Greater trochanteric pain syndrome (GTPS) has replaced the older diagnosis of "trochanteric bursitis" in most clinical literature. The shift reflects what imaging and histology have shown over the last twenty years: most lateral hip pain in runners is gluteal tendinopathy (primarily of the gluteus medius and minimus tendons), with bursal involvement secondary or absent. Long et al. (2013), Mellor et al. (2018), and Grimaldi and Fearon (2015) collectively reframed the condition. This article reviews the current evidence-based treatment protocol for runners.
The aim is rigour. Where evidence is strong, I will cite it. Where it is weaker, I will say so. GTPS is one of those conditions where running culture ("stretch, rest, anti-inflammatories") and current research ("progressive load, education, gait modification") diverge sharply.
The condition reframed
Greater trochanteric pain syndrome refers to lateral hip pain over or near the greater trochanter, often radiating down the lateral thigh. The underlying pathology, demonstrated by Bird et al. (2001) and subsequent imaging studies, is predominantly tendinopathy of the gluteus medius and gluteus minimus tendons at their insertion on the greater trochanter, often with associated thickening of the iliotibial band overlying the area. True isolated bursitis is uncommon.
Why the reframing matters for treatment
If the pathology is tendinopathy, the principles of management are progressive loading rather than passive treatment. Cook and Purdam's continuum model (2009) applies here: degenerative tendons need controlled load to rebuild collagen capacity, not rest and anti-inflammatories. Mellor et al. (2018) in their landmark LEAP trial (BMJ) demonstrated that exercise plus education outperformed corticosteroid injection at 8 weeks for GTPS, and the gap widened by 12 months.
The clinical presentation
Lateral hip pain reproduced by direct palpation of the greater trochanter, single-leg stance, and side-lying on the affected hip. Pain often worsens at night when lying on the affected side. Stair-climbing aggravates symptoms in moderate cases. Distance runners report pain that worsens through long runs and persists for hours afterwards.
The LEAP trial and the evidence hierarchy
The Mellor et al. (2018) LEAP trial is the strongest single piece of evidence for GTPS management in runners and active adults.
Study design and findings
A randomised controlled trial comparing education plus exercise (EDX), corticosteroid injection (CSI), and wait-and-see for GTPS. At 8 weeks, the EDX group reported higher global improvement than both other groups. At 52 weeks, the EDX group maintained superior outcomes. The implication is clear: passive treatment, even with the symptom relief of injection, produces inferior long-term outcomes compared to structured exercise.
What the exercise programme looked like
The LEAP exercise programme combined isometric loading, isotonic loading, education on managing daily activity (sitting positions, sleep positions, gait), and gradual progression. Sessions were 30 to 40 minutes, performed several times per week, supervised by a physiotherapist for the initial period. The programme is reproducible and forms the basis for most current clinical protocols.
The evidence-based protocol
The structure below synthesises the LEAP findings with broader tendinopathy literature (Goom et al., 2016; Reiman et al., 2012; the JOSPT clinical guidelines).
Phase 1: Symptom calming (Weeks 1 to 2)
Identify the load. Reduce weekly running volume by 30 to 40 percent. Cut hills, downhill running, and speed work. Modify daily activity: avoid sitting with legs crossed, avoid prolonged single-leg standing while holding the affected leg in adduction, sleep with a pillow between the knees if side-sleeping on the unaffected side. Begin isometric loading: side-lying clams, single-leg glute bridges held statically for 30 to 45 seconds, side planks held for 20 to 30 seconds. Two to three sessions per week.
Phase 2: Progressive loading (Weeks 3 to 8)
Add isotonic loading. Side-lying clams with band resistance (3 sets of 8 to 12), single-leg glute bridges with progression (3 sets of 8 to 12), side planks with hip lifts (3 sets of 8 to 10 per side), step-ups (3 sets of 8 to 10 per side), single-leg deadlifts (3 sets of 6 to 8 per side). Two to three sessions per week. Progress load every two weeks. Browse the STRIDD exercise library for the full programme.
Phase 3: Functional integration (Weeks 9 to 12)
Add functional patterns. Lateral lunges, step-downs (Bulgarian split squats can be added if tolerated), single-leg balance with perturbation, gait drills. Return to easy running, beginning with walk-run intervals and progressing through the standard return-to-run framework. Avoid hills until symptom-free in continuous easy running for two weeks.
Phase 4: Specificity (Weeks 13 onwards)
Goal-race specificity. Strength sessions continue twice per week indefinitely. Recurrence in GTPS is associated with cessation of strength work after symptom resolution. Build a plan in the STRIDD plan generator that respects current load tolerance, not pre-injury volume.
Education: the under-appreciated component
The LEAP trial's effect size was driven partly by structured education. The mechanism is plausible: daily life loads the affected tendon repeatedly, and most patients are unaware of which positions provoke symptoms.
Daily activity modifications
Avoid sitting with legs crossed for prolonged periods. When standing, distribute weight evenly across both legs rather than "hanging" on one hip. Avoid carrying a child or heavy bag on the affected hip. When climbing stairs, lead with the unaffected leg if symptoms are acute. Sleep on the unaffected side with a pillow between the knees, or supine.
The gait check
Several gait patterns associate with GTPS in biomechanical analyses. Increased contralateral pelvic drop during stance increases lateral hip load. Cross-over gait (foot strike inside the midline) similarly increases lateral hip load. Heiderscheit et al. (2011) demonstrated that increasing step rate by 5 to 10 percent reduces these patterns. Target cadence around 170 to 180 steps per minute by shortening stride and quickening turnover.
Adjunctive interventions and their evidence
Several adjunctive interventions are commonly considered. The evidence quality varies.
Corticosteroid injection
Mellor et al. (2018) demonstrated short-term symptom relief inferior to exercise plus education, and clearly worse outcomes at 52 weeks. Brinks et al. (2011) showed similar short-term improvement with significant recurrence by 12 months. Injection has a defined role as a bridge for severe symptoms that prevent participation in rehabilitation, not as a definitive treatment.
Extracorporeal shockwave therapy
Furia et al. (2009) and Rompe et al. (2009) demonstrated modest improvements in symptoms compared to home exercise alone. The evidence is moderate. Available at most major Indian sports clinics. Reasonable adjunct for cases plateauing on exercise alone.
Platelet-rich plasma (PRP)
The evidence base is mixed. Fitzpatrick et al. (2018) showed PRP outperformed corticosteroid injection at 12 weeks, but the comparison is against an inferior comparator. Direct comparison to structured exercise is sparse. Not a first-line intervention.
Surgical management
Reserved for refractory cases that have failed 6 to 12 months of structured non-operative care. Endoscopic bursectomy and tendon repair have reasonable outcomes but with non-trivial recovery times. Not a routine consideration for runners.
Monitoring and expected timeline
Most runners with GTPS see meaningful symptom improvement within 6 to 8 weeks of starting structured exercise plus education. Full return to pre-injury training typically takes 12 to 16 weeks. Chronic or recurrent cases require longer timelines.
The monitoring framework
Daily morning stiffness in the lateral hip is a useful proxy for tendon irritation. Pain on the first 5 minutes of any run is an early signal of re-irritation. Pain that wakes the runner at night, even with the unaffected side down, indicates the protocol is too aggressive. Read the STRIDD recovery guide for the structured return-to-run framework.
When to escalate care
If symptoms have not improved meaningfully after 8 weeks of structured exercise and education, escalate to a sports physician or orthopaedic specialist for imaging and consideration of adjunctive interventions. Read the STRIDD injuries hub for the wider clinical context. For more research-grounded guides, visit the Running Lab.