GTPS
- Collection of conditions that causes lateral-sided hip pain |
- GT Bursitis |
- ITB syndrome |
- Strain/tendinopathy of hip abductor muscles (more common) |
Causes
- Painful inflammed bursa (GT bursa - inbetween ITB and GT) by acute traum and or repetitive mechanical overloading |
- TFL + ITB tightness - excessive lateral hip compression |
- Hip abductor weakness, foot hyperpronation, pes planus, leg length inequality |
- Glut med weakness allows contralateral pelvis to drop during loading
- Causes excessive thigh adduction and medial rotation
Kinematic chain disruption
Increased tension on ITB and compression of GT bursa |
Risk Factors
- Can occur at any age, but more common in middle aged - elderly population |
- Both active and sedentary populations |
- Common in females |
- Can present bilaterally |
Presentation
- Chronic, persistent pain in the lateral hip, buttock and proximal thigh |
- Provoked by prolonged sitting (legs crossed), transitioning to a standing position, climbing stairs, prolonged standing, high impact activities (running) |
- Limits activity |
- May have an antalgic gait |
- Sleep disturbances - lying on affected side |
- TTP of GT - if TTP in posterior aspect of GT, think glut med. If anterior to GT, think Glut min |
- Hypertonic hip adductors, psoas, TFL, Gluteal and lx muscles |
- PROM painful on adduction or external rotation |
- RROM painful on abduction if glut med tendon involvement (can rule out bursitis) |
- +ve Thomas , Obers test, _ve Trendelenberg, -ve FABER (SI problems) |
Imaging
- Only needed if diagnosis cannot be confirmed clinically ruling out trauma, AVN , OA, osseous FAI |
DDx
- Hip OA |
- FAI |
- Lx radiculopathy |
- AVN |
- Stress f# |
- Avulsion F# |
- Neoplasm |
- Osteoid osteoma |
- Metastasis |
- SCFE |
- LCP |
- Infection |
- Labral injury/tear |
- Iliopsoas tendinopathy/tendinits |
- Chronic mechanical LBP |
- SI dysfunction |
- Meralgia Parasthetica |
- Piriformis syndrome |
- Rheumatologic disease |
- Fibromyalgia |
- Viscerosomatic referral - GI/GU |
Management
- Rest, activity modification and pain relief |
- Ice, US, electrical stimulation, shockwave therapy |
- Stretching and myofascial release of TFL, ITB, external hip rotations, flexors, glut max, quads, hip abductors |
- Foam roller |
- Strengthening of hip abductors and external rotators |
- Proper squatting and hip hinge techniques |
- Orthotics for pronation |
- Check for joint restrictions in Lx, hip and pelvis - SMT/mobilisation |
- Overweight patients should consider weight loss reduction programs |
- NSAIDs |
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