That stubborn ache on the outside of your hip may not be “just getting older,” a grumpy mattress, or punishment for skipping leg day. It could be greater trochanteric pain syndrome, commonly shortened to GTPS.

Greater trochanteric pain syndrome is an umbrella term for pain involving the soft tissues around the greater trochanterthe prominent bony area on the outside of the upper thigh. Although people often call it trochanteric bursitis, inflammation of the bursa is only one possible contributor. Gluteal tendon irritation or tearing, compression of the tissues, and snapping of the iliotibial band can also be involved. In other words, the neighborhood may be causing trouble even when the bursa is not the only noisy resident.

GTPS can interfere with walking, climbing stairs, exercising, standing for long periods, and sleeping on the affected side. Fortunately, most cases improve without surgery. Treatment usually centers on adjusting aggravating activities, gradually strengthening the hip, managing pain, and correcting movement patterns that overload the outer hip.

What Is Greater Trochanteric Pain Syndrome?

The greater trochanter is the wide, bony projection near the top of the femur, or thighbone. Several important tendons attach around this area, including the tendons of the gluteus medius and gluteus minimus muscles. These muscles stabilize the pelvis and help move the leg away from the body.

Small fluid-filled sacs called bursae sit between bones and nearby tendons or muscles. Their job is to reduce friction. When these tissues become irritated, compressed, overloaded, or injured, pain may develop over the outside of the hip.

Conditions grouped under GTPS may include:

• Gluteus medius or gluteus minimus tendinopathy
• Partial or complete gluteal tendon tears
• Trochanteric bursitis
• External snapping hip caused by the iliotibial band
• Combinations of tendon irritation and bursal inflammation

Modern research increasingly recognizes gluteal tendinopathy as a major driver of persistent lateral hip pain. That distinction matters because repeatedly treating the problem as isolated inflammation may provide temporary relief without addressing tendon strength, compression, and load tolerance.

Greater Trochanteric Pain Syndrome Symptoms

The signature symptom is pain over the outside of the hip. A person can often point to a tender spot near the bony prominence rather than deep inside the groin.

Common Symptoms

• Aching, burning, or sharp pain on the outside of the hip
• Tenderness when pressing over the greater trochanter
• Pain that spreads down the outer thigh, usually not below the knee
• Discomfort when lying on the affected side
• Pain when climbing stairs or walking uphill
• Pain after prolonged walking, running, or standing
• Discomfort when rising from a low chair
• Pain when crossing the legs
• Hip weakness, limping, or reduced exercise tolerance
• Occasional clicking or snapping over the outer hip

The pain may begin sharply after a fall or sudden increase in activity. In other cases, it develops gradually and becomes a broad, nagging ache. Night pain is especially common because lying on the affected side compresses the already sensitive tissues between the mattress and the greater trochanter.

Why Does GTPS Hurt at Night?

Side sleeping places direct pressure on the painful area. Sleeping on the opposite side can also provoke symptoms if the upper leg drops across the body, placing the gluteal tendons in a compressed position.

A pillow between the knees may help keep the hips aligned. Back sleeping may also reduce pressure, although convincing a devoted side sleeper to remain on their back all night can be more ambitious than teaching a cat to respect personal boundaries.

What Causes Greater Trochanteric Pain Syndrome?

GTPS does not always have one dramatic cause. It often appears when the demands placed on the outer hip exceed what the muscles and tendons can currently tolerate.

Repetitive Overload

Running, stair climbing, hill walking, prolonged standing, and repeated side-to-side movements can overload the hip abductors. A sudden training increase is a classic trigger. For example, jumping from occasional two-mile walks to daily six-mile hikes may leave the gluteal tendons filing a formal complaint.

Direct Trauma

A fall onto the side of the hip can irritate the bursa, bruise nearby tissues, or injure the gluteal tendons. Symptoms may begin immediately or become more noticeable during the following days.

Hip Muscle Weakness

The gluteus medius and minimus help keep the pelvis level while a person stands on one leg during walking. When these muscles are weak or poorly coordinated, the pelvis may shift and increase compression around the greater trochanter.

Changes in Lower-Body Mechanics

Knee pain, foot problems, leg-length differences, hip osteoarthritis, and spinal disorders may change the way a person walks. Those adjustments can increase stress on the outer hip. GTPS is also associated with low back pain and other conditions that affect lower-extremity movement.

Gluteal Tendon Degeneration or Tears

Tendons can become less organized and less tolerant of load over time. Some patients develop small partial tears, while severe cases may involve substantial tearing and weakness. This is somewhat similar to rotator cuff disease in the shoulder, except the hip has chosen a less famous but equally inconvenient location.

