Our hip joints are one the largest and strongest in our body. They provide strength and flexibility during walking, running, and jumping. However, the hip joints can take a beating leading to pain. One of the most common causes of hip pain is tendon swelling on the outside of the hip. We often call this problem greater trochanteric pain syndrome. It is also referred to as trochanteric tendonitis or bursitis and is common and readily treatable.
What causes greater trochanteric pain syndrome?
This condition occurs primarily from an overuse injury to the tendons on the outside of the hip. Adults who walk, run or play sports are more likely to get this injury. Moreover, women are more likely to suffer from this injury than men, perhaps related to the shape of a women’s pelvis. Other causes include a muscle or tendon tear, a fall onto the outside of your hip, or acute inflammation such as rheumatoid arthritis. Finally, weakness of the hip muscles is an essential factor.
A recent study found that those people who developed greater trochanteric bursitis were more likely to develop hip arthritis. Why people with tendon pain are more likely to develop arthritis is unknown. However, we suspect that weakness of the buttock muscles can lead to both tendon swelling and joint arthritis.
Symptoms of greater trochanteric pain syndrome
Usually, you’ll first notice pain on the outside of the hip. Pain is worse with lying directly on your hip, walking up and downstairs, and prolonged walking and running. Also, you may get pain when crossing your legs. The hip joint can feel stiff. Moreover, the outside of your hip is tender to touch, and pain occurs with moving the leg outwards.
Sometimes, we need further investigations such as ultrasound or MRI to confirm the cause and rule out other causes.
Trochanteric bursitis ultrasound
Generally, investigations are needed if you’re not responding to therapy or you present with unusual symptoms. Usually, ultrasound shows trochanteric tendonitis and bursitis. Sometimes, calcification or tendon tears can be seen. An X-ray or MRI is helpful if we think hip pain is due to another cause, such as hip arthritis.
Hip tendonitis treatment
Most trochanteric tendonitis responds to simple treatments.
Firstly, reducing pressure on the hip tendons by not lying on the hip is helpful if the hip is irritable. Using a pillow between the knees to help keep the hips apart while sleeping helps. Also, avoid crossing your legs if you can. Secondly, reduce activities that make your hip abductor tendonitis irritable such as prolonged walking. In hamstring tendonitis, keeping pain levels at a low level (<3/10) is a crucial principle. Thirdly, using a short course of tablets such as ibuprofen for 1-2 weeks with other treatments is effective.
Greater trochanteric pain syndrome exercises
It is essential to see an expert in therapy to guide you through hip tendonitis exercises. Recent evidence suggests that exercises are better than no treatment or injections. These improvements start at eight weeks and last for at least 12 months. Hip tendonitis exercises such as hip bridges build muscle around the hip joint, including glutes, hip flexors, and hip adductors. Sometimes soft tissue massage and acupuncture can help greater trochanteric tendonitis.
What happens if you get stuck?
Generally, in cases that don’t improve with physiotherapy, other options are available.
Shockwave therapy uses sound waves directed to the painful tendons. We think shockwave reduces pain by healing the tendon or stunning the small nerves sending pain messages to the brain. Often 3-5 sessions will help with pain.
Evidence suggests that a series of shockwave treatments improve pain at 6 months.
Greater trochanteric bursitis injections
Alternatively, injections can be suitable for some patients with trochanteric tendonitis. For example, injections are helpful if your pain keeps you up at night or stops you from doing your rehab. Again, there are different types of injections.
Cortisone is a potent anti-inflammatory that reduces pain by lowering inflammation.
Research suggests that cortisone injections for greater trochanteric pain syndrome are effective (but less so than exercise). In another study, pain is improved after six weeks after one cortisone injection and lasted for at least a year. In addition, the effects of cortisone are better in bursitis rather than tendonitis. However, we need to be careful with cortisone injections due to potential side effects.
Recently a new type of injection called PRP or platelet-rich plasma has been used for complex cases of trochanteric tendonitis. About 15-30 ml of whole blood is taken from a vein in the elbow. Next, we spin the blood down, so the heavier red cells move to the bottom. The plasma on the top, which contains a high concentration of platelets and growth factors, is injected into and around the swollen tendons in your hip. Studies suggest that improvements in greater trochanteric pain syndrome occur with PRP injections even after 2 years.
This procedure involves repeated needling of the hip tendon using a low dose of a local anaesthetic. We think that the needling of a tendon causes an acute inflammation leading to healing of trochanteric tendonitis. One study showed that needling improved pain from trochanteric tendonitis in about 80% of people after 2-3 months.
Generally, we suggest injections are done under ultrasound to improve accuracy. Therefore, you should only see a doctor who has experience in ultrasound-guided injections. You should be wary of other practitioners, such as physiotherapists who inject but have much less experience.
Other frequently asked questions about greater trochanteric pain syndrome
How long does greater trochanteric pain syndrome last?
Generally, like all tendonitis, pain from gluteal tendonitis can last for months. However, most people find that pain improves over time if they continue their exercises and rehab.
What if a cortisone shot doesn’t work for hip bursitis?
Cortisone injections have been shown to improve pain after six weeks. This effect lasts for up to a year. However, not all cortisone injections work. We think that only 2/5 people get sustained relief from one cortisone shot.
Generally, we try other options in cases that fail a cortisone shot. Shockwave therapy works for some people. Alternatively, we can use needle tenotomy or PRP injections.
Gluteal tendon tear: Is the treatment any different?
Overall, gluteal tendon tears are more challenging to treat than gluteal tendonitis. However, the treatments are similar.
Generally, we start with exercise therapy. Other treatments we use include shockwave therapy and injections. PRP is particularly effective in partial tears. Finally, repair of the gluteal tendon may be considered in cases that fail other treatments. Some surgeons perform keyhole surgery to reduce pain and hasten recovery.
Final word from Sportdoctorlondon about greater trochanteric pain syndrome
Greater trochanteric pain syndrome or trochanteric tendonitis is a common cause of hip pain. We suggest rehab first. If ineffective, then we recommend shockwave therapy or injections. If you’re thinking about an injection, choose a doctor who has experience injecting with ultrasound.
Other hip and groin conditions: