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GTPS in Active Individuals: Causes and Treatments

Writer's picture: Piotr KarcinskiPiotr Karcinski

GTPS, a medical abbreviation for Greater Trochanteric Pain Syndrome, is a frequently encountered but commonly misunderstood and misdiagnosed condition affecting active people, especially those who run and hike. This persistent outer hip discomfort can cause severe pain, limit your everyday movements, and halt your sports performance. Understanding GTPS is crucial for early intervention and effective management, allowing you to maintain an active lifestyle without compromising your hip health.


In this comprehensive guide, we'll explore the details of GTPS, its etiology (causes), symptoms, and various treatment options - including emerging ones such as shockwave therapy and guided injections. For both patients experiencing hip pain and medical practitioners looking to enhance their expertise, this guide offers essential information about GTPS care and prevention.


What is GTPS?

GTPS describes a group of symptoms marked by discomfort and sensitivity in regions around the greater trochanter. This is the outer hip area, a prominent bone projection on the external portion of your femur. The anatomy involved in GTPS includes:


  1. Greater trochanter: It is the large, bony projection on the upper part of the femur

  2. Gluteal tendons: These are non-bony, but tough cartilaginous insertions of the gluteus medius and minimus muscles onto the greater trochanter.

  3. Bursae: These are variable size fluid-filled sacs in the hip joint that reduce friction between bones and other connective tissues.


GTPS was previously known as trochanteric bursitis, but research has shown that the condition involves more than just inflammation of the bursa. It often encompasses tendinopathy of the gluteal tendons and other soft tissue disorders in the region.


The Etiology of GTPS: Understanding the Root Causes

A complete understanding of the etiology and risk factors of GTPS is crucial for its successful management and prevention. Several factors are involved in the development of this GTPS - including;


  1. Overuse and repetitive stress: Engaging in activities that involve repetitive hip movements, such as running or cycling, can lead to micro-trauma and inflammation in the affected area. This strain accumulates over time, especially during high-impact exercises and prolonged training sessions.


  2. Biomechanical abnormalities: Structural irregularities such as uneven leg lengths, overpronation of the feet during walking, or misaligned pelvic positioning can significantly disrupt your natural walking pattern and place undue strain on various hip components and surrounding tissues.


  3. Muscle imbalances: When hip abductor muscles (gluteus medius and minimus) become weak, they disrupt normal movement patterns and biomechanics of the hip joint. This dysfunction places excessive stress and strain on the greater trochanteric area.


  4. Trauma: Physical injuries from direct impacts, falls, or accidents affecting the hip region commonly trigger Greater Trochanteric Pain Syndrome symptoms.


  5. Age and gender: GTPS predominantly affects women, especially those in their middle years and beyond. This higher prevalence may be attributed to female-specific hormonal fluctuations and distinct anatomical characteristics of the female pelvis.


  6. Obesity: Carrying extra body weight significantly increases pressure on hip joints, causing strain on both bones and surrounding soft tissues.


  7. Underlying conditions: Chronic joint diseases like osteoarthritis and rheumatoid arthritis, along with various inflammatory disorders, can trigger GTPS development.


Conservative Treatment Approaches for GTPS

Conservative management is the cornerstone of GTPS treatment, with most cases responding well to non-invasive approaches. Here are some effective conservative strategies:


1.    Rest and activity modification:

●     Temporarily reduce or avoid activities that exacerbate your symptoms

●     Engaged in exercises having low impact on body (e.g., stationary cycling and swimming)


2.    Physical therapy:

●     Strengthening exercises for hip abductors and core muscles

●     Various stretching techniques to improve flexibility and range of motion

●     Gait retraining to optimize biomechanics

3.    Pain management:


●     Over-the-counter NSAIDs (e.g., ibuprofen) to reduce pain and inflammation

●     Topical analgesics for localized pain relief

●     Ice or heat therapy, depending on individual response


4.    Supportive devices:

●     Orthotic inserts to address foot pronation issues

●     Temporary use of a cane or crutch to offload the affected hip


5.    Lifestyle modifications:

●     Weight reduction and maintenance to reduce stress on the hip joint

●     Ergonomic work environment and adjustments at home to minimize hip strain


By consistently applying these conservative measures, many individuals experience significant improvement in their GTPS symptoms within 4-6 weeks.


Shockwave Therapy: A Promising Treatment for GTPS


Extracorporeal Shockwave Therapy (ESWT) is a form of shockwave therapy that stands out as an effective non-surgical treatment for GTPS. This advanced method delivers powerful sound waves to promote tissue repair. Here's what you should understand about shockwave therapy for GTPS:


1.    How it works:

Sound energy waves or acoustic waves are delivered to the target area. These waves penetrate deep into the affected tissue and create microtrauma, triggering the body's natural healing response. The treatment promotes neovascularization and collagen production


2.    Benefits of shockwave therapy:

ESWT is a non-invasive procedure with proven results, short treatment sessions, minimal side effects, and a quick recovery time. There is no need for local anesthesia or post-session medication.


3.    Treatment protocol:

ESWT usually involves 3-5 sessions, spaced 1 week apart. Results of shockwave therapy may be noticeable after the first session, however, its true healing power is linked to a continued improvement over time.


4.    Effectiveness:

A large-scale 2020 study has shown significant pain reduction and functional improvement in The study shows that patients with chronic GTPS pain may particularly benefit from ESWT sessions who haven't responded to other conservative treatments. (1)


5.    Considerations:

ESWT should be performed by a trained professional and is not recommended for lactating mothers, pregnant women, or individuals with certain medical conditions. It may cause temporary redness and soreness in the targeted area. It's essential to discuss this treatment modality with your provider to determine if you are a right candidate for this treatment.


The Role of Guided Injections in GTPS Management


When conservative measures and shockwave therapy don't provide sufficient relief, guided injections may be considered as part of your GTPS treatment plan. These injections typically involve corticosteroids or other therapeutic substances delivered precisely to the affected area. Here's an overview of guided injections for GTPS:


1.    Types of injections:

●     Steroid injections: Reduce pain and inflammation

●     Platelet-Rich Plasma (PRP) injections: Promote tissue healing using your own blood components

●     Hyaluronic acid injections: Improve lubrication and reduce friction in the affected area


2.    Guidance techniques:

●     Ultrasound-guided injections: Real-time visualization ensures accurate placement

●     Fluoroscopy-guided injections: X-ray guidance for precise needle positioning


3.    Benefits of guided injections:

●     Targeted delivery of medication to the specific site of pain

●     Minimizes risk of injecting into surrounding tissues or blood vessels

●     Can provide both diagnostic and therapeutic benefits


4.    Procedure overview:

●     A local anesthetic agent is used to numb the skin

●     The needle is inserted under imaging guidance

●     The medication is slowly injected into the target area

●     The procedure typically takes 15-30 minutes


5.    Post-injection care:

●     Rest the affected hip for 24-48 hours

●     Apply ice to reduce any post-injection soreness

●     Gradually resume the daily activities


Conclusion

GTPS can cause varying degrees of hip discomfort and prevent you from living an active life. You should seek professional help if you're worried about your hip condition or noticing signs of GTPS. Visit a qualified orthopedic specialist or sports medicine to get an accurate assessment and customized treatment strategy. This may include ESWT and guided injections - both are advanced, precision-focused treatments offering effective, non-surgical solutions for pain relief and tissue repair.

Remember, prompt diagnosis and treatment helps avoid long-term complications and gets you back to your routine activities you love. Book your visit today to start your journey to pain-free movement!

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