GREATER TROCHANTERIC PAIN SYNDROME (GTPS)
Greater Trochanteric Pain Syndrome (GTPS), also known as trochanteric bursitis or hip bursitis, is a condition characterised by pain and tenderness over the greater trochanter, which is the bony prominence on the side of the hip.
Causes
- The involved structures at the outer side of the hip includes the gluteus medius and minimus tendons and the greater trochanteric bursa, which is a fluid-filled sac that helps reduce friction between the greater trochanter and the overlying muscles and tendons.
- Muscle imbalance, overuse and abnormal hip biomechanics can result in the impingement of the gluteus medius and minimus tendons and bursa onto the greater trochanter of the hip. This results in inflammation of the trochanteric bursa and tendinopathy of the gluteal muscles, which causes pain over the lateral hip.
Common Signs and Symptoms
- Pain: Typically, individuals with GTPS experience pain on the outer side of the hip. The pain may radiate down the thigh and is often exacerbated by activities such as walking, climbing stairs, or lying on the affected side.
- Tenderness: The area around the greater trochanter may be tender to the touch.
- Swelling: Some individuals may experience swelling around the hip.
How Can Physiotherapy Help?
Assessment and Diagnosis: Physiotherapists perform a thorough assessment to identify the specific factors contributing to hip pain. This may include evaluating muscle strength, flexibility, joint mobility, and biomechanics of specific activities.
Gait and Biomechanical Analysis: Physiotherapists may analyse the individual’s gait (walking pattern) and biomechanics to identify any abnormalities that could contribute to hip pain. Corrections and modifications can then be suggested.
Education: Physiotherapists can educate patients about GTPS, its causes, and strategies for symptom management. This may include advice on modifying activities, improving posture, and adopting proper body mechanics to reduce stress on the hip.
Manual Therapy: soft tissue release to tight muscles, cryotherapy, therapeutic ultrasound and joint mobilisation may be employed by physiotherapists to reduce pain, relieve muscle tension and improve mobility.
Exercise Prescription: Tailored exercise programs are designed to address muscle imbalances, strengthen weak muscles, and improve flexibility. Specific exercises may target the muscles around the hip joint, including the gluteal muscles, hip abductors, and core muscles.
FEMOROACETABULAR IMPINGEMENT (FAI)
Femoroacetabular Impingement (FAI) is a hip joint disorder characterised by abnormal contact between the femoral head (the ball-shaped top of the thigh bone) and the acetabulum (the hip socket). This abnormal contact can lead to friction, pain, and potential damage to the hip joint. FAI is often classified into 3 main types: cam impingement (excess bone on the femoral head), pincer impingement (extra bone extends out over the normal rim of the acetabulum) and combined (both cam and pincer are present).
Causes
- Structural Abnormalities: FAI is commonly associated with structural abnormalities in the hip joint, such as a misshapen femoral head or acetabulum, leading to improper joint mechanics.
- Genetics: There may be a genetic predisposition to FAI, where certain individuals are more prone to developing abnormal hip anatomy.
- Repetitive hip movements: Activities that involve repetitive hip motion or excessive hip flexion, such as certain sports or occupations, may contribute to the development of FAI.
Common Signs and Symptoms
- Hip pain: individuals may experience persistent pain in the groin or outer hip. Pain may be exacerbated by activities that involve hip flexion, rotation, or prolonged sitting.
- Limited range of motion: Individuals with FAI may experience stiffness and a reduced range of motion in the hip joint.
- Painful clicking or catching sensation: some individuals may also complain of a clicking or catching sensation in the hip joint, especially during certain movements.
How Can Physiotherapy Help?
Patient education and activity modification: The physiotherapist can advise you to modify or avoid certain activities or positions that aggravate symptoms, which promotes healing and prevents further damage.
Pain management: Heat therapy and mobilisation of the hip joint may be employed to alleviate discomfort. Specific stretching exercises can also reduce stiffness in the hip.
Gait analysis: your physiotherapist may assess and correct gait abnormalities, which can contribute to hip pain in individuals with FAI.
Individualised exercise program: Your physiotherapist can design personalised exercise programs to address muscle imbalances and improve hip joint stability through specific strengthening exercises targeting the hip muscles.
