1. Introduction / Plain Theory

Greater Trochanteric Pain Syndrome (GTPS) describes pain over the lateral aspect of the hip, caused by irritation or degeneration of the gluteal tendons (especially gluteus medius and minimus) and the trochanteric bursa.

It replaces the older term “trochanteric bursitis,” since research shows that the primary cause is tendon overload and not inflammation of the bursa alone.

GTPS is one of the most common causes of lateral hip pain, affecting up to 25% of women and 10% of men in middle age.
It typically results from repetitive compression or friction of the gluteal tendons over the greater trochanter during activities such as walking, running, or side-lying.

Pain arises from degenerative changes within the tendon (tendinopathy), increased mechanical load, and reduced pelvic stability — rather than a single injury event.

2. Typical Symptoms and Functional Impact

• Pain on the outer side of the hip, sometimes radiating down the lateral thigh.

• Discomfort when lying on the affected side.

• Pain when climbing stairs, standing on one leg, or walking uphill.

• Tenderness over the greater trochanter (just below the bony prominence).

• Occasionally a sense of stiffness or weakness in the hip.

Functional impact:
GTPS can interfere with walking, sleeping, and physical activity.
Chronic irritation may lead to altered gait patterns, gluteal inhibition, and compensatory strain in the lumbar spine or opposite hip.

Red flags:
Groin pain, significant stiffness, or night pain unrelated to pressure on the hip may suggest hip joint osteoarthritis rather than GTPS.

3. Contributing Factors / Underlying Causes

GTPS arises when compressive and tensile forces exceed the tolerance of the gluteal tendons.
Common contributing factors include:

• Weak gluteal or core muscles, reducing pelvic stability.

• Pelvic or lumbar asymmetry altering hip loading.

• Tight iliotibial band (ITB) or tensor fasciae latae (TFL), increasing compression on the tendons.

• Overuse from repetitive walking or running.

• Sudden increase in activity or poor biomechanics.

• Hormonal changes affecting tendon elasticity (especially in perimenopausal women).

• Previous hip, SIJ, or lumbar dysfunction, creating secondary overload.

From an osteopathic viewpoint, GTPS reflects a failure of load distribution across the lumbopelvic–lower limb system — not just a local tendon irritation.

4. Osteopathic Approach

Osteopathic treatment aims to reduce local tension, improve load distribution, and restore functional pelvic stability.

An osteopathic assessment may include:

• Postural and gait analysis to identify asymmetry or compensatory movement.

• Palpation of the gluteal tendons, fascia lata, and trochanteric region.

• Mobilisation of the pelvis, lumbar spine, and sacroiliac joints to rebalance load.

• Myofascial and soft-tissue techniques for gluteals, TFL, and ITB.

• Indirect or functional techniques to modulate pain and improve circulation.

• Breathing and core coordination training to support pelvic stability.

• Guidance on graded loading, sleep positioning, and daily activity modification.

The aim is not simply to “treat the hip” but to restore the whole-body mechanics that determine tendon health and resilience.

5. Scientific Evidence & References

Recent research supports exercise-based rehabilitation, load management, and manual therapy as effective first-line care for GTPS.
Studies have shown that improving gluteal strength, pelvic control, and thoracolumbar mobility can substantially reduce pain and recurrence.

Osteopathic treatment aligns with this evidence, integrating manual therapy with functional rehabilitation and postural correction.

References

1. Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910–922. Link

2. Fearon AM, et al. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med. 2013;47(10):649–653. Link

3. Mellor R, et al. Exercise and load management versus corticosteroid injection for gluteal tendinopathy: randomized clinical trial. BMJ. 2018;361:k1662. Link

4. Ganderton C, et al. Clinical features that predict the response to load management in gluteal tendinopathy. Br J Sports Med. 2017;51(6):519–524. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for hip and pelvic pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Allison K, et al. Lumbopelvic contribution to gluteal tendinopathy: clinical implications. J Orthop Sports Phys Ther. 2020;50(6):310–321. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for lateral hip pain: network meta-analysis. Front Pain Res. 2024;15:1507473. Link