Hip Surgery or Altered Gait

GTPS can develop after surgery involving the hip or leg, particularly when recovery temporarily changes walking mechanics or weakens the surrounding muscles.

Who Is Most at Risk?

Anyone can develop lateral hip pain, but GTPS is especially common among middle-aged and older adults. Women are affected more frequently than men, and many clinical sources report a concentration of cases among women between approximately 40 and 60 years old.

Additional risk factors may include:

• A rapid increase in exercise intensity or distance
• Running, dancing, or sports with repetitive hip loading
• Overweight or obesity
• Hip abductor weakness
• Hip or knee osteoarthritis
• Low back pain
• Scoliosis or leg-length differences
• Previous falls or hip injuries
• Long periods of standing
• Habitually standing with weight shifted onto one hip

Having a risk factor does not guarantee GTPS, and people without obvious risk factors can still develop it.

How Greater Trochanteric Pain Syndrome Is Diagnosed

GTPS is primarily a clinical diagnosis. A healthcare professional will ask where the pain occurs, when it started, which activities aggravate it, whether it disrupts sleep, and whether symptoms include numbness, groin pain, back pain, weakness, or clicking.

Physical Examination

The examination may include:

• Pressing over the greater trochanter to locate tenderness
• Watching the patient walk
• Checking hip range of motion
• Testing hip abductor strength
• Assessing balance while standing on one leg
• Evaluating the lower back, knees, and feet
• Using movements that compress or load the gluteal tendons

Localized tenderness is common, but no single test provides a perfect diagnosis. Clinicians usually combine the patient’s history with several examination findings. Pain during resisted hip abduction or weakness while standing on one leg may increase suspicion of gluteal tendon involvement.

When Imaging May Be Used

Imaging is not always necessary for straightforward cases. It may be ordered when symptoms are severe, follow significant trauma, fail to improve, or suggest another condition.

• X-rays can help identify arthritis, fractures, bone spurs, or other bony abnormalities.
• Ultrasound may show bursal fluid, tendon changes, or tears and can guide an injection.
• MRI provides a more detailed view of gluteal tendons and surrounding soft tissues.

Imaging findings must be interpreted carefully because tendon changes or bursal fluid may appear in people who have no symptoms. A scan should support the clinical picture rather than boss it around like an overconfident intern.

Conditions That Can Resemble GTPS

Outer hip pain can come from several sources. Possible alternatives include hip osteoarthritis, lumbar radiculopathy, sacroiliac joint pain, meralgia paresthetica, stress fractures, labral injuries, muscle strains, and referred pain from the lower back.

Groin pain and major loss of hip rotation may point more strongly toward a problem inside the hip joint. Tingling, numbness, or pain extending below the knee may suggest nerve involvement. Sudden inability to bear weight after a fall raises concern for a fracture and requires prompt evaluation.

Greater Trochanteric Pain Syndrome Treatment

Most people begin with nonsurgical treatment. The goal is not simply to make the area quiet for a few days. Effective care gradually restores the hip’s ability to tolerate everyday and recreational loads.

1. Modify Aggravating Activities

Complete bed rest is rarely helpful. Instead, reduce or temporarily modify activities that repeatedly trigger pain. A runner might shorten distance, avoid hills, or substitute swimming. Someone who stands all day may benefit from position changes and brief seated breaks.

Daily habits also matter. Avoid hanging the body weight on one hip, sitting with the legs crossed, or repeatedly climbing unnecessary stairs during a flare. The aim is sensible load managementnot treating the hip like an antique vase forever.

2. Use Ice for Short-Term Relief

A wrapped cold pack can reduce pain and tenderness after aggravating activity. Ice should not be placed directly on bare skin. Some people prefer gentle heat for muscular stiffness, but heat should not replace medical evaluation when the area is unusually swollen, red, or hot.

3. Consider Pain Medication Carefully

Over-the-counter medications such as ibuprofen or naproxen may help some patients, but nonsteroidal anti-inflammatory drugs are not appropriate for everyone. They can interact with medications and may increase gastrointestinal, kidney, cardiovascular, or bleeding risks.

Patients with kidney disease, ulcers, heart disease, blood-thinner use, pregnancy, or other medical concerns should consult a clinician or pharmacist before using them. Medication may calm symptoms, but it does not rebuild tendon capacity by itself.

4. Begin Targeted Physical Therapy

Exercise-based rehabilitation is a central treatment for GTPS, especially when gluteal tendinopathy is suspected. Programs typically focus on progressive strengthening, movement control, pelvic stability, and education about positions that compress the tendons.

