Introduction
Pain on the outer side of the hip, traditionally called trochanteric bursitis, was thought to be caused by inflammation of the bursa (fluid sac) overlying the greater trochanter. Imaging research over the past two decades has overturned this model: the bursa is rarely significantly inflamed, and the primary pathology is a degenerative tendinopathy of the gluteal tendons (gluteus medius and minimus) at their insertion on the greater trochanter. This distinction matters because it changes the treatment entirely, the old approach of rest, anti-inflammatories, and corticosteroid injections does not address the tendinopathy, and the evidence for progressive loading (despite seeming counterintuitive) is now compelling.
Whether you are dealing with a recent flare-up or something that has nagged you for years, understanding why your body hurts is the most important first step. This guide draws on the latest pain science, physiotherapy research, and practical coaching wisdom meticulously validated and referenced to give you peace of mind.
Understanding the Anatomy
The greater trochanter is the bony prominence on the lateral side of the femur. The gluteus medius and minimus tendons insert onto the greater trochanter from superior and anterior angles respectively. Between the tendons and the trochanter lie several bursae, the trochanteric bursa being the largest. In GTPS, the gluteus medius and minimus tendons at the greater trochanter show the degenerative changes characteristic of tendinopathy: disorganised collagen, neovascularisation, and increased tendon thickness. Compression of the tendons against the greater trochanter (from hip adduction, crossing the legs, walking with the legs crossing the midline, or side-sleeping) is a primary driver of GTPS and the key to understanding what positions and activities to modify.
Key structures involved: Gluteus medius (primary, the most commonly affected tendon), Gluteus minimus, Tensor fasciae latae (TFL), IT band (transmits compression forces to the greater trochanter), Piriformis.
Why Does It Hurt? Root Causes
Modern pain science reminds us that pain is your nervous system's threat response, not simply a damage signal. That said, there are real, identifiable drivers.
1. Compressive Loading
Unlike most tendinopathies which are driven by tensile (stretching) load, GTPS has a significant compressive component, the tendons are compressed between the IT band and the greater trochanter when the hip is adducted (leg crossing midline). This makes crossing the legs, lying on the painful side, and walking with a wide hip swing particularly provocative.
2. Gluteal Weakness
Weak gluteus medius allows the hip to drop during single-leg stance (Trendelenburg pattern), increasing the compressive load on the gluteal tendon insertion. Progressive strengthening is therefore both treatment and prevention.
3. Postmenopausal Hormonal Changes
GTPS is disproportionately common in postmenopausal women, likely related to oestrogen's effects on tendon metabolism and the changes in body composition and biomechanics that accompany menopause.
4. Training Load Errors in Runners
Rapid increases in running volume or a change to a route with significant camber can trigger GTPS in runners through increased compressive loading of the greater trochanteric region.
How Massage Helps
Massage for GTPS focuses on the gluteal muscles and TFL rather than directly over the greater trochanter (which can worsen compressive irritation in the acute phase). Deep effleurage and petrissage of the gluteus medius and minimus muscle bellies, accessible in side-lying, reduces the hypertonia and trigger points that alter tendon loading. TFL release reduces the IT band tension that compresses the gluteal tendons. Once the acute compressive sensitivity settles, gentle progressive loading of the tendon through the exercises below is the primary treatment approach.
Beyond specific mechanical effects, massage floods the nervous system with safe, rich sensory input, downregulating the threat response and creating conditions in which healing becomes easier.
Stretches to Try
Consistency matters far more than intensity. Gentle, daily stretching with calm breathing reduces perceived tightness and signals safety to the nervous system.
Avoid Hip Adduction Stretches
Counterintuitively, stretching the TFL and glutes by crossing the leg (pigeon pose, figure-four) should be avoided in acute GTPS, these positions compress the tender tendons against the greater trochanter. Benefit: Understanding what not to stretch is as important as knowing what to stretch in GTPS.
Gluteal Stretch in Neutral Hip Position
Lie on your back. Draw one knee towards your chest (not across the body). Hold 30 seconds. Benefit: A safe hip stretch that lengthens the gluteals without the adduction that would compress the greater trochanteric region.
Standing Hip Flexor Stretch
Kneeling lunge, hold 30 seconds per side. Avoids hip adduction while maintaining hip flexor length. Benefit: Maintains hip flexor mobility without the compressive hip positions that aggravate GTPS.
Strengthening Exercises
Loading tissues progressively tells your nervous system they are capable and resilient.
Isometric Hip Abduction (Pain Control)
Stand sideways to a wall. Press the lateral aspect of the affected leg gently into the wall, held isometrically for 30 to 45 seconds. 4 to 5 repetitions. Benefit: Isometric loading provides immediate analgesic effects in tendinopathy and is the appropriate starting point in GTPS rehabilitation.
Side-Lying Hip Abduction with Neutral Hip
Side-lying, affected leg on top. Lift the top leg with a neutral spine (not adducted). 3 sets of 15. Benefit: Progressive loading of the gluteus medius in a compressive-free position, the foundation of GTPS rehabilitation.
Single-Leg Squat with Trunk Lean
Stand on the affected leg. Slowly lower into a single-leg squat, allowing a slight trunk lean towards the weight-bearing side. 3 sets of 10. Benefit: Loads the gluteus medius in the most functionally important position while minimising compressive tendon load, the progression from isometric and isolation work.
Practical Self-Care
- Do not cross your legs, this is the single most provocative position for GTPS.
- Sleep with a pillow between your knees in side-lying to prevent hip adduction overnight.
- Do not lie on the affected side during acute phases.
- Walk with a narrower gait if you tend to 'waddle', reduce the lateral hip swing.
- Avoid deep soft chairs that create hip adduction, sit in chairs with a firm seat that keeps the hips in neutral.
When to See a Professional
- GTPS not responding to progressive loading after 8 to 12 weeks, consider platelet-rich plasma injection (evidence-supported alternative to corticosteroid).
- Significant bursitis with dramatic swelling, aspiration may be required.
- Hip joint involvement alongside lateral hip pain. X-ray to rule out OA or labral pathology.
- Significant limp or functional impairment.
A qualified physiotherapist, sports therapist, or massage therapist can identify the specific drivers of your pain.
References and Further Reading
- Grimaldi A et al. Gluteal tendinopathy. Br J Sports Med. 2015.
- Allison K et al. Corticosteroid injection vs. physiotherapy vs. combined for greater trochanteric pain syndrome. BJSM. 2016.
- Mellor R et al. Education plus exercise versus corticosteroid injection for GTPS. BMJ. 2018.
- Ingraham P. Greater trochanteric pain syndrome. painscience.com.
- Morrison T. Hip stability and tendon loading. tommorrison.uk.
Content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before beginning any new exercise or treatment programme.