Physical Therapy Guide to Greater Trochanteric Bursitis
Greater trochanteric bursitis (GTB) is one of the most common causes of hip pain. Although GTB affects both active and inactive individuals, it is most commonly diagnosed in moderately active, middle-aged females or those who have recently increased their activity level. In all individuals, pain on the outside of the hip from GTB can result in a limited ability to lie on the involved side, walk, climb stairs, squat, or participate in recreational activities. Physical therapists treat people experiencing GTB with a combination of stretching, strengthening, and movement retraining activities to decrease irritation in the hip, resolve pain, and help restore normal function.
What is Greater Trochanteric Bursitis?
Greater trochanteric bursitis (GTB) is an irritation of the bursa, a fluid-filled sac that sits on top of the greater trochanter, a bony prominence on the outside of the hip bone (femur). The bursa acts as a cushion to decrease friction between the outside of the hip bone and muscles attaching to the bone; bursitis results when the bursa on the outside of the hip bone becomes irritated. Greater trochanteric pain syndrome is the term used when the condition also includes irritation to the tendons of the gluteal muscles that sit beneath the bursa.
Most often, GTB is the result of repetitive friction to the bursa due to a combination of muscle weakness and tightness affecting the outside of the hip. The condition is most often treated with physical therapy to restore normal function.
GTB may result from a combination of several different variables, including:
- Gluteal muscle weakness
- Iliotibial (IT) band (a thick band of tissue that runs along the outside of the leg from the pelvis to the knee) tightness
- Hip muscle tightness
- Abnormal hip or knee structure
- Abnormal hip or knee mechanics (movement)
- Improper movement technique with repetitive activities
- Change in an exercise routine or sport activity
- Improper footwear
How Does It Feel?
People with GTB may experience:
- Tenderness to touch on the outside of the hip
- Pain that can vary from sharp to dull, and can radiate to the buttock, groin, thigh, or knee
- Pain that is intermittent and symptomatic for a prolonged period
- Pain when lying on the involved side
- Pain and stiffness with prolonged sitting, walking (worst with the first few steps), negotiating stairs, or squatting
- Pain that may increase during prolonged activity
How Is It Diagnosed?
The goals of the initial examination are to assess the degree of the injury, and determine the cause and contributing factors to it. GTB is a condition that develops as a consequence of repetitive irritation in the hip; it seldom results from a single injury. Your physical therapist will begin by gathering information about your condition, including your health history and your current symptoms. Your therapist will then examine your hip and thigh region to determine the presence of GTB. Your physical therapist may ask you questions about:
- Your health history
- Your current symptoms and how they may affect your typical day
- The location and intensity of your pain, and how it may vary during the day
- How the pain affects your activity level, and what you do to reduce the pain
- How any injury may have occurred prior to your symptoms developing
- How you have sought treatment, such as seeing other health care practitioners or having imaging or other tests done
Your physical examination will focus on the region of your symptoms, but also include other areas that may have been affected as your body has adjusted to pain. Your physical therapist may watch you walk, step onto a stair, squat, or balance on one leg. Following the interview and physical examination, your physical therapist will assess the results and develop an individualized treatment program to address your specific condition and goals.
Imaging techniques, such as X-ray or MRI, are typically not needed to diagnose GTB.
How Can a Physical Therapist Help?
You and your physical therapist will work together to develop a plan to help achieve your specific goals. To do so, your physical therapist will select treatment strategies in any or all of the following areas:
- Patient education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as the type and amount of exercises you perform, your athletic activities, or your footwear. Your therapist will recommend improvements in your daily activities, and develop a personalized exercise program to help ensure a pain-free return to your desired activity level.
- Pain management. Your physical therapist will design a program to address your pain that includes applying ice to the affected area as well as a trial of heat, such as a hot shower or heating pad. The exercises discussed below also can have a pain-reducing component. Your physical therapist also may recommend decreasing some activities that cause pain. Physical therapists are experts in prescribing pain-management techniques that reduce or eliminate the need for medication.
- Range-of-motion exercise. Your low back, hip, or knee joint may be moving improperly, causing increased tension at the greater trochanter. Your physical therapist may teach you self-stretching techniques to decrease tension and help restore normal motion in the back, hip, and knee.
- Manual therapy. Your physical therapist may apply “hands-on” treatments to gently move your muscles and joints, most likely in your low back, hip, or thigh. These techniques help improve motion and strength, and often address areas that are difficult to treat on your own.
