Greater trochanteric pain syndrome (GTPS) -- commonly but often inaccurately called trochanteric bursitis -- is among the most common causes of lateral hip pain in adults over 40. It encompasses inflammation of the trochanteric bursa and, more commonly, gluteal tendinopathy at the greater trochanter. The lateral hip pain it causes is worsened by specific loading patterns that occur during walking and by positions that increase tension through the iliotibial band.
Pain Mechanics in GTPS
GTPS pain is triggered or worsened by:
- The hip adductor moment during single-leg stance -- when the contralateral foot is off the ground, the hip must produce a lateral force through the gluteal muscles to prevent pelvic drop
- Compression of the trochanteric bursa and gluteal tendons against the greater trochanter by the overlying iliotibial band
- Activities that load the lateral hip in an adducted position: crossing legs, lying on the affected side, ascending stairs, and walking up inclines
Cane Side Decision: The GTPS Exception
This is the second condition in this series (alongside gluteal tendinopathy specifically) where the standard contralateral cane rule has an important exception.
The standard rule (cane in contralateral hand) is designed to reduce hip joint loading through a moment arm effect. For GTPS specifically, the relevant load is the hip adductor moment -- the lateral force the gluteal muscles must generate during single-leg stance. Research suggests that an ipsilateral cane (same side as the painful hip) reduces this adductor moment more effectively than a contralateral cane for GTPS, by providing a lateral support force that substitutes for the gluteal muscle moment.
This means: if the right hip has GTPS, try the cane in the right hand (ipsilateral), not the left.
This is a contested area with some conflicting evidence, and individual variation exists. A physiotherapist who specialises in GTPS should confirm the cane side -- empirically trying both sides and assessing which reduces pain more during walking is also a valid approach.
Loading Positions to Avoid in GTPS
| Activity / Position | Why It Worsens GTPS | Modification |
|---|---|---|
| Crossing legs when seated | Increases ITB tension over trochanter | Sit with hips level, feet on floor |
| Lying on affected side | Direct compression of bursa | Sleep on unaffected side or back with pillow between knees |
| Ascending stairs | Single-leg loading increases adductor moment | Use handrail; take one step at a time |
| Walking fast pace | Increases adductor moment per unit time | Slower pace; wider stance if comfortable |
| Running or hill walking | Peak hip loading exceeds bursal/tendon threshold | Avoid during acute phase |
Cane Use Pattern in GTPS
GTPS is typically episodic -- pain during flares, significant reduction between them. The cane is most useful during flares when lateral hip pain is limiting walking distance. During remission, the cane may not be needed. This variable pattern requires a cane that is practical for intermittent use -- lightweight and easy to carry or set aside.
View the full DaiWalk cane range. Related: Walking Cane for Tendinopathy | Walking Cane for Hip Osteoarthritis
