In contrast, tendon-related pain such as GTPS is usually felt on the outside of the hip, often tender to touch, and aggravated by lying on the affected side, prolonged standing, or walking. It may radiate down the outer thigh. GTPS is most common in adults aged 40–60 and is more prevalent in women. Risk factors include altered hip biomechanics, weak gluteal muscles, increased body weight, and prolonged single-leg loading activities such as standing or walking.
Assessment involves a detailed clinical history and physical examination, including movement analysis, strength testing, and functional tasks to help differentiate between joint and tendon-related pain. Ultrasound imaging is a reliable, evidence-based tool used to identify tendon pathology (such as thickening or tearing), bursitis, and joint-related changes, and is particularly useful in guiding targeted treatments.
Management is individualised and evidence-based. Exercise therapy is the cornerstone of treatment, focusing on improving hip strength, control, and load tolerance. Manual therapy may be used alongside exercise to improve joint mobility and reduce pain. For persistent tendon-related pain such as GTPS, shockwave therapy has good evidence for improving pain and function. Injection therapies, including corticosteroid or image-guided injections, may be considered in selected cases to reduce pain and support rehabilitation. A combined approach addressing both symptoms and underlying risk factors provides the best long-term outcomes.