.com/shorts/lpmIviZ3vog

4. Crab walk

https://www.youtube.com/shorts/m8pg1G2Afd8

5. Hip abduction with band

https://www.youtube.com/shorts/LjB3ffFrMBk

Level 3.

Exercise	Duration	Repetitions	Sets	Frequency
Single leg bridge	Hold 3 – 5 seconds	8 - 12	3	3 – 5 x a week
High step up	Up quick, down slow	8 - 12	3	3 – 5 x a week
Lunges		8 - 12	3	3 – 5 x a week
Side plank clam	Hold 5 – 10 seconds	5 - 10	3	3 – 5 x a week
Kettle Bell Romanian Deadlift (RDL)	Up quick, down slow	8 - 12	3	3 – 5 x a week

1. Single leg Bridge

https://www.youtube.com/shorts/OhUgGi5pkuI

2. High step up

https://www.youtube.com/shorts/Q5jz2XSeyUg

3. Lunges

https://www.youtube.com/shorts/I9--ETqLgRE

4. Side plank clam

https://www.youtube.com/shorts/3CeqnU9ZBAo

5. Kettle bell RDL

https://www.youtube.com/shorts/0m6Z7cIu-iw

physio logos