What is GTPS? Greater Trochanteric Pain Syndrome Explained, Chronic Hip Pain & Why It Affects Women More
If you've had a persistent, deep ache on the outside of your hip that gets worse when you lie on that side at night, climb stairs or walk any distance, you may have been told it's trochanteric bursitis. Research over the last decade has largely moved away from that diagnosis. The more accurate name now is Greater Trochanteric Pain Syndrome, or GTPS.
It's one of the most common causes of lateral hip pain in adults over 50. It's frequently misdiagnosed, and it responds well to the right clinical approach. Here's what you need to know.
What is GTPS?
Greater Trochanteric Pain Syndrome describes persistent chronic pain over the outer side of the hip. It centres on the greater trochanter, the bony prominence at the top of the femur (thigh bone) that you can feel on the side of your hip.
For many years this pain was put down mainly to inflammation of the trochanteric bursa, a small fluid-filled sac that cushions the tendons around the greater trochanter. That's where the old name, trochanteric bursitis, came from. More recent research has shown that bursitis on its own, without the tendons being involved, is actually rare. In most cases GTPS involves tendinopathy: irritation or degeneration of the gluteus medius and gluteus minimus tendons where they attach to the greater trochanter.
This distinction matters clinically, because it changes how the condition should be treated.
Where do you feel it?
The pain of GTPS is typically felt:
On the outer side of the hip, over the greater trochanter
As a deep, sometimes burning ache that can be severe
Spreading down the outer thigh, sometimes as far as the knee
When lying on the affected side at night, which is often one of the most disruptive symptoms
When climbing stairs or hills, or getting up from sitting
When walking for long periods
When crossing your legs or standing with your weight on one hip
Tenderness when pressing directly on the greater trochanter is one of the most consistent clinical findings. Many clients tell me they've avoided lying on that side for months, or even years, before seeking help.
Is GTPS gender specific?
Yes, significantly so. GTPS is far more common in women than men, and research consistently shows a female-to-male ratio of around 4:1.
A large community study of adults aged 50 to 70 found GTPS in one hip in 15% of women, compared with 6.6% of men. GTPS in both hips was reported in 8.5% of women and just 1.9% of men.
So why are women so disproportionately affected?
Why women are more vulnerable to GTPS
There are two main reasons: biomechanical and hormonal.
Biomechanics: pelvic shape Women generally have a wider pelvis than men. This changes the angle of the femur and increases the leverage the body weight has on the outer hip, particularly when standing on one leg. The result is more compressive load on the gluteal tendons at the greater trochanter with every step.
Over time, especially if the gluteus medius isn't stabilising the pelvis well during single-leg loading, this extra load builds up as stress on the tendons, and tendinopathy develops.
Hormonal factors Tendons contain oestrogen receptors, and oestrogen helps maintain tendon strength, elasticity and repair. As oestrogen levels fall around perimenopause and menopause, tendons become more vulnerable to degenerative change and slower to recover from loading.
This is why GTPS most commonly appears in women over 50. Higher biomechanical loading combined with reduced hormonal protection creates the conditions for tendinopathy to develop.
The gluteus medius connection
The gluteus medius sits at the centre of the GTPS picture. Its tendon is one of the main ones attaching at the greater trochanter, and its dysfunction is a key driver of the condition.
When the gluteus medius isn't working effectively, through weakness, inhibition or altered movement patterns, it can't absorb its share of the load during walking, stair climbing and single-leg activities. That load passes to the tendon itself instead. Repeated overloading like this is how GTPS develops.
This is why addressing gluteus medius function is central to any effective treatment plan for GTPS. It's also why managing symptoms alone, without addressing the underlying cause, often gives only temporary relief.
What else increases your risk?
Beyond being female and over 50, recognised risk factors for GTPS include:
Higher body weight, which increases load on the outer hip tendons
Low back pain, which often coexists with GTPS and contributes to it through altered movement patterns
Knee pain and osteoarthritis, which change your gait in ways that load the outer hip
Iliotibial band tension, since the IT band runs directly over the greater trochanter and its tension compresses the tendons beneath
Prolonged sitting, particularly on hard surfaces or with your legs crossed
A sudden increase in activity, such as running, walking or exercise programmes that build up too quickly
Self-help Strategies
Clinical treatment gives the most meaningful and lasting results, but there are several things you can do to manage GTPS symptoms and avoid making them worse.
Change your positions and habits
Avoid crossing your legs when sitting
Don't stand with your weight shifted onto one hip
Sleep with a pillow between your knees to reduce compression on the outer hip
Avoid low or hard seats for long periods, and use a cushion where you can
Be cautious with stretching
This is important and often counterintuitive. Stretches that pull the leg across the midline of the body, such as drawing the knee across your chest or the standing IT band stretch, compress the tendons at the greater trochanter. They can significantly aggravate GTPS, so avoid them, especially during a flare.
Gentle loading is better than rest
Complete rest tends not to help tendinopathy. Gentle, pain-free gluteal work helps maintain tendon health without overloading it. A good starting point is a static hold, such as gently pressing the outside of the knee into a wall or against a resistance band, before progressing to controlled movements. Research supports this approach: a randomised controlled trial (LEAP) found that exercise programmes for GTPS gave better outcomes than corticosteroid injections or a wait-and-see approach. keele
Ice for acute pain
If symptoms are particularly acute, 10 minutes of ice on the outer hip can help manage the pain.
How clinical massage therapy helps GTPS
GTPS responds well to clinical soft tissue treatment, particularly when it addresses both the local tendon irritation and the underlying gluteus medius dysfunction. At Complete Balance, treatment typically involves the following.
Soft tissue release and myofascial work
Easing tension in the tensor fasciae latae, gluteus maximus and the surrounding hip and thigh tissues helps reduce the compressive load on the greater trochanter tendons. Myofascial release is particularly useful for the widespread fascial tightness that builds up around the outer hip over time.
Trigger point therapy
Active trigger points in the gluteus medius, gluteus minimus and piriformis are common in GTPS. They produce both local pain and referred pain that can extend well beyond the hip, and skilled trigger point work can significantly reduce this.
Gluteus medius rehabilitation
Addressing weakness and dysfunction in the gluteus medius is central to lasting improvement. I build movement guidance and specific activation work into treatment to support better tendon loading over time.
Assessment-led treatment
GTPS often coexists with low back pain, knee pain and IT band tension, so a thorough clinical assessment is essential. It helps me understand the full picture and make sure treatment addresses the real drivers rather than just the site of pain.
A note on diagnosis
GTPS is often misdiagnosed, most commonly as pain referred from the lower back or as a problem with the hip joint itself. It also frequently goes unrecognised alongside low back pain, where a sizeable proportion of patients have been found to have GTPS as well.
If you've been told your hip pain is coming from your back, or if investigations of the hip joint have come back clear, GTPS is worth considering. A clinical assessment that includes specific testing for greater trochanteric tenderness and gluteus medius function can help clarify the picture.
If you're concerned about your symptoms or haven't had a formal diagnosis, please consult your GP before seeking massage treatment.
Ready to address your hip pain in Worthing?
If you recognise your experience in the description above, clinical massage therapy at Complete Balance could be an effective part of your recovery.
Kim Noyce is a CNHC registered Clinical Massage Therapist in Worthing, with advanced training in soft tissue techniques, myofascial release and trigger point therapy. She has a particular interest in the relationship between gluteus medius dysfunction and lateral hip pain.
Book online at completebalance.co.uk, or get in touch to discuss whether treatment is right for you.
You don't have to keep managing hip pain alone.
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