Greater Trochanteric Pain Syndrome Explained

Greater trochanteric pain syndrome is pain over the bony point on the outer hip, where the gluteal tendons attach to the femur. It was once labeled trochanteric bursitis, but imaging showed the tendons rather than the bursa carry most of the problem, and the name changed to reflect that. It is most common in women between forty and sixty.

Compression is the characteristic aggravator, which is why lying on the affected side at night is typically the worst part, and why crossing the legs or standing with the weight on that hip provokes it. Sleeping on the other side with a pillow between the knees prevents the upper leg dropping across and compressing the tendon for hours. Gluteal strengthening follows once the area has settled.

Key Takeaways

  • A tendon problem more than a bursa problem: in most cases the gluteus medius and minimus tendons are the main source of pain, with the bursa involved secondarily if at all.
  • Compression keeps it irritated: side-lying, crossed legs, low chairs and hanging on one hip all press the tendon against the bone.
  • Education and exercise have the best trial results: in a randomized trial they gave more people global improvement than a steroid injection at both 8 weeks and one year.

This guide to greater trochanteric pain syndrome, and why it is usually not bursitis, is published by Chiropractic Specialty Center, Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000

What Greater Trochanteric Pain Syndrome Is

The greater trochanter is the bony prominence on the outer side of the upper thigh bone (femur). The gluteus medius and gluteus minimus tendons attach to it, and several bursae lie nearby. Greater trochanteric pain syndrome (GTPS) is the umbrella term for pain in this area, most often from gluteal tendinopathy, sometimes with an irritated bursa. The older name, trochanteric bursitis, is still widely used.

GTPS is common, particularly in women in mid-life, and it is more frequent in people who also have lower back pain or knee osteoarthritis. It usually develops gradually and can persist for months without the right changes.

Arranging an Outer Hip Assessment at CSC

To arrange an assessment of outer hip pain, see the Bukit Damansara contact page and the Bandar Sri Damansara contact page, or call either center directly:

Symptoms of Greater Trochanteric Pain Syndrome

  • Pain and tenderness on the point of the outer hip, sometimes spreading down the outside of the thigh toward the knee.
  • Pain lying on the affected side at night, and often also lying on the other side if the top leg drops across.
  • Pain with stairs, walking uphill, standing on one leg, or getting up from a low chair.
  • Pain after sitting with the legs crossed or standing with the weight on one hip.

Outer hip pain can also come from the hip joint itself, or be referred from the lower back. Pain that travels below the knee with numbness or tingling points more toward a nerve from the spine, for example with spinal disc problems, than toward the tendon.

Why It Is Usually Not Bursitis

Imaging and surgical studies have shifted the understanding of this condition. In most cases the primary problem is a tendinopathy of the gluteus medius and minimus tendons, with the bursa involved secondarily if at all (Grimaldi et al., 2015).

That distinction matters. A bursitis framing points toward rest and an anti-inflammatory injection. A tendinopathy framing points toward removing compression and progressively loading the tendon, which is what the trial described below tested.

Can the Lower Back Be Involved?

Yes. Lower back problems and GTPS often occur together, and pain referred from the spine can feel similar to outer hip pain. The assessment therefore checks the lower back, the hip joint and the nerves as well as the tendons on the outer hip, so that care is directed at the right source. If the main driver is in the back, treating only the hip is unlikely to settle it.

The Positions That Keep It Irritated

The gluteal tendons are compressed against the greater trochanter whenever the hip is brought across the midline, so the aggravating positions are ordinary ones:

  • Sleeping on the painful side, or on the good side with the top leg falling forward across the body. A pillow between the knees keeps the top leg in line.
  • Sitting with the legs crossed, or in low, deep chairs where the knees sit above the hips.
  • Standing with the weight slumped onto one hip.
  • Stretching the outside of the hip by pulling the knee across the body, which feels as if it should help but compresses the tendon further.

Removing these positions is often what allows exercise to start working. A program of exercises alone, with no attention to how you sit, sleep and stand, tends to stall (Cook and Purdam, 2012).

What the Trial Evidence Says

In a randomized trial, people with gluteal tendinopathy were assigned to education plus exercise, a corticosteroid injection, or a wait-and-see approach. At eight weeks, about 77% reported global improvement with education plus exercise, 58% with the injection and 29% with wait and see. At 52 weeks the figures were about 78%, 57% and 52% (Mellor et al., 2018).

Three things follow. Education and exercise did better than the injection at both time points. The injection did better than waiting in the short term, so it is not useless. And about half of those who simply waited had improved by a year, which shows the condition often improves with time, but more quickly and reliably with loading and advice.

How Greater Trochanteric Pain Syndrome Is Managed at CSC

Our chiropractors and physiotherapists start by confirming which tissue is involved and what is loading it, including the lower back and the hip joint. A typical plan includes:

  • Education on the compressive positions above and practical changes to sleep, sitting and standing.
  • A graded exercise program for the gluteal muscles and tendons, progressed as symptoms allow.
  • Non-rotatory chiropractic care for the lower back and pelvis where the examination points there.
  • Other methods, such as shockwave therapy, considered case by case as an addition to exercise, not a replacement for it.

Progress is measured by function, such as stair tolerance, walking distance and sleep, rather than by pain on the day.

Conservative Care and Steroid Injections

A structured conservative program is the usual first-line approach for outer hip pain. A steroid injection can reduce pain in the short term, and in the trial above it helped more than waiting at eight weeks, but it did not change the loading behind the problem, and education plus exercise gave more people lasting improvement. Injections and surgery are therefore kept as a last resort, considered when a properly conducted exercise-based program has not helped (Del Buono et al., 2012; Pianka et al., 2021).

Still have questions? You may find our pages on hip, knee, ankle and foot problems, Achilles heel pain, and a sprained hip helpful too. And for the bigger picture, our back pain guide brings our lower back, pelvis and leg topics together in one place.

For planning, the chiropractic price list in Kuala Lumpur and physiotherapy fees in Kuala Lumpur pages set out what each visit costs.

Peer-Reviewed References

  • Mellor R, Bennell K, Grimaldi A, et al. 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.
  • Grimaldi A, Mellor R, Hodges P, et al. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Med. 2015;45(8):1107-1119.
  • Del Buono A, Papalia R, Vulpiani MC, Denaro V, Maffulli N. Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull. 2012;102:115-131.
  • Fearon AM, Scarvell JM, Neeman T, et al. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med. 2013;47(10):649-653.
  • Cook JL, Purdam CR. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163-168.
  • Pianka MA, Serino J, DeFroda SF, Bodendorfer BM. Greater trochanteric pain syndrome: evaluation and management of a wide spectrum of pathology. SAGE Open Med. 2021;9:20503121211022582.

These sources describe greater trochanteric pain syndrome in general; none of them evaluates care at Chiropractic Specialty Center.

The Author of Greater Trochanteric Pain Syndrome: Outer Hip Pain

Greater Trochanteric Pain Syndrome: Outer Hip Pain was written by Yama Zafer, D.C., who has 30+ years in chiropractic and physiotherapy and founded Chiropractic Specialty Center in Kuala Lumpur in 2006.

Last Updated: Greater Trochanteric Pain Syndrome Explained

Greater Trochanteric Pain Syndrome Explained was last reviewed and updated on September 25, 2026.