Why We’re Seeing More of This
As Exercise Physiologists, we’ve noticed a significant uptick in women presenting with
lateral hip pain – particularly Greater Trochanteric Pain Syndrome (GTPS). Whether
you’ve been told you have “hip bursitis,” trochanteric bursitis, or gluteal tendinopathy,
you’re likely dealing with the same condition that affects up to 25% of women at some
point in their lives.
What Exactly Is GTPS?
Greater Trochanteric Pain Syndrome is an umbrella term for pain on the outside of your
hip, specifically around the bony prominence you can feel on the side of your thigh.
While it was traditionally blamed on inflamed bursa (fluid-filled sacs that cushion the
hip), we now understand that the primary issue is usually gluteal tendinopathy—a
problem with the tendons of your gluteus medius and minimus muscles.
Think of it like this: your gluteal tendons act as critical stabilizers for your pelvis and hip.
When they’re overloaded or underperforming, they become irritated, weakened, and
painful.
What We Look For Clinically
When assessing GTPS, here’s what we’re investigating:
Pain Patterns:
- Sharp or aching pain on the outer hip that may radiate down the thigh
- Worse when lying on the affected side at night
- Aggravated by stairs, walking (especially uphill), standing on one leg, or crossing
your legs - Often develops gradually rather than from a single injury
Movement Assessment:
- Trendelenburg gait pattern (hip dropping on the opposite side when walking)
- Reduced hip strength, particularly in hip abduction and external rotation
- Compensatory movement patterns—often using your back or other muscles to
make up for weak glutes - Poor single-leg balance and control
Contributing Factors We Often See:
- Sudden increases in activity (“too much, too soon”).
- Prolonged sitting or a sedentary lifestyle leading to deconditioning.
- Hormonal changes, particularly perimenopause and menopause.
- Biomechanical factors like leg length differences or foot mechanics.
The Exercise Physiologist Approach: What You Can Do
The good news? GTPS responds exceptionally well to a structured exercise program.
Here’s our evidence-based approach:
1. Modify Aggravating Activities (Temporarily)
We don’t want you to stop moving, but we do need to reduce the load on irritated
tendons:
- Avoid sitting with legs crossed
- Use a pillow between your knees when sleeping on your side
- Temporarily reduce high-impact activities like running or high-intensity interval
training - Avoid stretching into pain, particularly those common hip stretches where you
pull your knee across your body
2. Strengthen Progressively
This is where the magic happens. We focus on rebuilding capacity in your gluteal
muscles through a carefully graded program:
Early Stage (Weeks 1-3):
- Isometric exercises (holding positions without movement)
- Gentle resistance band work in pain-free ranges
- Focus on muscle activation and control
- Hydrotherapy/aquatic exercises – an excellent option for early-stage
management
The buoyancy of water reduces load on the hip while still allowing movement and muscle activation. Water- based exercises are particularly beneficial if land-based activities are too painful initially. Pool walking, gentle leg lifts, and hip abduction exercises in waist-deep water provide a safe environment to begin strengthening without excessive tendon load. The hydrostatic pressure can also help reduce any inflammation present. Many of our clients find hydrotherapy sessions 2-3 times per week in the early stages help kickstart their recovery while maintaining fitness and confidence in movement.
Mid Stage (Weeks 4-8):
- Progressive loading with resistance bands and weights
- Single-leg exercises for stability
- Functional movements like squats, lunges, and step-ups
Late Stage (Weeks 8-12+):
- Higher-load strength training
- Plyometric exercises (if relevant to your goals)
- Return to sport or recreational activities
- Energy storage and release exercises for the tendon
3. Address Movement Patterns
We’ll work on:
- Improving your walking and running mechanics
- Correcting Trendelenburg patterns
- Strengthening your core and hip stabilizers
- Ensuring proper activation sequencing of your muscles
4. Load Management
One of the most critical pieces—learning how much is too much:
- Gradual progression is key (we typically increase load by no more than 10% per
- week)
- Monitoring your pain response (some discomfort during exercise is acceptable,
but it shouldn’t linger for more than 24 hours) - Building in adequate recovery between sessions
Frequently Asked Questions
Q: How long until I feel better? Most people start noticing improvements within 4-6 weeks of a consistent exercise program, but full recovery typically takes 3-6 months. Tendons heal slowly—patience and consistency are crucial.
