A note on this column: This article is general medical information, not a description of a service offered at this practice. Dr. Ishiguro's surgical practice is focused on hip and knee joint replacement, ligament reconstruction, and cartilage repair procedures — he does not treat greater trochanteric pain syndrome or repair hip abductor tendons. This column is written to help readers understand a common cause of outer-hip pain and know when and how to seek the right specialist, typically a sports medicine physician, a physiotherapist, or an orthopaedic surgeon with a hip focus.
Key points
- "GTPS" is a description, not a single diagnosis — it means pain over the greater trochanter (the bony point on the outer hip)
- The most common underlying problem is tendon-related — usually the gluteus medius and minimus tendons, rather than an inflamed bursa on its own
- Diagnosis is clinical — imaging helps exclude other causes and assess tendon tears but does not always match symptoms
- Education plus exercise is the best-supported first-line treatment — including avoiding tendon-compressing positions
- Injections may give short-term relief — but a randomised trial found education plus exercise did better at one year
- Surgery is uncommon — considered mainly for significant tendon tears that do not respond to conservative care
What greater trochanteric pain syndrome is
Greater trochanteric pain syndrome (GTPS) describes persistent pain and tenderness over the greater trochanter, the bony prominence on the outer side of the upper thigh where the hip abductor muscles attach. The pain is typically felt on the outside of the hip and may spread down the outer thigh. It is often worse when lying on the affected side, when standing on one leg, walking, climbing stairs, or getting up from a chair after sitting.
The older label "trochanteric bursitis" implied that an inflamed fluid-filled sac (bursa) was the cause. Imaging and surgical studies have since shown that the bursa is rarely the sole problem. The more common finding is tendinopathy — degeneration or partial tearing — of the gluteus medius and gluteus minimus tendons, which work like a "rotator cuff of the hip." Bursal changes often appear alongside tendon changes, and the term gluteal tendinopathy is now widely used for this pattern.
Who gets it
Gluteal tendon problems are more common in women, and frequency rises with age. Lateral hip pain is particularly frequent in women between roughly 40 and 60 years old, and it can disturb sleep and daily activity for a long time.
What the evidence shows: A review of hip abductor lesions in EFORT Open Reviews reports that abductor tendon lesions and insertional tendinopathy are among the most common causes of lateral thigh pain, that gluteal tendon pathology is more prevalent in women, and that its frequency increases with age (Kenanidis et al., 2020). In a study of 500 consecutive unselected patients who had pelvic MRI, peritrochanteric lesions were seen in about 31% of patients (22% of hips), showing how common these findings are (Oehler et al., Archives of Orthopaedic and Trauma Surgery, 2019).
Why it develops
Like other tendinopathies, GTPS is thought to reflect a mismatch between the load placed on a tendon and its capacity to tolerate it. A particular feature of the hip is compression: the gluteal tendons are pressed against the greater trochanter when the hip is pulled across the body's midline (adduction). Everyday habits can do this repeatedly — sleeping on the painful side with the top leg falling forward, sitting with legs crossed, standing with weight hanging on one hip, or walking with a narrow step width.
Factors commonly associated with lateral hip pain
- Female sex and age over 40 — hormonal and tendon-quality changes are suspected, though the reasons are not fully established
- Hip abductor weakness — women with GTPS have been reported to have lower strength across hip muscle groups than those without symptoms
- Sudden increases in walking, running, or stair use — a rapid rise in tendon load
- Repeated hip adduction postures — crossing legs, side-lying, hip-hanging stance
- Coexisting lumbar spine or hip joint problems — these can contribute to or mimic lateral hip pain
How the diagnosis is made
GTPS is diagnosed mainly from the story and examination. Typical features are pain on the outer hip for weeks to months, tenderness when pressing directly over the greater trochanter, and pain reproduced by standing on the affected leg. A 30-second single-leg stance that provokes pain is a commonly used bedside test. The examiner will also check the lumbar spine and the hip joint itself, because pain from a pinched nerve in the back or from hip osteoarthritis can be felt on the outer thigh.
X-rays are often taken to look at the hip joint and bone. MRI or ultrasound can show tendinopathy or tears of the gluteal tendons and bursal fluid, and MRI is generally considered the most informative test for a suspected abductor tear. However, imaging has limits.
What the evidence shows: In a small comparison of women aged over 45, MRI findings such as tendinopathy, bursitis and enthesitis did not clearly differ between women with GTPS and those without it, although a gluteus medius tendon tear was more common in the GTPS group; muscle strength and endurance of the hip and trunk were what clearly distinguished the groups (Miyasaki et al., International Journal of Rheumatic Diseases, 2021). In another series, 73% of patients who had surgery for a gluteus medius tear had an MRI-confirmed tear in the opposite, symptom-free hip, and about 37% of those developed symptoms within two years (Arvesen et al., American Journal of Sports Medicine, 2022). These findings show that an MRI abnormality alone does not always explain pain, so results need to be interpreted alongside the examination.
| Condition | Typical pain location | Key distinguishing feature |
|---|---|---|
| Gluteal tendinopathy (GTPS) | Outer hip, over the trochanter | Tender over trochanter; worse lying on side, single-leg stance, stairs |
| Hip joint osteoarthritis | Groin, sometimes thigh or buttock | Reduced hip rotation; X-ray joint space narrowing |
| Lumbar radiculopathy | Back, buttock, leg | Nerve-type pain; may have numbness or weakness; back movement provokes it |
| Iliotibial band / snapping hip | Outer hip or thigh | Visible or palpable snapping with movement |
| Femoral neck stress fracture | Groin or deep hip | Pain with weight bearing; history of increased load or low bone density |
What the evidence says about treatment
Most people improve without surgery. The main options studied are education combined with exercise, corticosteroid injection, and other approaches such as shockwave therapy and platelet-rich plasma.
