The femur, commonly known as the thigh bone, stands as the body’s longest and strongest bone, providing the primary structure for the leg. Near the hip joint, the femur features a large, distinct bony projection called the greater trochanter. This prominence is readily felt on the outside of the upper thigh, serving as a significant anatomical landmark for the hip region. Its size and placement establish it as an anchor point, facilitating the complex mechanics of walking, running, and maintaining balance.
Anatomy and Location
The greater trochanter is a prominent, four-sided mass of bone located at the proximal end of the femur where the femoral neck meets the shaft. This protuberance extends laterally and slightly posteriorly, making it the outermost point of the hip region. Its position is slightly lower than the head of the femur, which forms the ball of the hip joint itself.
The structure’s lateral surface is broad and rough, designed to accommodate the powerful attachments of several muscles. It functions like a large knob, increasing the distance between the joint’s center and the muscle attachments. This feature enhances the leverage of the muscles that move the leg. The greater trochanter is easily felt on the side of the hip, making it a common reference point for lateral hip pain.
Role in Movement
The greater trochanter is central to hip mechanics, acting as the primary insertion point for muscles responsible for controlling the leg and stabilizing the pelvis. Specifically, the gluteus medius and gluteus minimus muscles attach directly onto this bony mass. This arrangement allows the muscles to leverage the greater trochanter as a pulley system, converting muscle contraction into movement.
The leverage provided is especially important for abduction, the movement of lifting the leg out to the side. These attached muscles also play a significant role in pelvic stability during single-leg stance activities, such as walking or running. When one foot leaves the ground, the gluteal muscles on the standing leg contract, using the greater trochanter as their fixed point to prevent the pelvis from dropping. This stabilization is fundamental for a smooth, efficient gait.
Understanding Trochanteric Pain Syndrome
The greater trochanter is a common site for pain, often diagnosed as Greater Trochanteric Pain Syndrome (GTPS). This syndrome describes chronic pain felt over the lateral, or outer, aspect of the hip and thigh. Historically, pain was attributed to trochanteric bursitis, the inflammation of the fluid-filled sac that cushions the area. However, current understanding points more frequently to injury of the gluteal tendons.
Gluteal tendinopathy, involving micro-tears or degeneration of the gluteus medius and minimus tendons, is now recognized as a more frequent cause of GTPS. Symptoms typically include a deep, aching or burning pain that worsens over time. Increased pain when lying on the affected side is a common complaint, as this puts direct pressure on the inflamed tissues.
Activities that load the gluteal tendons, such as climbing stairs, long walks, or standing on one leg, often aggravate the pain. GTPS can be triggered by a sudden increase in physical activity, direct trauma, or structural issues like having one leg slightly longer than the other. Prolonged sitting or standing with uneven weight distribution can also contribute by placing excessive load on the tendons. The condition is more prevalent in women between 40 and 60 years old, though it can affect anyone with risk factors like an inactive lifestyle or high body mass index.
Treatment and Rehabilitation
Management of Greater Trochanteric Pain Syndrome begins with conservative, non-surgical approaches, which are successful in the majority of cases. Initial care focuses on reducing inflammation and pain through strategies like applying ice and taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). Activity modification is also necessary, involving temporarily avoiding positions and movements that compress the greater trochanter, such as lying directly on the painful hip.
Physical therapy forms the foundation of long-term recovery, focusing on strengthening the hip abductor muscles. Eccentric exercises, which involve lengthening the muscle while it is under tension, are often recommended to improve the health and capacity of the gluteal tendons. A physical therapist can also help correct movement patterns and poor posture contributing to the issue.
If conservative measures do not provide relief, medical interventions may be considered. Corticosteroid injections can be administered directly into the area to reduce localized inflammation, often providing short-term relief. In rare, chronic cases that persist despite months of rehabilitation, a specialist may evaluate the need for advanced treatments, such as shockwave therapy or surgical repair of the gluteal tendons.