Can Greater Trochanteric Pain Syndrome (GTPS) be caused by overuse from activities such as running and hiking?

Greater Trochanteric Pain Syndrome and Overuse from Running and Hiking

Yes, Greater Trochanteric Pain Syndrome (GTPS) can be caused by overuse from activities such as running and hiking due to the repetitive mechanical stress these activities place on the gluteal tendons and surrounding structures. 1

Etiology of GTPS Related to Running and Hiking

• GTPS is the most prevalent of all lower limb tendinopathies, affecting 1 in 4 women over 50 years of age and commonly individuals in their fifth and sixth decades regardless of activity level 1
• The condition originates from degenerative changes in the hip abductor tendon insertions and surrounding bursae, which can be exacerbated by repetitive high-impact activities like running 1
• Mechanical causes of pain related to running include repetitive high-impact mechanics that can cause damage to soft tissues, similar to how running impacts the intestinal lining in studies of gastrointestinal distress 2
• The repetitive impact trauma from running, especially on hard or uneven surfaces during hiking, contributes to tendon degeneration over time 2

Biomechanical Factors

• Faulty mechanics during functional activities, particularly loss of pelvic control in the frontal plane due to hip abductor weakness, play a significant role in developing GTPS 3
• Running and hiking on uneven terrain (common in trail running and hiking) can exacerbate these biomechanical issues by creating additional stress on the hip abductors 3
• Abnormal hip biomechanics, whether congenital or acquired through repetitive activities, can significantly worsen GTPS symptoms 1

Pathophysiology

• GTPS involves degeneration of the normally highly arranged collagen fiber structure in the tendon, resulting in collagen disorientation and fiber separation 4
• Most cases represent chronic tendinosis rather than acute inflammation, particularly in runners who continue training despite early symptoms 4
• The condition typically presents with insidious onset of load-related localized pain on the lateral hip, coinciding with increased activity levels such as intensified running or hiking regimens 4

Clinical Presentation in Runners and Hikers

• Pain is typically described as "sharp" or "stabbing" and is exacerbated by activities that load the tendon, such as navigating stairs, hills, or uneven terrain common in hiking 4
• Symptoms often worsen after prolonged periods of activity and may be particularly noticeable after long runs or hikes 4
• Pain may also be present during prolonged sitting after activity, which is common when runners or hikers rest after their activities 4

Management for Active Individuals

• Activity modifications are the first-line approach for runners and hikers with GTPS, which may include reducing mileage, avoiding hills, or temporarily switching to lower-impact activities 1
• Eccentric strengthening exercises should be the primary treatment approach as they reduce symptoms, increase strength, and promote tendon healing 4
• Relative rest to decrease repetitive loading of the damaged tendon is essential, but complete immobilization should be avoided 4
• For recalcitrant cases, additional treatments may include corticosteroid iontophoresis or extracorporeal shock wave therapy 4

Prevention Strategies for Runners and Hikers

• Gradual progression of training volume and intensity to allow proper adaptation of tendon tissue 3
• Implementation of hip-strengthening exercises, particularly targeting the gluteus medius and minimus 3
• Proper footwear selection and consideration of terrain variability to minimize excessive mechanical stress 2
• Addressing biomechanical abnormalities through targeted exercises and potentially gait retraining 3

The mechanical stress from repetitive impact activities like running and hiking is a well-established contributor to GTPS, particularly when combined with individual biomechanical factors and training errors. Management should focus on addressing both the symptoms and the underlying mechanical causes to allow for safe return to activity.