Which hip‑loading activities exacerbate greater trochanteric pain?

Hip-Loading Activities That Worsen Greater Trochanteric Pain

Activities involving repetitive hip loading, prolonged sitting, stair navigation, and high-impact movements consistently exacerbate greater trochanteric pain and should be avoided or modified during acute phases of the condition. 1, 2

Primary Aggravating Activities

Stair Navigation and Incline Walking

• Navigating stairs (both ascending and descending) significantly worsens symptoms by increasing repetitive loading on the damaged tendon and bursa 2
• This activity requires forceful hip abductor muscle contraction to stabilize the pelvis, directly stressing the gluteus medius and minimus tendons 2

Prolonged Sitting

• Extended periods of sitting exacerbate lateral hip pain due to direct compression of the trochanteric bursa and surrounding soft tissues 2
• This is particularly problematic when sitting on hard surfaces or with legs crossed, which increases pressure over the greater trochanter 2

Repetitive Loading Activities

• Any activity involving repetitive loading of the affected hip area should be modified or avoided, as recommended by the American College of Sports Medicine 1
• This includes repetitive pivoting movements, acceleration activities, and sports requiring rapid changes in direction 3

High-Impact Activities to Avoid

High-Impact Aerobic Training

• High-impact aerobic training involves rapid application of loads across joint structures and should be avoided, as advised by the American Geriatrics Society 1
• This includes running, jumping, and plyometric exercises during acute phases 1

Activities Requiring Hip Adduction Under Load

• Activities involving forceful hip adduction can stress the lateral hip structures, though the primary pathology involves the abductor mechanism 3
• Sports involving acceleration, repetitive movements, and pivoting (such as ice hockey and soccer) can aggravate symptoms 3

Positional and Postural Aggravators

Side-Lying on Affected Hip

• Lying directly on the affected side compresses the trochanteric bursa and inflamed tissues, reproducing pain 4, 5
• This is actually used diagnostically—tenderness to palpation over the greater trochanter with the patient in side-lying position is a classic finding 5

Single-Leg Weight-Bearing Activities

• Activities requiring prolonged single-leg stance increase demand on hip abductor muscles and can worsen symptoms 6
• This includes activities like standing on one leg while dressing or stepping up onto elevated surfaces 6

Clinical Considerations for Activity Modification

The Biomechanical Rationale

• The gluteus medius and minimus tendons attach to the greater trochanter and are responsible for hip abduction and pelvic stabilization 5, 7
• Repetitive or sustained contraction of these muscles during weight-bearing activities creates tensile stress on already damaged tendons and inflamed bursal tissue 7
• Poor hip and pelvic control during unilateral support positions (such as gait) may contribute to abnormal loading patterns 6

Important Caveats

• Differentiation between trochanteric bursitis and gluteus medius/minimus tendinosis can be difficult, and the two conditions frequently coexist, as noted by the American College of Sports Medicine 1, 2
• The same activities that aggravate bursitis will typically worsen tendinopathy, making activity modification universally important regardless of the specific pathology 1, 2

Recommended Modifications

• Activity modification to decrease repetitive loading of the damaged tendon and bursa is recommended by the American College of Sports Medicine as a first-line intervention 1
• Land-based physical therapy interventions are conditionally recommended over aquatic therapy, though aquatic exercise may allow for movement with reduced loading during acute phases 1
• Eccentric strengthening exercises are particularly effective for tendon healing once acute symptoms subside, but should be introduced gradually 2