Nonpharmacological management for greater trochanteric pain syndrome

Nonpharmacological management for greater trochanteric pain syndrome is determined by the nature of the identified pathology. Discuss the natural history of greater trochanteric pain syndrome with the person, including their concerns, goals and expectations, and a proposed management plan including self-management. Discuss that greater trochanteric pain syndrome is usually associated with gluteal tendinopathy but avoid terms such as ‘degenerative’ and ‘inflammation’. Emphasise the concept that tendinopathy is associated with temporary overload of the tendon(s). Encourage maintenance of general physical fitness.

For people with suspected gluteal tendinopathy, see Management principles for tendinopathy. Advise people to specifically avoid compression of the gluteal tendons near the greater trochanter (eg avoid stretching of the iliotibial band, leg-crossing, hip-hanging, and lying on the affected side). If necessary, a pillow can be placed between the knees when sitting or lying down to reduce compression.

Exercise for people with suspected gluteal tendinopathy aims to improve the tensile strength of the gluteus medius and minimus tendons. The most appropriate exercise program has not been clearly defined.

A 2020 review¹ indicated that studies looking at the efficacy of physiotherapeutic protocols for gluteal tendinopathy are limitedde Castro, 2020. It suggested that nonsurgical treatment should be first line, recommending specific exercises in conjunction with tendon management and gradual load increase.

Some people may benefit from a specific exercise program to address muscle imbalance contributing to compression loading of the gluteal tendonsBoyd, 2020. Encourage them to persist with their exercise program even if symptom relief is achieved with analgesia, because exercise is likely to prevent recurrence of symptomsMarin-Pena, 2020.