Greater Trochanteric Pain Syndrome (GTPS) causes persistent pain on the outer side of the hip, an area that bears significant load during movement. Walking is a primary form of exercise and a necessary daily activity, making the relationship between this condition and ambulation a major concern for sufferers. The dilemma is whether continuing to walk will maintain mobility or further aggravate the irritated tissues. Understanding the specific biomechanical forces at play is necessary to turn walking from a potential source of pain into a tool for recovery.
Understanding Greater Trochanteric Pain Syndrome (GTPS)
GTPS causes lateral hip pain and tenderness, often incorrectly referred to as trochanteric bursitis. The primary issue is typically tendinopathy of the gluteus medius and gluteus minimus muscles, which attach to the greater trochanter on the femur. While the trochanteric bursa may become inflamed, this is often a secondary complication resulting from the underlying tendon issue.
GTPS is classified as a load management problem, meaning the tendons have been overloaded beyond their current capacity to adapt. The pain stems from soft tissues responsible for stabilizing the pelvis during activities like standing and walking, not from a joint problem like arthritis. The tendinopathy involves a breakdown of collagen fibers due to overuse or sudden stress, leading to pain and dysfunction.
The gluteal tendons are subjected to two main types of mechanical strain: tensile load (stretching) and compressive load (squashing). During walking, the tendons are stretched as the leg moves backward and compressed against the greater trochanter as the hip moves across the midline. Successfully managing GTPS requires reducing both these loads on the affected tendons.
Walking: The Critical Considerations
Walking is not inherently detrimental for GTPS; movement is necessary to promote tendon health by encouraging blood flow and adaptation. The key concept is “load tolerance,” which is the amount of activity the affected tendon can handle without a pain flare-up. The goal is to walk at an intensity and duration that provides a beneficial stimulus without exceeding the tendon’s current capacity.
Walking aggravates GTPS primarily through two mechanisms related to hip mechanics. The first is high tensile load, which occurs with longer strides, causing the tendons to stretch aggressively at the end of the step. The second is excessive compression, often seen when the pelvis drops on the side opposite the painful hip during the single-leg stance phase. This pelvic drop increases the angle at which the gluteal tendons press against the greater trochanter.
A practical rule for monitoring activity is the 24-hour pain response. If a walk causes an increase in hip pain that does not return to the baseline level within a day, the activity exceeded the tendon’s load tolerance. Conversely, walking that results in minimal pain during the activity, and no lasting increase afterward, is considered therapeutic and should be maintained.
Modifying Walking Technique and Environment
Modifying walking mechanics is necessary to reduce the forces on the gluteal tendons. A primary modification involves shortening the stride length, which minimizes the stretch on the gluteal muscles at the end of the swing phase. Consciously taking smaller steps reduces the overall tension placed on the tendon insertion point.
Increasing the walking cadence, or the number of steps taken per minute, is often beneficial alongside a shorter stride. A faster foot turnover rate decreases the amount of time spent in the single-leg stance phase on the affected side. Since the highest loads occur during this single-leg support, reducing its duration effectively lowers the overall strain on the tendon.
Environmental Adjustments
The environment where walking takes place plays a significant role in load management. Walking up or down steep inclines should be avoided, as both motions increase the mechanical load on the gluteal tendons. Downhill walking, in particular, increases compression as the body decelerates with each step. Switching from hard surfaces like concrete to slightly softer surfaces, such as paved paths or grass, can help absorb some impact forces.
Footwear and Gait
Footwear choice should focus on support rather than extreme cushioning or minimalist design. Stable, supportive shoes help maintain proper foot and ankle alignment, which indirectly supports optimal hip mechanics during the walking cycle. Avoiding excessive hip adduction, where the painful knee moves inward toward the midline, is a goal that can be assisted by supportive shoes and conscious effort during gait.
Essential Non-Walking Management Strategies
Walking modification alone is rarely sufficient to resolve GTPS; targeted therapeutic exercises are necessary to increase the tendon’s capacity to handle load. Rehabilitation involves strengthening the gluteal muscles, especially the gluteus medius and minimus. This process typically begins with isometric exercises, which involve holding a muscle contraction without movement to reduce pain.
The strengthening program must progress to isotonic or heavy slow resistance exercises, such as bridges, step-ups, or side-stepping with a resistance band. These exercises are performed slowly and deliberately to promote tendon remodeling and build the strength needed to stabilize the pelvis during walking. Strengthening the hip abductors is important because weakness in these muscles contributes directly to pelvic drop and increased compression during single-leg stance.
Postural and Sleep Modifications
Daily postural habits must be addressed to reduce chronic compression on the greater trochanter. Individuals should avoid standing with the hips swayed out to the side or resting weight predominantly on one leg, often called “hanging on the hip.” These postures put the hip in adduction, which presses the tendons against the bone.
Sitting and sleeping positions also require modification to prevent unnecessary tendon compression. Avoid crossing the legs while sitting, as this causes the affected hip to adduct excessively. When sleeping, avoid lying directly on the painful side. If sleeping on the unaffected side, place a pillow between the knees to prevent the top leg from dropping and compressing the gluteal tendons.