What the evidence shows: A randomised trial in Australia enrolled 204 adults aged 35–70 with more than three months of lateral hip pain and gluteal tendinopathy confirmed clinically and on MRI. Participants received a physiotherapist-led education and exercise programme (14 sessions over eight weeks), a single corticosteroid injection, or a "wait and see" approach. At eight weeks, 51 of 66 in the education-and-exercise group, 38 of 65 in the injection group, and 20 of 68 in the wait-and-see group reported global improvement, and pain was lowest in the exercise group. At 52 weeks, education plus exercise still gave better global improvement than injection, while pain scores no longer differed between those two groups; both were better than wait-and-see (Mellor et al., BMJ, 2018).
What the evidence shows: A 2025 systematic review restricted to higher-quality randomised trials concluded that exercise and education has moderate-strength evidence of a medium effect on pain and function in the short term, with smaller effects in the medium and long term, and can be cautiously recommended as the core approach. Corticosteroid injection showed a small short-term effect on pain. The review noted that trials were few and different from one another, and that evidence for shockwave therapy and platelet-rich plasma is promising but needs confirmation in definitive trials (Bremer et al., Clinical Rehabilitation, 2025). An earlier review of shockwave therapy across several lower-limb tendon conditions likewise described the GTPS evidence as low-level and mixed (Korakakis et al., British Journal of Sports Medicine, 2018).
Commonly recommended treatment components
- Education on load management — reducing tendon compression: avoid crossing legs, avoid hip-hanging stance, use a pillow between the knees when side-lying, and keep walking and stair loads sensible
- Progressive hip abductor strengthening — gradual, supervised where possible, typically over 8–12 weeks or longer
- Avoiding aggressive stretching over the trochanter — stretching that pulls the leg across the body can compress the tendons
- Simple pain relief — short-term use of analgesics as advised by a doctor; painkillers do not address tendon capacity
- Injection or other procedures — corticosteroid injection may help short-term pain; other options are less well established and are discussed case by case
When surgery is considered
Surgery is uncommon. It is generally reserved for people with a significant partial or complete gluteal tendon tear who have not improved after a proper trial of conservative care. Options range from tendon repair (open or arthroscopic) to more complex reconstructions for long-standing, irreparable tears. Outcome evidence for these operations is limited, and the condition of the muscle (for example, fatty infiltration seen on MRI) influences what can be achieved (Kenanidis et al., 2020).
When to see a specialist
Mild outer-hip pain can reasonably begin with the position changes and gentle strengthening described above. It is worth being assessed if pain has lasted more than a few weeks, if it disturbs sleep, if walking is limited, if the leg feels weak or gives way, or if the pain followed a fall or is felt deep in the groin, which suggests a different cause. Pain with a fever, unexplained weight loss, or a history of cancer or steroid use also needs prompt evaluation. A sports medicine physician, physiotherapist, or orthopaedic surgeon can confirm the diagnosis and rule out hip joint or spine problems.
References (PubMed)
Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. DOI: 10.1136/bmj.k1662
Bremer T, Nicklen P, Fearon A, Morrissey D. The efficacy of gluteal tendinopathy treatments: A systematic review. Clin Rehabil. 2025;39(5):600-617. DOI: 10.1177/02692155251327298
Kenanidis E, Kyriakopoulos G, Kaila R, Christofilopoulos P. Lesions of the abductors in the hip. EFORT Open Rev. 2020;5(8):464-476. DOI: 10.1302/2058-5241.5.190094
Oehler N, Ruby JK, Strahl A, Maas R, Ruether W, Niemeier A. Hip abductor tendon pathology visualized by 1.5 versus 3.0 Tesla MRIs. Arch Orthop Trauma Surg. 2020;140(2):145-153. DOI: 10.1007/s00402-019-03228-1
Miyasaki MR, Marcioli MAR, da Cunha APRR, Polesello GC, Marini MG, Fernandes KBP, Macedo CSG. Greater trochanteric pain syndrome in women: Analysis of magnetic resonance, sagittal alignment, muscular strength and endurance of the hip and trunk. Int J Rheum Dis. 2021;24(7):941-947. DOI: 10.1111/1756-185X.14149
Arvesen J, McCallum J, Pill SG, Cannady H, Adams KJ, Jackson I, Wienke JR, Folk J. Prevalence of Contralateral Hip Abductor Tears and Factors Associated With Symptomatic Progression. Am J Sports Med. 2022;50(6):1603-1608. DOI: 10.1177/03635465221083671
Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med. 2018;52(6):387-407. DOI: 10.1136/bjsports-2016-097347