Greater Trochanter Bursitis?

Recovering from Greater Trochanteric Pain Syndrome: A Physical Therapist's Approach

Greater Trochanteric Pain Syndrome (GTPS) is a common yet often misunderstood condition. As an experienced physical therapist, I’ve seen many patients struggle with the sharp, persistent pain on the outside of the hip that characterizes GTPS. Often misdiagnosed as trochanteric bursitis, we now understand that GTPS is usually due to tendinopathy of the gluteus medius and minimus, along with other structures in the hip.

In this post, I’ll guide you through a structured rehabilitation process designed to help you recover from GTPS. This approach is based on the latest research and my own clinical experience. Whether you're an athlete or someone dealing with chronic hip pain, these phases will help you regain function and return to your normal activities.

Phase 1: Pain Reduction and Load Management

The first step in recovering from GTPS is to reduce pain and manage the load on your hip. If you’re experiencing sharp pain that persists for more than 24 hours after activity, or if you find it difficult to maintain your usual activity levels, it’s crucial to start with pain management.

Activity Modifications: The goal here is to minimize compressive forces on the tendon. Educate yourself on the importance of avoiding positions that worsen your pain. For instance, avoid lying on the affected side and minimize activities that involve crossing your legs or standing with your weight shifted to one side. If walking is painful, consider using a cane or crutches temporarily.

Prolonged Isometric Contractions: These exercises are essential in this phase. Start with isometric exercises, where the muscle contracts without moving the joint. For GTPS, perform these exercises with the hip in a slightly abducted position to avoid compressing the tendon. Aim for 5 repetitions of 45-60 seconds, 2-3 times per day.

Phase 2: Isotonic Loading Progression

Once your pain is under control, the next step is to build strength in the gluteal muscles. Weakness in the gluteus medius and minimus is a common contributor to GTPS.

Heavy, Slow Resistance (HSR) Exercises: Begin with 3-4 sets of concentric-eccentric exercises, starting with 15 repetitions and gradually progressing to 6 reps. It’s important to avoid hip adduction during the early stages of these exercises to prevent tendon compression. As your strength improves and pain decreases, you can increase the range of motion.

Suggested Exercises: Incorporate movements like upright skating, side-stepping, and bridges. These exercises target the gluteal muscles without putting excessive strain on the tendon.

Phase 3: Energy Storage Loading Progression

In this phase, the focus shifts to more dynamic, sport-specific movements. By now, your strength should be nearly symmetrical between both legs, and you should be able to tolerate more challenging exercises.

Sport or Activity-Specific Movements: Begin to reintroduce sport-specific drills and plyometric exercises, such as hopping. Progress slowly, focusing on maintaining proper form and avoiding any positions that might compress the tendon.

Phase 4: Return to Sport/Activity

The final phase involves a gradual return to your normal activities. The key here is to progress slowly and monitor your symptoms carefully. Any increase in pain or discomfort should be a signal to reduce your activity level and possibly revisit the previous phase.

Long-Term Maintenance: To prevent recurrence, it’s essential to maintain a regular exercise routine that includes strength training and dynamic warm-ups. Tendons require consistent loading to maintain their integrity, so don’t neglect your exercises, even in the off-season.

Conclusion

Recovering from GTPS requires patience, consistency, and a structured approach. By following these phases, you can effectively manage your symptoms and return to your normal activities. Remember, the key to success is to listen to your body and make adjustments as needed. If you find yourself struggling or if symptoms persist, consult with a physical therapist who can provide personalized guidance.

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