Learning Objectives:
On session completion, participants will:
1. Be aware of biopsychosocial factors involved in the presentation of GTPS, implications for management and the current evidence for various management approaches
2. Understand the rationale and current evidence for exercise and load management approaches for GTPS and identify current gaps and future research directions.
3. Be aware of the recommended core outcomes to be used in research and clinical practice of GTPS
Description: Greater trochanteric pain syndrome (GTPS) is a common condition characterised by pain and tenderness over the greater trochanter, which adversely affects function and quality of life. It encompasses tendinopathy of the gluteus medius and minimus tendons (gluteal tendinopathy) with or without distention of the trochanteric bursae. Traditionally, corticosteroid injection (CSI) has been a first-line intervention despite concerns regarding long-term impacts on local soft tissues. In recent years, studies elucidating alterations in musculotendinous morphology and function, kinetics and kinematics, in this patient population (Allison et al, 2015; Allison et al., 2016) provided the basis for innovation of management techniques through integration of this evidence-base. Emerging evidence shows that pain may not just be nociceptive in nature, and psychological factors may contribute to the complexity and severity of the clinical presentation and require consideration in management (Plinsinga et al., 2018; French et al., 2019).
As tendinopathy is recognised as the most common pathology, focussing on exercise and load management is justified. Randomised controlled trials investigating exercise for gluteal tendinopathy/GTPS have been undertaken (Mellor et al., 2018; Clifford et al., 2019; Ganderton et al., 2018; Cowan et al., 2022)), with varying results. This symposium will explore the pathological basis and principles underpinning exercise and load management, current evidence, and gaps remaining in relation to the role of exercise for gluteal tendinopathy. Exploratory analysis of results from the landmark LEAP trial, which compared exercise and education to CSI or wait-and-see, identified underlying causal mechanisms and patient features that may influence the observed treatment effects of exercise and education. These findings will be discussed in the symposium (Mellor et al., 2022).
While education and exercise provide the framework for management of GTPS, other interventions used in clinical practice such as shockwave therapy and platelet rich plasma (PRP) injection have also been investigated. The current evidence for these interventions will also be presented, as well as adjunctive therapies such as dynamic tape (Robinson et al., 2019) and orthotics (Hunter et al., 2023), that have been used with the aim of reducing the increased hip adductor moment seen in this population (Allison et al., 2016).
To continue to build the evidence on the optimal management approaches for gluteal tendinopathy, it is important that standardised use of outcome measures to determine treatment effectiveness are applied in clinical practice and research (Nasser et al, 2022). A core set of outcome domains have been devised for use in gluteal tendinopathy trials, and the results of this 6-stage process to develop this core set will be presented during this symposium.
Implications/Conclusion: Until recently, gluteal tendinopathy/GTPS was a poorly understood condition, with the literature suggesting that physiotherapy treatments had little to offer those with GTPS. Over the last few years, a substantial body of evidence has evolved regarding physical and psychological impairments associated with GTPS and the success of targeted load management and exercise, laying a solid foundation for a more efficacious management approach. Current gaps in our knowledge and evidence, with recommendations for future research and implementation into practice will be presented during the symposium.

Implications/Conclusion: Gluteal tendinopathy/GTPS is one of the most common painful tendon conditions assessed by medical practitioners and physiotherapists, causing disability equal to that of severe hip osteoarthritis, imposing a substantial health and economic burden. Current evidence indicates this is a complex condition with physical and psychosocial features. This symposium will focus on the increasing body of, and often conflicting, evidence for different management approaches, as well as highlighting the importance of using consistent core outcomes in research and practice to determine treatment effectiveness.