Greater Trochanteric Pain Syndrome (GTPS): When Physiotherapy Alone Isn’t Enough
Lateral hip pain, often diagnosed as Greater Trochanteric Pain Syndrome (GTPS), is a common condition that affects both active individuals and those with more sedentary lifestyles. Symptoms often include pain on the outside of the hip, discomfort when lying on the affected side, and pain when standing on one leg or climbing stairs.
While physiotherapy and load management are the first line of treatment, some patients continue to experience persistent pain that limits their daily life. In these cases, injection therapy may be an appropriate next step.
What is GTPS?
GTPS refers to pain arising from the structures around the greater trochanter of the femur. It is often linked with gluteal tendinopathy, bursitis, or irritation of surrounding soft tissue.
Key clinical signs include:
- Pain is felt when touching the outside of the hip.
- Pain with resisted hip abduction
- Pain when standing on one leg for 30 seconds
- Reproducible pain during functional testing
NICE Guidelines for GTPS
The National Institute for Health and Care Excellence (NICE) recommends:
“If initial conservative treatment does not provide adequate symptom relief, a peri-trochanteric corticosteroid injection and referral to physiotherapy should be offered.”
This means that when patients fail to improve with exercise therapy alone, corticosteroid injection therapy (CSI) can be considered to reduce pain and facilitate rehabilitation.
Evidence from Research
- Corticosteroid Injections (CSI): Provide effective short-term relief (up to 3 months), but benefits often reduce over time.
- Exercise Therapy: Strong evidence supports progressive strengthening and load management as the most effective long-term strategy.
- Shockwave Therapy & PRP: Some studies suggest benefit, but evidence remains mixed.
- The LEAP Trial (204 participants): Found exercise and load management produced better outcomes than CSI in both short- and long-term follow-up.
The consensus: injections can help open a window for rehab, but they should not be used in isolation.
Case Study: Ms X
- Presentation: Persistent right lateral hip pain, unresponsive to physiotherapy and previous pain management.
- Assessment: Confirmed GTPS diagnosis through palpation, resisted tests, and single-leg stance pain.
- Decision-Making: Following a shared discussion of the risks and benefits, Ms X opted for a corticosteroid injection.
- Outcome: 6 weeks post-injection, she reported 80% improvement, pain reduced to 1/10, and no longer experienced night pain.
- Rehab Plan: Continued physiotherapy with progressive gluteal strengthening and load management.
Practical Takeaways for Patients
Corticosteroid injections can provide valuable short-term pain relief
The real long-term gains come from exercise therapy and education
Injections are best used to create a rehab “window” so strengthening can be performed more effectively
Addressing psychosocial factors (such as fear of movement) is vital for recovery
Conclusion
GTPS can be stubborn and frustrating, but effective management options are available. Physiotherapy remains the gold standard for long-term recovery, while injections may be considered when conservative treatment alone isn’t enough. Importantly, treatment decisions should always be made collaboratively, based on patient goals, evidence-based guidelines, and clinical judgment.
References:
- NICE Clinical Guidance (2020) – Management of GTPS
- Mellor R, et al. (LEAP Trial) – BMJ, 2018
- Systematic Reviews on CSI, PRP, and Exercise Therapy
“At MSK Clinic Physio, we provide comprehensive assessment and evidence-based treatment for hip pain and GTPS. Our team combines physiotherapy, load management, and (where appropriate) injection therapy to help patients recover and return to the activities they love.
Book an assessment today and take the first step towards lasting hip pain relief.”