- Muscle strength. Muscle weaknesses or imbalances can result in excessive strain at the greater trochanter. Based on your specific condition, your physical therapist will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremity. You may begin by performing strengthening exercises lying on a table or at home on the bed or floor (eg, lifting your leg up while lying in different positions). You then may advance to exercises in a standing position (eg, standing squats). Your physical therapist will choose what exercises are right for you based on your age and physical condition.
- Functional training. Once your pain, strength, and motion improve you will need to safely transition back into more demanding activities. To minimize the tension on the hip and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your own unique movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely.
Physical therapy promotes recovery from GTB by addressing issues, such as pain in the body structure, that is under stress from any lack of strength, flexibility, or body control. Your physical therapist may also recommend a period of relative rest, then help you slowly resume activities and carefully guide your progression. When GTB remains untreated, however, your pain will persist and result in long-term difficulty performing your desired activities.
Can This Injury or Condition Be Prevented?
GTB may be the result of changes in the body’s shape, such as one leg being longer or shorter on the involved side. This condition can occur from an injury to the lower extremity or subtle differences that occur in the body’s growth and development.
Maintaining appropriate lower-extremity mobility and muscle strength, and paying particular attention to your exercise routine—especially changes in an exercise activity, the volume of exercises performed, and your footwear—are the best methods for preventing GTB.
Your physical therapist will help guide you through a process that will progressively reintegrate more demanding activities into your routine without overstraining your hip. Keep in mind that returning to activities too soon after injury can cause the condition to be more difficult to fix, and often leads to persistent pain.
Real Life Experiences
Karen is a 47-year-old teacher who is training for her first 5K road race. She runs 3 to 4 days each week, then walks the other days. Over the past 2 weeks, she has begun to experience pain in the outside of her right hip. Her pain is worse while running and lying on her right side; she experiences hip pain and stiffness when taking her first steps in the morning and walking up stairs, and also notes a dull ache with prolonged sitting and standing. She typically performs stretches for 5 minutes before her runs. Karen had not run consistently before she began training for the 5K.
Karen is concerned about the sharp hip pain she feels when running and her inability to complete her training due to pain. She is worried about her ability to perform daily activities and train for her upcoming race. She decides to seek the help of a physical therapist.
Karen's physical therapist takes a full history of her condition. Karen describes her typical daily running routine, including distance, pace, and running surface; her stretching routine; and her footwear. Her physical therapist then assesses Karen’s motion, strength, balance, movement, and running mechanics. He skillfully palpates (gently presses on) the front, side, and back of her hip to determine the precise location of her pain. Based on these findings, he diagnoses greater trochanteric bursitis.
Karen and her physical therapist work together to establish short- and long-term goals and identify immediate treatment priorities, including icing and stretching to decrease her pain, as well as gentle hip-strengthening exercises. They also discuss temporary alternative methods for Karen to maintain her fitness without continuing to aggravate her injury and prolong her recovery, such as swimming or biking. She is also prescribed a home-exercise program consisting of a series of activities to perform daily to help speed her recovery.
Together, they outline a 4-week rehabilitation program. Karen sees her physical therapist 1 to 2 times each week. He assesses her progress, performs manual therapy techniques, and advances her exercise program as appropriate. He advises her as to when she can begin to carefully resume running, and establishes a day-by-day plan to help her safely build back up to her desired mileage. Karen performs an independent daily exercise routine at home, including stretching and strengthening activities, which her physical therapist modifies as she regains strength and movement.
After 4 weeks of patient work, Karen no longer experiences pain or stiffness in her hip, and resumes her desired training program in preparation for her upcoming 5K race.
On the day of the race, Karen runs pain free and crosses the finish line in a personal best time!
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat greater trochanteric bursitis. However, you may want to consider:
- A physical therapist who is experienced in treating people with greater trochanteric bursitis. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have greater trochanteric bursitis.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of greater trochanteric bursitis. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Tan LA, Benkli B, Tuchman A, et al. High prevalence of greater trochanteric pain syndrome among patients presenting to spine clinic for evaluation of degenerative lumbar pathologies. J Clin Neurosci. 2018;53:89–91. Article Summary in PubMed.
Mulligan EP, Middleton EF, Brunette M. Evaluation and management of greater trochanter pain syndrome. Phys Ther Sport. 2015;16(3):205–214. Article Summary in PubMed.
Grumet RC, Frank RM, Slabaugh MA, et al. Lateral hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2010;2(3):191–196. Free Article.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Allison Mumbleau, PT, DPT, SCS. Revised by Caleb Pagliero, PT, of APTA's Academy of Orthopaedic Physical Therapy. Reviewed by APTA Section liaison.