Q: Should I get a cortisone injection? While cortisone can provide short-term pain relief, research shows that exercise-based rehabilitation produces better long-term outcomes. We generally recommend trying a structured exercise program first. If you do opt for an injection, it should be combined with—not replace—exercise therapy.
Q: Can I still exercise with GTPS? Absolutely! In fact, exercise is the cornerstone of treatment. We’ll modify your program to avoid aggravating positions while maintaining your fitness. Swimming, cycling (with seat height adjustments), and upper body work are usually well-tolerated.
Q: Will this come back? If you address the underlying strength deficits and movement patterns, your risk of recurrence is significantly reduced. This is why we emphasize not just getting out of pain, but building robust, resilient hips for the long term.
Q: I’ve had this for years—is it too late? Not at all. While chronic GTPS can take longer to rehabilitate, we regularly see excellent outcomes in people who’ve had symptoms for months or even years. The key is committing to the process.
Q: Why do women get this more than men? This is one of the most common questions we receive, and the answer is multifaceted:
Biomechanical Factors: Women typically have a wider pelvis (to accommodate childbirth), which changes the angle at which the femur (thigh bone) meets the hip socket. This increased Q-angle creates greater mechanical stress on the gluteal tendons, particularly during weight-bearing activities. The wider pelvis also means the gluteus medius and minimus muscles have to work harder to stabilize the pelvis during single-leg stance—something we do thousands of times per day just walking.
Hormonal Influences: Estrogen plays a significant role in maintaining tendon health and collagen integrity. During perimenopause and menopause, declining estrogen levels can reduce the tensile strength and elasticity of tendons, making them more vulnerable to injury and slower to heal. This is why we often see a spike in GTPS cases in women aged 40-60. Post-menopausal women may also experience changes in body composition, with reduced muscle mass (sarcopenia) that can further compromise hip stability.
Pregnancy and Postpartum Changes: Pregnancy brings additional challenges—the hormone relaxin loosens ligaments to prepare for childbirth, which can affect hip stability. The growing belly shifts the center of gravity forward, altering movement mechanics and placing additional demands on the gluteal muscles. Many women also experience weakened deep core and pelvic floor muscles postpartum, which can contribute to altered hip mechanics and increased load on the gluteal tendons.
Historical Strength Training Gaps: Traditionally, women’s fitness programs emphasized cardiovascular exercise and flexibility over progressive strength training, particularly for the lower body. This has left many women with underdeveloped gluteal strength relative to their activity demands. The good news is this trend is changing, and we’re seeing more women engage in strength training—which is exactly what we need for GTPS prevention.
Movement Pattern Differences: Research shows women tend to move with less hip and knee flexion during activities like landing from jumps or going down stairs, placing more stress on the hip tendons. Women also tend to have greater knee valgus (knees caving inward) during single-leg tasks, which increases lateral hip loading.
Understanding these factors helps us tailor treatment approaches specifically for women and emphasizes why strength training and load management are so crucial for both treatment and prevention.
Q: What about stretching? Contrary to popular belief, excessive stretching—especially positions that compress the hip tendons—can actually aggravate GTPS. We focus on targeted strengthening first, with gentle mobility work as needed.
When to Seek Help
You should consult with an Exercise Physiologist or physiotherapist if:
- Pain persists despite rest and activity modification
- Pain is significantly affecting your sleep, work, or daily activities
- You’re unsure how to start an appropriate exercise program
- You want to prevent this from becoming a chronic issue
The Bottom Line
Greater Trochanteric Pain Syndrome is frustrating, but it’s also highly treatable. As Exercise Physiologists, we see this condition respond beautifully to well-designed, progressive loading programs. The key is getting the right diagnosis, understanding what’s driving your symptoms, and committing to a structured rehabilitation approach.
Your hips are designed to be strong, stable, and resilient. With the right guidance and effort, we can get them back to doing what they do best—supporting you in all the activities you love.