If you are reading this, odds are you are probably from the Edmonton area and you or someone you care about is suffering from greater trochanteric pain syndrome. We feel your pain, and we want to help. Read on to find out more about GTPS and feel free to contact us at Unpain Clinic for a free no-obligation telehealth consultation if you have any questions.

What is greater trochanteric pain syndrome (GTPS)?

Greater Trochanteric Pain Syndrome (GTPS) is an orthopedic condition that presents as lateral pain in the hip, radiating all over the buttock and sometimes down the leg. Patients are often able to move well but will experience pain on palpation or on specific movements. Greater trochanteric pain syndrome (GTPS) is actually a catchall name for a group of conditions that can cause pain in the lateral hip area. This condition is fairly common and affects as many as 1.8/1000 adults. It is more common to get GTPS if you are female and between 40 and 60 years of age. Some conditions that fall under the heading of greater trochanteric pain syndrome include trochanteric bursitis, external coxa saltans and abductor tendinopathies (including gluteal tendonitis, piriformis tendinopathy).

Location of greater trochanter (where the heck is it?)

The greater trochanter is a large bony prominence that
is a part of your femur. It is located on the lateral or
outside part of the femur and serves as an attachment
site for many muscles. If you drop your hands to your
sides, most people will be able to feel their greater
trochanter at about the level of their wrist or palm (this,
of course, depends on how long your arms are). The
muscles that attach to the greater trochanter include
the obturator internus, gemelli, piriformis, gluteus
minimus, and gluteus medius.

What are the causes of greater trochanteric pain syndrome?

Direct trauma to the lateral hip such as a fall on your side or being hit in a contact

sport can cause GTPS. It can also be aggravated during certain activities, such as climbing stairs, playing tennis or even sitting or lying down for too long!
Counterintuitively, it is believed that the current true cause
of GTPS pain is the underlying tendinopathy in gluteal
muscles and NOT the swollen bursa that results from it. Out
of the three aforementioned gluteal muscles, it is typically
only the smaller two that could be contributing to the
painful issue: gluteus medius and gluteus minimus.
GTPS can also come on over time with:

• prolonged pressure to the hip area
• repetitive movements (walking/running)
• commencing unaccustomed vigorous exercise
• weight-bearing on one leg for long periods
• having one leg longer or shorter than the other

GTPS can also be a side effect of: hip instability, being overweight, hip, foot or knee arthritis or bone spurs in the hip, painful foot conditions such as a bunion, callous, plantar fasciitis, or Achilles tendinitis, spine problems including scoliosis and arthritis of the spine, and muscle imbalances that put more stress on the hip muscles.

What are the symptoms of greater trochanteric pain syndrome?

The symptoms of this condition can vary depending on the underlying reason for your GTPS, but the most common things that patients can experience include:

• Pain on the lateral side of the hip that can radiate along the outside of the thigh
• Pain that may be sharp or intense when you first move and then may become more of a dull ache after you have been moving for some time
• Pain or difficulty walking or running
• Joint stiffness
• Swelling or warmth over the lateral hip
• A clicking or catching sensation in the hip
• Pain that can be aggravated by getting out of bed or a chair, long periods of
  sitting, going up stairs, sleeping on or putting pressure on the affected side

Your healthcare provider will assess you and consider your symptoms as well as your clinical presentation when making a diagnosis. Often, no special tests are required to diagnose greater trochanteric pain syndrome, however, your practitioner may order imaging like x-rays, ultrasounds or an MRI if they feel they are needed to rule out other causes of pain and confirm your diagnosis.

How to prevent greater trochanteric pain?

Sometimes injuries that happen suddenly can’t be prevented, but trochanteric bursitis that comes on as a result of overuse may be more preventable. Some strategies for preventing GTPS include:

• maintaining a healthy body weight and getting the proper amount ofcardiovascular exercise each week
• working with the appropriate healthcare provider to address any spine, foot, ankle or knee related conditions that could be affecting your gait or how you weight bear
• performing proper warm ups and cool downs before and after exercise
• taking appropriate rest days and breaks when training or exercising
• slowly increasing your activity levels over time as your fitness and endurance improve -this is especially important when you are beginning a new fitness activity, exercise routine or training for an event or sports competition.

What are the best/most effective treatment options for greater trochanteric pain
syndrome?

That depends. Every person is different, and the best and most effective treatment for your GTPS depends on the cause of your pain and a few other individual aspects. At Unpain Clinic, skilled therapists are trained to look beyond the diagnosis and delve into why it happened in the first place. We won’t just treat where it hurts, we treat why it hurts, so that the pain can go away and not come back. We like to assess every patient fully so we can create the best treatment plan for you, but some of our favorite treatments for GTPS include:

• Shockwave therapy
• manual myofascial release or massage therapy (including some special
• techniques like ART, Rapid NFR or Graston)
• dry needling or clinical acupuncture
• ultrasound, laser therapy or TENS
• KT taping

Most studies agree on one thing: GTPS treatment outcomes are improved with gentle, consistent activity. If you are looking for a way to expedite your treatment plan, stay moving and avoid sedentary habits and specific, aggravating motions. We also like to educate our patients on some topics like rest and reduction/modification of aggravating activities, using ice or heat (or both) to control pain, stretching, foam rolling and strengthening exercises for weak muscles. We believe that understanding your body and condition are key to feeling in control of your health and recovery, so we emphasize education as a foundational component of patient interactions at Unpain Clinic.

What exercises are good for greater trochanteric pain syndrome?

