Greater trochanteric pain syndrome — side hip pain explained (Seremban & Nilai)

The 'greater trochanter' is the bony bump on the outside of your upper thigh — the one you can feel with a thumb. Running over it are two gluteal tendons (gluteus medius and minimus) that stabilise your pelvis when you stand on one leg. Underneath the tendons sit small fluid-filled sacs called bursae. For decades we called this 'trochanteric bursitis' — but modern imaging and surgical studies show the bursa is only inflamed in a minority of cases. The real issue is usually tendon compression and overload, similar to other tendinopathies. Why does that matter? Because naming it correctly changes treatment. A bursitis framing leads to rest + injection + rest. A tendon framing leads to controlled loading, which is far more effective. Classic presentation: pain on the outside of the hip, worse lying on the painful side at night, worse after sitting with legs crossed, worse on stairs or single-leg activities. Referred pain can go down the outer thigh (not usually below the knee).

Not every hip-area pain is GTPS. The three common causes we screen in our Seremban 2 and Nilai clinics: (1) GTPS — pain localised to the bony bump on the outside; worst lying on that side; reproduced by single-leg standing for 30 seconds. Often in Seremban Chinatown seniors and Bandar Sri Sendayan young families (toddler hip-carry). (2) Hip osteoarthritis — pain deeper in the groin or front of the hip, stiffness with prolonged sitting, reduced range of internal rotation. Common in Port Dickson retirees and Rembau smallholding farmers. (3) Lumbar referred pain — pain radiating from the lower back into the buttock and outer hip, often with numbness or altered sensation, aggravated by specific spine positions. Common in daily Seremban–KL commuters and Senawang shift-workers. These three can coexist — and often do in patients over 60 — which is why a 20-minute assessment matters more than a single test. Imaging is rarely needed for simple GTPS; we only order MRI if rehab has not moved the pain at all after 12 weeks, or if we suspect a gluteal tendon tear.

Step 1 — reduce compression. The gluteal tendons get pinched when the hip crosses midline. So: stop sitting with legs crossed, avoid sleeping with the top leg dropped in front (use a pillow between your knees), and for mothers, alternate hips when you carry your toddler. Step 2 — isometric gluteal holds (week 1–2). Stand beside a wall, push the hip away from the wall against the wall, hold 30 seconds, 5 reps, twice a day. Pain during the hold should stay under 3/10. This desensitises the tendon and starts rebuilding tolerance. Step 3 — progressive strengthening (week 3–8). Side-lying clams, side-planks with progressions, step-ups, and single-leg work. 3 sessions a week, heavy enough that the last 3 reps are hard. Step 4 — return to loading. Stairs, hills, then running or sports for those who do them. We monitor the 24-hour pain response. What about injections? A cortisone injection can break a pain cycle that stops you sleeping — reasonable as a one-off adjunct if night pain is relentless. Repeated injections weaken the tendons and are avoided. Shockwave has modest evidence. Surgery (gluteal tendon repair) is reserved for confirmed full-thickness tears failing 6+ months of rehab.

Most side hip pain is safely managed by a physio. But please go to Hospital Tuanku Ja'afar (HTJ) A&E same day if you have any of the following: (1) recent fall onto the hip with severe pain and inability to weight-bear — rule out hip fracture, especially in older adults; (2) hot, red, swollen hip with fever — rule out septic bursitis or joint infection; (3) sudden inability to lift the leg off the bed with severe pain — possible acute gluteal tendon rupture; (4) hip pain with saddle-area numbness, new bladder/bowel problems, or progressive leg weakness — possible cauda equina, neurosurgical emergency; (5) night pain with weight loss, fever, or a history of cancer — rule out bone lesion. If you had recent hip surgery and have wound redness, leaking, or new severe pain, contact your surgeon urgently. Everything else is almost always safe to rehab with physio.