The Science of Greater Trochanteric Pain Syndrome
Greater Trochanteric Pain Syndrome (GTPS), previously called "trochanteric bursitis," is primarily a gluteal tendinopathy affecting the gluteus medius and minimus tendons at their insertion on the greater trochanter. For years, this condition was called "trochanteric bursitis," and the presumed treatment was rest, ice, and anti-inflammatory injections. We now understand this is often incorrect. Research has shown that the primary issue is frequently not an inflamed bursa, but a distressed gluteus medius or minimus tendon - a gluteal tendinopathy. The bursa can become secondarily irritated, but it's rarely the main driver. This changes everything. Treating a tendinopathy is not about rest; it's about managing load and progressively strengthening the tendon. The idea that you just need to "rest it" is perhaps the most unhelpful advice for this condition. The condition involves a load-capacity imbalance where compressive forces (from positions that bring the IT band across the trochanter) and tensile loads exceed the tendon's ability to adapt. Postures that bring your thigh across the midline of your body can cause the iliotibial (IT) band to compress the gluteal tendons against the hip bone, a key source of irritation in GTPS. Weakness in the gluteus medius and minimus doesn't just cause local pain; it degrades movement quality throughout the kinetic chain. When these muscles aren't doing their job of stabilizing the pelvis, you can develop a "hip drop" or Trendelenburg gait pattern. This leads to compensations everywhere: the tensor fascia latae (TFL) and IT band may become overworked and tight, the low back can be subjected to shearing forces, and the knee can collapse inwards (valgus), potentially contributing to patellofemoral pain. Chronic tendon pain is frustrating because the pain is often worse with rest (like at night), creating a cycle of anxiety and poor sleep. Poor sleep, in turn, is known to increase pain sensitivity.