Unpain therapists have assembled our top 5 recommended exercises to specifically target GTPS-related hip pain. This is not an exhaustive list and is not replacement for proper diagnosis. Follow the link below to get started.

Can Shockwave Therapy Help with greater trochanteric pain syndrome?

Short answer, YES –there are a number of studies that have shown that shockwave therapy can be an effective treatment for greater trochanteric pain syndrome. Every person is different and not all people respond to treatments in the same way. Recent studies have shown focused extracorporeal shockwave therapy to be an effective treatment (86.8% at 2 month follow-up) for GTPS, when paired with an
appropriate exercise program. If one of the muscles is not firing properly, muscle activation may be key in restoring balance and function to the area – a job fit for an electrohydraulic shockwave device and a choice exercise or two. If another muscle is too tight and causing restrictive problems, release of adhesions in that area using radial pressure wave technology and stretching of the muscle may be in order. At Unpain Clinic we assess every patient before we treat them to ensure that shockwave is the right fit. Thorough assessments also help us to give our patients a more accurate prognosis and allow us to suggest alternative or complimentary types of treatments to help our patients get back to feeling better sooner.

FAQS

How long can greater trochanteric pain last?

Without treatment, greater trochanteric pain syndrome can last from weeks to years and in some people can become a chronic condition. In some cases, treatment can cure GTPS, while in other people with chronic trochanteric pain, treatments may just be used to help improve functionality and discomfort levels. The key to effective treatment is determining the underlying cause(s) for disease and pain.

What is the best treatment for trochanteric bursitis?

That depends. There is research that supports a number of treatments including shockwave therapy, rehab exercise plans, ultrasound therapy and injections of various pain and inflammation reducing medications, among other treatments. One interesting trend in some comparison studies of shockwave against other interventions, is that shockwave therapy seems to produce results that hold up better over the long term. That said, the best way to know what the best treatment is for you, is to get assessed by a qualified professional.

Is physiotherapy or chiropractic good for greater trochanteric pain syndrome?

Seeing these types of practitioners can definitely be a good option. Our team at the Unpain Clinic Edmonton will assess your condition and create a plan of management that can help get you back to feeling better sooner. Our practitioners are also trained shockwave therapists who are skilled in using shockwave to treat a number of conditions including GTPS.

Do I need to take medication for greater trochanteric pain syndrome?

That’s a very good conversation to have with your medical doctor or pharmacist. Some patients do need or choose to take medications to manage some of the pain and inflammation related to GTPS. These can be over the counter options or something prescribed, and some medications may even be injected or applied to the skin directly. At the Unpain Clinic our team focuses on drug-free ways of treating greater
trochanteric pain syndrome.

Will I need surgery for greater trochanteric pain syndrome?

You might, but this would be pretty rare. Most people don’t need surgery unless they have suffered a tendon rupture or your pain is not responding to more conservative therapies. Your medical doctor will advise you if this is something you might need and refer you to an appropriate orthopedic surgeon for a consult.

What methods does Unpain Clinic use to treat greater trochanteric syndrome?

Your treatment plan will always be individualized to your unique needs and circumstances and the practitioner who treats you may also suggest some options for care that are unique to their scope of practice and abilities, but one treatment we love to use is shockwave therapy. There is a fair amount of evidence to support the use of shockwave for GTPS and we have seen some of our best (and fastest) patient recoveries when we have used this modality.

Is a Physiotherapist covered by Alberta Health Care?

Yes and no. Confusing, right? Alberta Health Care holds contracts with specific clinics – so you could have a perfectly good physiotherapist in a private practice who is not covered under Alberta Health Care since they do not negotiate contracts with them. It usually comes down to cost. If a clinic is offering a more specialized service that is more expensive to offer, it is not typically covered by Alberta Health. There are, however, many reputable clinics out there that provide excellent traditional care for clients under Alberta Health Care contracts. Unpain Clinic does NOT bill to Alberta Health Care at this time.

How much does physiotherapy cost in Edmonton, Alberta?

Physiotherapy in Edmonton can range anywhere from $50-$400+ per visit. The price depends on the therapist, the clinic, and the technology or treatment being offered.

Do you need a referral to see a physiotherapist in Edmonton, Alberta?

No. Physiotherapists are considered primary healthcare providers, along with medical
doctors, chiropractors, naturopathic doctors and acupuncturists. These professionals do
not require a referral from a medical doctor for you to see them. Be aware that your
extended health benefits plan may require a doctor’s prescription in order for you to
claim your visit. The best way for you to know if you need a referral is to call your
benefits provider or check out their website.
Here at Unpain Clinic we always accept and appreciate referrals from medical doctors
and other healthcare providers and are happy to collaborate and communicate with
them to ensure you get the best care possible.

Sources

Ramon, Silvia MD, PhD1,2,3,a; Russo, Sergio MD4; Santoboni, Flavia MD5; Lucenteforte,
Giacomo MD6,7; Di Luise, Carla MD4; de Unzurrunzaga, Rocio MD1,2; Vetrano, Mario
MD, PhD5; Albano, Mariantonia MD4; Baldini, Rosella PhD5; Cugat, Ramon MD,
PhD1,2,3,8; Stella, Giulia MD5; Balato, Giovanni MD4; Seijas, Roberto MD, PhD1,2,3;
Nusca, Sveva-Maria MD5; Servodidio, Valeria MD4; Vulpiani, Maria-Chiara MD5 Focused
Shockwave Treatment for Greater Trochanteric Pain Syndrome, The Journal of Bone
and Joint Surgery: August 5, 2020 – Volume 102 – Issue 15 – p 1305-1311