GREATER TROCHANTERIC PAIN SYNDROME CLINICAL PRACTICE GUIDELINE

Oct 12, 2026

GREATER TROCHANTERIC PAIN SYNDROME (GTPS) is defined as lateral hip pain in the peritrochanteric region, with pain that may radiate and is linked to gluteal tendinopathy rather than isolated trochanteric bursitis. The guideline emphasizes evidence-based load management: progression based on time and pain criteria, effective prescription of loading variables, and use of progressive mechanical loading (isometrics, isotonic, eccentric, isokinetic, and energy-storage options). It provides risk factors, differential diagnosis, examination and outcome tools, phased interventions, and discharge criteria for safe return to activity.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages13

Reading Time5 min

AccessFree to download

Summary of Recommendations

Risk factors

Differential Diagnosis

Examination

Phases of Progression Interventions

Criteria for Discharge

GREATER TROCHANTERIC PAIN SYNDROME CLINICAL PRACTICE GUIDELINE Disclaimer This guideline is intended as an aid for clinicians treating patients diagnosed with greater trochanteric pain syndrome, utilizing an evidence-based load management treatment strategy. Progression is time and criterion-based, dependent on soft tissue healing, patient demographics and clinician evaluation. Contact Ohio State Sports Medicine at 614-293-2385 if questions arise. Background Greater trochanteric pain syndrome (GTPS) has been defined as lateral hip pain to palpation of the peritrochanteric region. The pain can radiate down the thigh and into the posterior hip, but rarely distal to the knee. Previously, the cause of pain has been attributed solely to trochanteric bursitis. However, the origin of pain can include the trochanteric bursa, gluteus medius and minimus tendons, and iliotibial band. MRI examination in studies involving GTPS show trochanteric bursitis was an uncommon finding and was not found in isolation; when found, bursal distension coexisted with gluteal pathology.2 Recent studies have shown gluteal tendinopathy to be the primary cause of lateral hip pain.2 The greatest incidence of GTPS often occurs between the fourth and sixth decades of life with a female to male ratio of 4:1 .6 Recent studies of gluteal tendinopathy demonstrate the deep undersurface fibers of the gluteal tendons preferentially develop pathology and tears and yet are relatively stress-shielded from tensile load in the lower ranges of hip abduction.1 They are exposed to high compressive loads in the ranges of hip adduction against the bony insertion.1 Normal, daily function of the hip is in the low ranges of abduction or slight hip adduction.6 These compressed sides of the tendons adapt to form somewhat of a cartilaginous or atrophic area in response to a lack of tensile load.1 This makes the tendon vulnerable to becoming symptomatic even with small changes in activity. For this reason, tendinopathy can occur in the absence of a traditional overuse injury model and explains how tendinopathy is more common in the older patients.1 Because the turnover rate of collagen decreases with advancing age, it may take longer for older athletes to recover from tendinopathy.3 Compressive forces (not solely tensile loads) may be at fault and need correction for treatment of GTPS. A key determinant in rehabilitation progression of tendinopathy is whether or not a tendon reacts, or develops an increase in pain that does not return to baseline pain level within 24 hours.8 Load management and prescribing effective loading variables (duration, frequency, nature, magnitude, direction, and intensity) is important in guiding the rehabilitation process. Progressive mechanical loading has been found to be an effective management strategy. Different modes of strength training, including isometric, isotonic, isolated eccentric, and isokinetic can be used to control pain, improve motor control, and enhance function in pathological tissue. Isometrics have been found to reduce pain while reducing cortical inhibition of muscles. Generally clinical management of tendinopathy should include aspects of load management and education, progressive mechanical loading, treatment of kinetic chain deficits, and a graded return to activity. For OSUWMC USE ONLY. To license, please contact the OSU Technology Commercialization Office at [https://tco.osu.edu](https://tco.osu.edu). Definitions • Strong level evidence: supported by systematic review, meta-analysis, or >5 RCT • Moderate level evidence: supported by 3-4 RCT • Low level evidence: supported in 1-2 RCT or clinical case series • Expert opinion: supported by case studies, expert opinions or opinions of the authors Summary of Recommendations | Risk factors | •
•
•
• | Sudden increase in activity
Repetitive compressive/tensile loads
Lumbopelvic and LE mechanics
Female>40 years | | --- | --- | --- | | Diff

FAQs

How is GTPS defined in the guideline?

GTPS is defined as lateral hip pain to palpation of the peritrochanteric region, with pain that can radiate down the thigh and into the posterior hip.

What is the central rehabilitation principle emphasized for GTPS?

Rehabilitation progression is guided by evidence-based load management, including prescribing effective loading variables and progressing based on time and patient pain response criteria.

Which loading types does the guideline recommend for tendinopathy management?

The guideline recommends progressive mechanical loading, including isometric loading, isotonic (heavy-slow resistance through concentric-eccentric phases), and energy-storage loading (plyometric loading), with options such as isokinetic and eccentric strategies depending on goals.

Oct 12, 2026

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