Greater Trochanteric Pain Syndrome Treatment in Delhi.

Expert Greater Trochanteric Pain Syndrome Treatment in Delhi

What is Greater Trochanteric Pain Syndrome ?

Greater Trochanteric Pain Syndrome (GTPS) is a common condition characterized by pain on the outer side of the hip. It’s often referred to as lateral hip pain and was historically, and sometimes incorrectly, termed “trochanteric bursitis.” Current understanding points to gluteal tendinopathy (degeneration or injury of the gluteus medius and gluteus minimus tendons) as the primary cause in most cases, with bursal inflammation often being a secondary issue or even absent.

The greater trochanter is the prominent bony knob on the side of your upper thigh bone (femur). It serves as the attachment point for several important muscles of the hip and buttocks, including the gluteus medius and minimus, which are crucial for hip abduction (lifting the leg out to the side) and stabilizing the pelvis during walking and standing

Causes of Greater Trochanteric Pain Syndrome

GTPS develops when the tissues around the greater trochanter become irritated, degenerated, or overloaded. This often happens due to a combination of factors that put excessive stress or compression on the gluteal tendons.

Common causes and contributing factors include:-

Compressive Loading: This is a key mechanism. The gluteal tendons can be squashed or compressed against the greater trochanter by the iliotibial band (IT band) or by direct pressure. This occurs in positions such as:
- Side-lying: Especially sleeping on the affected side, or even on the unaffected side if the top hip drops, causing compression.
- Sitting with legs crossed.
- “Hip hanging” or “lazy standing”: Resting your weight on one hip, allowing the opposite hip to drop, which increases compression on the weight-bearing side.
- Excessive hip adduction: Movements where the leg crosses the midline, either actively or passively.
Overload or Underload:-
- Sudden increase in activity: Starting a new exercise regimen, increasing running mileage, or unaccustomed activities like hiking uphill/downhill.
- Repetitive activities: Long-distance running, walking, cycling, or stair climbing, especially with poor biomechanics.
- Underuse or Deconditioning: Weakness in the gluteal muscles (gluteus medius and minimus) can lead to the tendons being unable to tolerate even normal daily loads.
Muscle Weakness and Imbalance: Imbalances between stronger hip flexors/adductors and weaker hip abductors (gluteus medius/minimus) can alter hip mechanics and increase stress on the gluteal tendons.
Biomechanical Factors:-
- Pelvic Instability: Poor control of the pelvis during movement.
- Gait Abnormalities: Altered walking or running patterns.
- Leg Length Discrepancy.
- Foot Overpronation (flat feet): Can affect the alignment up the kinetic chain to the hip.
Direct Trauma: A fall directly onto the side of the hip.
Age and Gender: Most prevalent in middle-aged and older women (40-60 years), likely due to wider pelvic anatomy and hormonal factors (e.g., menopause affecting collagen integrity).
Associated Conditions: Obesity, osteoarthritis of the hip or knee, low back pain, and certain medical conditions like diabetes.

Symptoms of Greater Trochanteric Pain Syndrome

The primary symptom of GTPS is pain located on the outer side of the hip, directly over the greater trochanter.

Common symptoms include:-

Lateral Hip Pain: A deep, aching, or burning pain on the outer aspect of the hip, precisely localized to the bony prominence.
Radiating Pain: The pain often radiates down the outside of the thigh, sometimes as far as the knee, and occasionally into the buttock or groin.
Pain with Side-Lying: A classic symptom, especially when sleeping on the affected side. Even lying on the unaffected side can cause pain if the painful hip adducts (drops towards the bed) and creates compression.
Pain with Weight-Bearing Activities: Worsens with activities that load the gluteal tendons:
- Walking (especially long distances, uphill, or downhill)
- Running
- Climbing stairs or inclines
- Standing for prolonged periods
- Standing on one leg (e.g., getting dressed)
Pain with Sitting: Prolonged sitting, or sitting with legs crossed, can aggravate symptoms. Pain is often worse when rising from a seated position.
Tenderness to Touch: Significant tenderness when direct pressure is applied to the greater trochanter.
Weakness: Subtle weakness in hip abduction (moving the leg out to the side) may be present.
Stiffness: Especially in the morning or after periods of inactivity.
Clicking or Snapping: In some cases, if the IT band is very tight and snaps over the trochanter (external snapping hip syndrome), it can contribute to the pain.

Advanced Physiotherapy for Greater Trochanteric Pain Syndrome

Understanding Tendinopathy: Educating the patient that the pain is typically from a “cranky” or “degenerated” tendon, not just acute inflammation, helps manage expectations and adherence.
Identifying and Avoiding Compressive Loads:
- Sleeping: Avoid sleeping directly on the painful hip. Suggest sleeping on the back with a pillow under the knees, or on the unaffected side with a pillow between the knees to keep the hips aligned and prevent adduction of the top hip.
- Sitting: Avoid crossing legs. Use a softer cushion on hard chairs. Avoid very low chairs.
- Standing Posture: Avoid “hip hanging” (resting weight heavily on one hip). Stand with weight evenly distributed or consciously engaging the glutes.
- Activity Modification: Temporarily reducing aggravating activities (e.g., long walks, running, stairs) and gradually reintroducing them.
Progressive Tendon Loading (Strengthening): This is the core of rehabilitation, aiming to increase the tendon’s capacity to tolerate stress. Exercises are chosen based on the pain level and progressed carefully.
Phase 1: Isometric Exercises (Pain Relief & Initial Muscle Activation):
- Purpose: To reduce pain and activate gluteal muscles without significant tendon movement or compression.
- Examples:
  - Side-lying isometric hip abduction: Lying on the unaffected side, top leg slightly bent, press the knee into a pillow or a therapist’s hand for 30-45 seconds, 3-5 repetitions.
  - Standing isometric hip abduction: Stand next to a wall, press the outer thigh into the wall for 30-45 seconds.
Phase 2: Isotonic Strengthening (Building Strength and Endurance):
- Purpose: To gradually increase the strength and endurance of the gluteus medius and minimus, and other hip extensors. Focus on controlled, slow movements.
- Examples:
  - Clamshells: Start without resistance, progress to resistance bands (focus on form, avoiding hip rotation).
  - Side-lying leg lifts: Ensure controlled movement, avoid hiking the hip.
  - Glute bridges (double and single leg): Focus on glute activation, not lower back or hamstrings.
  - Standing hip abduction: With or without resistance bands, focusing on minimal trunk sway.
  - Hip hikes/drops: Standing on one leg, letting the opposite hip drop, then lifting it up (emphasizes glute med control).
  - Squats and Lunges: Progress from double-leg to single-leg, emphasizing proper knee alignment (avoiding knee collapse inwards) and glute activation.
  - Step-ups/Step-downs: Controlled movements to build single-leg strength.
Phase 3: Energy Storage/Release & Functional Integration:
- Purpose: To prepare the tendon for higher-impact activities by training its elastic energy storage and release capabilities.
- Examples: Hopping, jumping drills, plyometrics, agility drills, running drills (if applicable). This phase is highly specific to the patient’s goals (e.g., returning to sport).

Advanced Physiotherapy Techniques

Manual Therapy
- Soft Tissue Mobilization/Myofascial Release: To address tightness and restrictions in the surrounding muscles (e.g., TFL, IT band, hip flexors, hamstrings, quadratus lumborum) that might be contributing to altered hip mechanics or compensatory patterns. This can help improve flexibility and reduce compressive forces.
- Dry Needling: Can be very effective for releasing deep, persistent trigger points within the gluteus medius, minimus, or piriformis muscles. This reduces muscle spasm, alleviates pain, and can improve muscle function, allowing for better engagement in strengthening exercises.
- Joint Mobilizations: To address any stiffness or restrictions in the hip joint capsule, sacroiliac joint, or lumbar spine that could influence hip mechanics and exacerbate tendon load.
Biomechanics and Movement Retraining:
- Gait Analysis and Retraining: Detailed assessment of walking and running patterns to identify and correct faulty mechanics (e.g., excessive hip adduction, “Trendelenburg gait” or hip drop during stance phase). Training often involves verbal cues, visual feedback (mirror), and tactile cues to promote better hip and pelvic control.
- Postural Correction: Active training and education on maintaining optimal standing and sitting postures to reduce chronic compressive loads on the gluteal tendons.
- Neuromuscular Control Exercises: Focusing on precise activation and coordination of the gluteal muscles during functional movements. This can involve exercises that challenge balance and stability, often progressing from stable to unstable surfaces.
Kinesiology Taping
- Mechanism: Can provide sensory feedback, reduce swelling, or offer gentle support. It can help de-load the tendon by lifting the skin, potentially reducing compression, or facilitate gluteal muscle activation during movement.
- Application: Taping techniques can be applied over the greater trochanter or along the gluteal muscles to provide proprioceptive input.
Extracorporeal Shockwave Therapy (ESWT)
- Mechanism: Involves delivering high-energy acoustic waves to the affected tendon. This is thought to stimulate cellular regeneration, promote collagen remodeling, break down calcifications (if present), and reduce pain by affecting nerve endings.

BOOK AN APPOINTMENT

Working Hours

Mon - Sat: 9:00AM to 8:30PM
Sunday: 9:30AM to 7:30PM

Call Us

+91 8090080906
+91 8090080907
+91 8866991000