Facet Joints

Behind the Neck Pain: What You Need to Know About Cervical Facet Joints

Physiotherapy for Trochanteric Hip Pain:
The Science Behind Long-Term Relief

Understanding Trochanteric Hip Pain: More Than Just a “Hip Bursitis”

If you've ever experienced a deep, nagging pain on the outside of your hip especially when lying on your side, walking uphill, or crossing your legs, you might be dealing with what's commonly referred to as trochanteric hip pain. While many people call this "hip bursitis," the true cause is often related to the tendons of your hip muscles, particularly the gluteal tendons.

What Is Trochanteric Hip Pain?

Trochanteric pain refers to discomfort around the greater trochanter, the bony point on the outer side of your hip. For a long time, this pain was blamed on inflammation of the trochanteric bursa—a small fluid-filled sac meant to reduce friction. However, current research shows that the real issue in most cases is gluteal tendinopathy, a condition where the tendons of your gluteus medius and minimus become irritated or degenerated.

While bursitis can be present, it usually occurs alongside tendon problems rather than being the main issue.

Who Is Most Affected?

Trochanteric pain is most common in:

Post-menopausal women – likely due to hormonal changes that affect tendon health
Postpartum women – the drop in estrogen during breastfeeding may impact tendon strength
Individuals with hip osteoarthritis or after a hip replacement
Those with acetabular dysplasia (a condition affecting hip joint shape) – due to higher stress placed on the hip muscles

What About the IT Band?

It used to be thought that a tight iliotibial band (ITB) contributed significantly to outer hip pain. But the latest evidence suggests that stretching the ITB or other aggressive stretches might actually worsen symptoms by putting more pressure on the affected tendons. Instead, treatment should be individualized and based on a full-body assessment.

Is a Corticosteroid Injection the Answer?

Steroid injections are sometimes offered for quick pain relief, and while they can help in the short term, they’re not the best long-term solution.

Here’s why:

· The benefits often don’t last longer than placebo or dry needling

· They can negatively impact tendon health over time

· Relying on injections may lead to less healthy movement habits

· Exercise and education consistently provide better long-term outcomes

Tendon Tears – Do You Always Need Surgery?

Partial tears of the gluteal tendons are fairly common in people over 50 and usually don’t require surgery. They can often be managed conservatively with physiotherapy.

Even full-thickness tears don’t always cause severe disability and can sometimes be managed without an operation, depending on the size and symptoms.

What Can You Do About It?

Physiotherapy is the gold standard for managing gluteal tendinopathy. A good rehab plan includes:

· Education about how to avoid positions and movements that put pressure on the tendons (e.g. lying on the sore side, sitting with crossed legs, or deep hip stretches)

· Controlled exercise to improve tendon strength without overloading

· Isometric exercises, like pressing the leg out to the side against resistance, which are often pain-relieving

· Guidance on activity pacing – sudden increases in walking, running, or jumping can trigger symptoms

· Teaching patients to track their 24-hour pain response to ensure exercises are helping, not hurting

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References

Blankenbaker, D.G., Ullrick, S.R., Davis, K.W., De Smet, A.A., Haaland, B. & Fine, J.P., ‘MR Imaging of the Hip: Prevalence of Findings in Asymptomatic Volunteers’, Radiology, 248(3), 2008, pp. 904–910.
Fearon, A.M., Scarvell, J.M., Neeman, T.M., Cook, J.L. & Cormick, W., ‘Greater trochanteric pain syndrome: defining the clinical syndrome’, British Journal of Sports Medicine, 44(10), 2010, pp. 658–662.
Lange, T., Ferber, R., Bizzini, M. & Stark, T., ‘Consensus statement on clinical classification criteria for greater trochanteric pain syndrome’, Journal of Orthopaedic & Sports Physical Therapy, 52(4), 2022, pp. 211–221.
Long, S.S., Surrey, D.E. & Nazarian, L.N., ‘Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis’, AJR American Journal of Roentgenology, 2013, 201(5), pp. 1083–1086.
Gordon, E.J., ‘The trochanteric syndrome’, The Journal of Bone and Joint Surgery. American Volume, 43(6), 1961, pp. 1130–1134.
Ruangchaijatuporn, T., Chung, C.B., Hughes, T., Statum, S., Bae, W.C. & Trudell, D., ‘MR anatomy of the gluteus medius and minimus tendon insertions and bursae: Cadaveric correlation’, Skeletal Radiology, 46(4), 2017, pp. 531–544.
Moerenhout, K., Zsidai, B., Dora, C. & Sutter, R., ‘Gluteus Medius and Minimus Tendinopathy: Clinical Features, Diagnosis, and Management’, EFORT Open Reviews, 6(2), 2021, pp. 145–151.
Ganderton, C., Cook, J., Semciw, A., Byrt, A., & Pizzari, T., ‘Gluteal loading versus corticosteroid injection for greater trochanteric pain syndrome: a randomized controlled trial’, BMJ Open, 7(10), 2017a, e014087.
Ganderton, C., Semciw, A., Cook, J., & Pizzari, T., ‘Greater trochanteric pain syndrome: An evaluation of the clinical utility of five physical tests’, Clinical Journal of Sport Medicine, 27(4), 2017b, pp. 405–410.
Garzón, J., Mc Auliffe, S., Pietrosimone, B., & Vicenzino, B., ‘Exercise Therapy and Education Versus Corticosteroid Injection for Gluteal Tendinopathy: A Systematic Review and Meta-analysis’, Journal of Orthopaedic & Sports Physical Therapy, 54(1), 2024, pp. 30–42.