If you have been in this career long enough, you tend to notice that the diagnoses that you treat come in waves. The first three months of 2026 were rich and full of lateral hip pain, which, unfortunately, were not a straightforward case originating from the spine (a cause that is really a fast fix). When a patient has lateral hip pain and the spine has been completely ruled out (which occurs 60-80% of the time), one has to start thinking about greater trochanteric pain syndrome, or GTPS, and it is often caused by irritation or injury of the gluteus medius and gluteus minimus tendons, with or without bursa irritation.
What Do You Mean Lateral Hip Pain Is Coming From The Spine?
If you read our previous blogs, you would understand that pain can travel from the spine from different affected structures (spinal discs, spinal nerve roots, facet joints, and inflamed ligaments) along a defined pattern, or mimic that pattern as seen above. You can see that irritability at spinal levels L4 or L5 runs right over the lateral hip. When the presentation comes from the spine, it’s a beautiful thing because it is very easily and successfully treated. But when it is not, it can take several months of neuromuscular training to resolve the issue.
For many years, people called this pain presentation as “trochanteric bursitis.” A bursa is a fluid-filled sack that sits between the bone and a tendon or muscle (see the purple structure in the picture below the pulley picture). Its purpose is to decrease friction so that the tendon or muscle can properly perform movement, stabilize, and absorb forces without irritation from constant rubbing against bone during movement. We now know that trochanteric bursitis is usually more than a simple bursa problem. Most cases are really tendon trouble around the outside of the hip, often with extra pressure from the iliotibial band, rubbing on the area.
Think of the side of the hip like a rope-and-pulley system. If the rope is weak, tight, or pulled in the wrong direction, the pulley gets stuck, and the rope does not move smoothly. That is often what is happening here when certain muscles, tendons, or bands of tissue (the rope) are weak, tight, or pulling in the wrong direction going across the greater trochanter (see the green dot in the picture just above).
Why Does It Develop?
Greater trochanteric pain syndrome is seen more in women by 2-5x compared to men secondary to differentiation in the anatomy of wider hips. This leads to an increased likelihood of compression of the hip abductor muscles (gluteus minimus and gluteus medius, marked in red dots above) that insert on the greater trochanter (see the green dot in the picture above). In addition to gluteal tendinopathy and/or weakness (of the gluteus minimus or gluteus medius muscles that prevent the hips from falling inward), obesity, knee or hip arthritis, and leg-length differences all may contribute. Interestingly, even an acute presentation of shingles involving the lower lumbar or sacral nerve roots can mimic the pain pattern of greater trochanteric pain syndrome, as I have recently observed with a patient.
A big mechanical theme of greater trochanteric pain syndrome is compression. When the hip falls into excessive inward motion, the gluteal tendons (gluteus medius and gluteus minimus) compress against the bursa beneath them on the outside of the hip, which can worsen the pain. Weak hip abductors and poor pelvic control can increase that squeeze.
Why Age Matters
Greater trochanteric pain syndrome is seen most often in women ages 40 to 60, and risk tends to rise with age secondary to a decrease in estrogen levels. Hormonal changes of estrogen, especially after menopause, may reduce tendon strength and decrease overall collagen production of those tendons, which leads those tendons to be more susceptible to injury as they are not as resilient and do not recover as quickly from repetitive stress brought on by certain activities such as crossing your legs, stair climbing, or lying on one’s side. This helps explain why middle-aged and older women are affected more often than men, and why certain exercises, like clamshells (which is not a bad exercise), can be irritating at first.
How Do You Identify Greater Trochanteric Pain Syndrome?
The patient’s history is a major clue, as certain characteristics and activities show a consistent pattern with this diagnosis. Patients usually describe pain on the outside of the hip, tenderness over the greater trochanter, pain when lying on that side at night, and pain with walking, climbing stairs, standing on one leg, or getting up from a chair. Some people also feel pain running down the outside of the thigh toward the knee.
Kinsella et al. (2024) identified two easy tests to administer: The first one is having tenderness to touch at the lateral insertions of the gluteal tendons at the greater trochanter (See the above). The second is lateral hip pain reproduced with resisted hip abduction.
If both tests are positive and the spine has been clear of involvement, the likelihood of having trochanteric pain syndrome goes up 37%. If both are negative, the likelihood decreases by 45%.
Ruling out spinal contribution is incredibly important, as irritated nerves from the lower back can cause these two tests, or any clarifying tests, to be falsely positive. If the pain comes from the spine, the treatment path and area of focus are completely different, so sorting body regions out matters.
So, What Is The Best Course of Action?
Greater Trochanteric Pain Syndrome is largely managed conservatively, with 90% of cases resolving within three months. The treatment involves progressively loading the affected tendons so they can once again resume activities such as sleeping, going from sitting to standing, squatting, sitting cross-legged, or climbing stairs.
The best treatment usually starts with load management and exercise-based rehab. That means reducing tendon pinching, improving hip strength, and correcting movement patterns that overload the outside of the hip. You can do this by avoiding standing on one leg, using pillows between your knees at night, not crossing your legs, and getting a proper assessment to determine whether there are spinal contributions. The spine can either refer pain to the lateral hip and/or cause weakness in the muscles of the hip and pelvis, which can eventually lead to the repetitive-injury condition of greater trochanteric pain syndrome. Sometimes patients are so irritable that they need ways to take the edge off of the lateral hip pain to allow them to be able to engage in therapeutic exercises to begin the process of healing. Those pain-relieving actions typically involve corticosteroid injections into the lateral hip area to reduce inflammation. However, that doesn’t always work. Other modalities, such as dry needling and extracorporeal shockwave therapy, have shown very promising effects on partially torn and degenerated tendons. At this time, neither has been proven better than the other, but as usual, research is constantly changing, which is why we stay on top of what is occurring.
The Big Picture
The most important thing to remember is that lateral hip pain is often a load, tendon, and movement problem all at once. In a mobile spine practice, we think of it as a regional issue, not just a hip issue, because the low back, pelvis, and movement patterns all contribute. It can be very confusing to know where to start putting the puzzle together. If you need guidance on how to delineate this involved presentation, we are here for you. Don’t wait, reach out!
Sources:
Ghorbani, M., Parsa, A., Esmaeilian, S., Moshtaghioon, S.A., Mirzaei, M., Rahmanipour, E., Daskareh, M., Mohammadi, M., 2026. Unlocking relief: Exploring non-operative solutions for recalcitrant greater trochanteric pain syndrome; a systematic review and meta-analysis. Journal of Orthopaedic Reports 5, 100662.
Jacobson, J.A., Yablon, C.M., Henning, P.T., Kazmers, I.S., Urquhart, A., Hallstrom, B., Bedi, A., Parameswaran, A., 2016. Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet‐Rich Plasma Injection for Treatment of Gluteal Tendinosis. J of Ultrasound Medicine 35, 2413–2420.
Kinsella, R., Semciw, A.I., Hawke, L.J., Stoney, J., Choong, P.F.M., Dowsey, M.M., 2024. Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome: A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy 54, 26–49.
Li, Z., Chen, Y., Chen, L., He, J., 2025. Comparing Dry Needle Therapy and Extracorporeal Shockwave Therapy for Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Archives of Rehabilitation Research and Clinical Translation 7, 100432.
Pumarejo Gomez L, Li D, Childress JM. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis) [Updated 2024 Feb 25].
