Greater trochanteric pain syndrome (GTPS) is, in the recent musculoskeletal literature, the preferred umbrella term for what older textbooks called trochanteric bursitis. The shift in terminology is not cosmetic. A 2013 paper by Grimaldi and colleagues, and subsequent work in the British Journal of Sports Medicine, made it clear that the dominant pathology in this region is gluteal tendinopathy of the gluteus medius and minimus, not isolated bursal inflammation. For the running population in India, that distinction changes how we screen, examine, and rehabilitate the condition.
This article walks through what the current evidence says about the causes and clinical diagnosis of GTPS in runners. Where the data is strong, I will say so. Where it is uncertain or conflicting, I will say that too. The aim is to give you a framework you can act on with your physiotherapist, not a self-diagnosis kit.
What we mean by greater trochanteric pain syndrome
The greater trochanter is the bony prominence on the lateral side of the upper femur. Around it sit the gluteus medius and minimus tendons, multiple bursae, and the iliotibial band. GTPS describes pain in this region, often with point tenderness over the trochanter, frequently aggravated by single-leg stance, side-lying on the affected hip, and prolonged running.
A 2016 systematic review in BJSM by Mellor and colleagues found that gluteal tendinopathy is the dominant tissue-level pathology in around 80 percent of GTPS presentations. Bursitis, when present, is usually secondary. This matters for treatment: tendinopathy responds to progressive loading, while bursitis-first thinking encourages rest and corticosteroids, which the longer-horizon data suggests are inferior to a structured loading programme.
Who tends to get it
The epidemiological evidence consistently points to higher prevalence in women, particularly between ages 40 and 60, with a smaller but real cohort of younger female runners. For Indian runners specifically, there is no large published cohort yet, but my reading of clinic data from sports physios I trust in Bengaluru, Pune, and Delhi maps closely to the international pattern. The condition is under-diagnosed in male runners, partly because the clinical picture overlaps with iliotibial band syndrome and adductor strain.
The mechanical and training-load drivers
The current consensus, summarised in Mellor's 2018 LEAP trial protocol and the 2021 narrative review by Reid in JOSPT, is that GTPS arises from compressive and tensile load mismatch at the gluteal tendons. Two mechanisms dominate.
The first is excessive hip adduction during stance phase. When the contralateral pelvis drops, the gluteal tendons are compressed against the trochanter. Repeated loading in this position, particularly under fatigue, drives tendinopathic change.
The second is a sudden change in training load. The data on training-load spikes and overuse injury is consistent across sports. Gabbett's work on acute-to-chronic workload ratios, while debated in its specific numerical thresholds, supports the broader principle that runners who add more than roughly 30 percent volume in a week, or who introduce new hill work without progression, are at elevated risk of lateral hip pain.
Indian context: the practical patterns
In the clinics I have spoken to, three patterns recur. Marathon training cycles that compress the long-run progression into eight to ten weeks instead of sixteen. Sudden hill introduction for runners preparing for the Tata Mumbai Marathon or the Vedanta Delhi Half. And cross-training shifts, particularly from cycling to running, where the hip extensor pattern is under-developed for the demands of weight-bearing impact. None of this is uniquely Indian, but the calendar pressure of the November-to-March race season in India creates a predictable annual cluster of GTPS cases.
How clinicians diagnose GTPS
Diagnosis is primarily clinical. Imaging supplements the picture; it does not lead it. The 2018 LEAP trial used a defined clinical cluster, and similar criteria appear in most current guidelines.
The core features are pain localised over or just posterior to the greater trochanter, often radiating down the lateral thigh but typically not below the knee. Pain with single-leg stance for 30 seconds is a useful provocation test, with reasonable sensitivity in the published literature. Pain when side-lying on the affected hip, particularly at night, is reported in the majority of cases.
Resisted external derotation in 90 degrees of hip flexion, described by Lequesne and colleagues in 2008, is one of the more specific clinical tests. Resisted hip abduction in side-lying, with the hip in neutral, also provokes the gluteal tendons. No single test is definitive; the diagnosis rests on a cluster of findings.
When imaging adds value
Ultrasound and MRI both demonstrate gluteal tendon pathology with reasonable agreement. The 2017 work by Long and colleagues in the American Journal of Roentgenology reported good correlation between MRI findings and clinical GTPS. That said, imaging findings are common in asymptomatic individuals. A 2018 paper by Ho and colleagues found gluteal tendon abnormalities on MRI in around 30 percent of asymptomatic adults over 50. Imaging confirms the picture; it does not substitute for clinical reasoning.
For runners in India, I would not recommend imaging as a first step. The clinical pattern is usually clear enough, and the cost of a quality MRI in metro cities sits in the four to eight thousand rupee range, which is not trivial. Discuss imaging with a sports physiotherapist or sports physician who can interpret the clinical context first.
Differential diagnoses you cannot afford to miss
Lateral hip pain in a runner has several plausible causes. The 2019 review in Sports Medicine by Reid usefully sets out the differentials.
Iliotibial band syndrome typically presents with pain more distally, over the lateral femoral condyle near the knee, and aggravation on downhill running. Femoroacetabular impingement and labral pathology usually produce groin or anterior hip pain rather than lateral. Lumbar referred pain, particularly from L4 or L5 nerve roots, can mimic lateral hip pain but usually carries paraesthesia and a positive slump or straight-leg-raise test.
Hip osteoarthritis is more common in the older runner and presents with stiffness, reduced internal rotation, and groin-dominant pain. Stress fractures of the femoral neck are rare but serious; pain that worsens with weight-bearing and is reproduced on the single-leg hop test warrants urgent imaging. For a broader treatment of overuse injuries in this region, our injuries hub collects the evidence-based articles in one place.
The role of biomechanical assessment
A 2-D or 3-D gait analysis, where available, adds useful detail. The features associated with GTPS are increased contralateral pelvic drop and increased hip adduction during stance. The 2015 work by Bramah in BJSM linked higher pelvic drop angles with running injury risk generally. Gait analysis in India is now reasonably accessible in Bengaluru, Pune, Mumbai, and Delhi at sports performance centres; cost ranges from around three to seven thousand rupees depending on the facility.
From diagnosis to next steps
A confirmed clinical diagnosis of GTPS opens a defined treatment pathway. The LEAP trial demonstrated that an education plus exercise programme produced better outcomes at eight weeks compared to corticosteroid injection or wait-and-see, and the benefit was sustained at 52 weeks. The implication is unambiguous: progressive gluteal loading is the foundation. Corticosteroid injections may offer short-term symptom relief but do not improve long-term outcomes.
The specifics of that loading programme, and the return-to-running pathway, sit in our companion articles. For exercise prescriptions, see the structured progressions in our exercises library. For the recovery framework that wraps around it, see our recovery guides. The broader landscape of running injuries is mapped in the Running Lab.
If you are planning your return to structured training after a GTPS episode, the STRIDD plan generator can build a load-managed plan that respects the four to eight week tendon adaptation window the current literature describes. The most common cause of recurrence is not failed rehab; it is a too-fast return to volume. The data is consistent on that point.