Greater Trochanteric Pain Syndrome (GTPS) is a common source of discomfort located on the outer side of the hip and thigh. This condition can make simple daily activities challenging, especially weight-bearing movement like walking. For those dealing with GTPS, the question of whether to walk or rest presents a significant dilemma. This guide provides actionable steps for safely integrating walking into a management plan.
Understanding Greater Trochanteric Pain Syndrome
Greater Trochanteric Pain Syndrome refers to pain in the soft tissues surrounding the greater trochanter, the bony prominence on the side of the upper thigh bone (femur). Although historically known as trochanteric bursitis, the pain is most frequently caused by gluteal tendinopathy—irritation or degeneration of the gluteus medius and minimus tendons. These tendons attach to the greater trochanter and stabilize the hip during movement.
Symptoms typically include tenderness directly over the outer hip bone and pain that may radiate down the side of the thigh. The pain often worsens with activities that compress the tendons, such as lying directly on the affected side at night or climbing stairs. Prolonged standing, especially leaning onto one leg, can also increase discomfort.
When Walking Helps and When It Hurts
Walking presents a dual challenge for individuals managing GTPS, acting as both a necessary activity and a potential source of aggravation. Movement helps maintain blood flow to the tendons and surrounding tissues, supporting the healing process. Staying mobile also prevents hip stiffness and contributes positively to overall well-being.
However, walking can easily overload an already irritated tendon, particularly during an acute flare-up. The repetitive motion places compressive and tensile forces on the gluteal tendons as they rub over the greater trochanter. This friction is especially pronounced with longer strides or walking up hills.
The decision to walk should be guided by a simple pain monitoring model. If the pain is minor (rated 0-3 on a 10-point scale) and does not significantly increase during or immediately after the activity, the level is acceptable. If walking causes a sharp increase in pain or leaves the hip throbbing for hours afterward, the activity should be temporarily reduced or stopped. The goal is to find a level of activity that promotes tissue loading without causing irritation.
Modifying Your Walk for Pain Relief
When walking is appropriate, several modifications can minimize the load on the irritated hip tendons. One effective adjustment is to shorten your stride length, which reduces the hip adduction and internal rotation that compresses the tendons. Taking smaller, quicker steps helps keep the pressure manageable.
Footwear and Terrain
Choosing appropriate footwear is important, as supportive, well-cushioned shoes help absorb impact forces traveling up the leg to the hip. Softer terrain like dirt paths or grass is preferred over hard concrete or pavement. It is also helpful to avoid walking on steep inclines or hills, as the increased effort significantly loads the gluteal muscles and tendons.
Pacing and Posture
Pacing your activity is another tool for managing symptoms. Instead of attempting one long walk, break it into several shorter outings throughout the day, allowing for frequent rest periods. If you find yourself compensating by leaning or “hip-hitching,” consciously focus on maintaining an upright posture and spreading your weight evenly over both feet.
Strengthening and Postural Adjustments
Long-term management of GTPS requires addressing weakness in the hip abductor muscles, particularly the gluteus medius. Strengthening these muscles helps stabilize the pelvis and reduces excessive tension and compression placed on the tendons during weight-bearing activities. A progressive loading program, beginning with exercises in non-weight-bearing positions, is recommended.
Exercises that target the hip abductors and core stabilizers are beneficial, such as clamshells, side leg lifts, and glute bridges. These movements initially focus on building strength without over-compressing the tendon, and isometric holds are helpful for pain reduction. The goal is a gradual, controlled progression to enable the tissues to adapt and become stronger.
Postural changes also reduce compressive load throughout the day. Avoid sleeping directly on the painful hip; instead, lie on your back with a pillow beneath your knees or on the unaffected side with a pillow placed between the legs for alignment. When sitting, avoid crossing your legs, as this position significantly increases tension on the gluteal tendons.