"Trochanteric Bursitis" is often Gluteal Enthesopathy

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Patient guide to Greater Trochanteric Pain Syndrome

My approach has evolved in how to treat and prescribe exercises to patients with lateral hip pain or greater trochanteric pain syndrome (GTPS). In the majority of GTPS cases, the gluteal tendons and their attachment sites to the hip are causing pain not a bursitis.

Gluteal Tendinopathy and Enthesopathy Treatment

If you are reading this you probably have been diagnosed with a gluteal tendinopathy or enthesopathy (the attachment site of the tendon to the bone). I hope this post helps provide some helpful information, and if you are in my area make an appointment. Through the decades, I have refined my approach to the point where I now have great success treating gluteal enthesopathy:

myofascial release of the gluteus medius, with a focus on the anterior fibers and the TFL
hip abduction exercises starting with low pain isometrics ( contract the muscle against something, with no movement)
manage the load on the tendons through exercise and education on the underlying pathomechanics
Gluteal enthesopathies (GE) are treated differently than a bursitis! An exercise approach of high load isometrics progressing to eccentrics, is recommended for GE.
strengthen the hip stabilizers
address any weakness or tightness of all lower extremity muscles and joints

Evidence:

evidence that gluteal tendinopathy is more common than trochanteric bursitis. A research review was published in 2015
often imaging tests do not reveal any obvious abnormality in patients with lateral hip pain
after one year 36% (29% after five years) of GTPS cases are still symptomatic
2015 study found that patients with glute tendinopathy on one side had weakness of the glutes on both side
a high prevalence of cases have leg length discrepancy, ITB syndrome or OA at the knee, suggesting a lower limb biomechanical link
2016 study revealed, “Individuals with gluteal tendinopathy exhibit greater hip adduction moments and alterations in trunk and pelvic kinematics during walking. Findings provide a basis to consider frontal plane pelvic control in the management of gluteal tendinopathy.”

“The cause of lateral hip pain is usually some combination of pathology involving the gluteus medius and gluteus minimus tendons as well as the iliotibial band. Bursitis is present in only the minority of patients. These findings have implications for treatment of this common condition.” 2013 study of 877 patients