A 2024 systematic review supported exercise as a first-line treatment for clinically diagnosed GTPS. A major randomized trial also found that education combined with exercise produced strong improvements for gluteal tendinopathy and performed better over time than relying only on a corticosteroid injection.

Possible exercises may include carefully selected hip abductor isometrics, bridges, controlled sit-to-stand movements, and gradual standing exercises. The correct program depends on pain severity, strength, balance, and other health conditions. Aggressive stretching into hip adduction can sometimes increase tendon compression, so random internet stretching marathons are not always the heroic solution they appear to be.

5. Adjust Sleeping Position

Avoid lying directly on the painful hip during a flare. When lying on the opposite side, place a thick pillow between the knees and ankles to prevent the upper thigh from dropping inward. A mattress topper may reduce pressure, although no mattress can compensate for an untreated tendon problem indefinitely.

6. Corticosteroid Injections

A corticosteroid injection around the trochanteric bursa or affected tissues may reduce pain and help a patient participate in rehabilitation. Ultrasound guidance can help place medication accurately when needed.

Research suggests that injections may offer useful short-term relief, but their advantage often becomes less clear over the longer term. Repeated injections may also carry risks, including temporary blood sugar elevation, skin changes, infection, and tendon weakening. They should be considered as one component of a treatment plan rather than a magical reset button.

7. Shock Wave Therapy

Extracorporeal shock wave therapy delivers focused or radial energy to the painful area. It may be considered when symptoms persist despite appropriate rehabilitation. A 2024 meta-analysis found that three weekly sessions may provide short-term pain relief, although treatment protocols and study quality vary.

8. Platelet-Rich Plasma and Other Procedures

Platelet-rich plasma injections are sometimes offered for resistant gluteal tendinopathy. Evidence remains mixed, and techniques are not standardized. Patients should ask about expected benefits, costs, uncertainties, and alternatives before choosing an intervention that may not be covered by insurance.

9. Surgery

Surgery is uncommon and generally reserved for persistent symptoms that have not improved after a well-designed course of nonsurgical care. The procedure depends on the underlying problem and may involve repairing a torn gluteal tendon, removing an inflamed bursa, or releasing a tight iliotibial band.

How Long Does GTPS Take to Heal?

Recovery varies. Mild cases may improve within several weeks, while chronic tendon-related symptoms may require several months of progressive rehabilitation. Improvement is rarely perfectly linear. A patient may feel better, enthusiastically reorganize the garage, walk five miles, and discover the next morning that the hip did not approve the revised schedule.

Temporary flare-ups do not necessarily mean new damage. They may indicate that activity increased faster than the tissues could tolerate. A clinician or physical therapist can help adjust the program without abandoning it entirely.

When to Seek Medical Care

Arrange an evaluation when lateral hip pain lasts more than a couple of weeks, repeatedly returns, disrupts sleep, causes limping, or limits normal activities.

Seek prompt medical attention for:

• Severe pain following a fall or collision
• Inability to stand, walk, or bear weight
• A visibly deformed leg or hip
• Rapid swelling, redness, warmth, or fever
• Progressive leg weakness or numbness
• Loss of bladder or bowel control
• Unexplained weight loss or persistent night pain unrelated to position

These symptoms may indicate a fracture, infection, nerve compression, or another condition requiring urgent assessment.

Can Greater Trochanteric Pain Syndrome Be Prevented?

Not every case is preventable, but several habits may reduce the risk of recurrence:

• Increase walking or running volume gradually.
• Include regular hip and core strengthening.
• Avoid repeatedly standing with weight shifted onto one leg.
• Address persistent foot, knee, or back problems.
• Wear footwear appropriate for the activity.
• Allow recovery after demanding exercise.
• Maintain a sustainable body weight when medically appropriate.
• Continue maintenance exercises after pain improves.

Hip conditioning can support stability, relieve pain, and reduce the likelihood of future injury, but exercises should be matched to the individual rather than copied blindly from a fitness influencer performing sideways gymnastics on a beach.

Conclusion

Greater trochanteric pain syndrome is a common cause of pain on the outside of the hip. It may involve the gluteal tendons, trochanteric bursae, iliotibial band, or several tissues at once. Typical symptoms include localized tenderness, night pain, discomfort on stairs, and pain during prolonged walking or standing.

Most cases improve through education, activity modification, progressive strengthening, and appropriate pain management. Injections or shock wave therapy may help selected patients, while surgery is generally reserved for stubborn cases involving significant structural problems. The most useful strategy is usually not to chase one quick fix, but to identify what is being overloaded and gradually teach the hip to handle life again.