Should you stretch patients with GTPS?
A simple equation
Doctor of Physical Therapy
Should patients with lateral hip pain stretch?
Understanding the compression tradeoff
What is GTPS?
Greater Trochanteric Pain Syndrome: A presentation of symptoms characterized by lateral hip pain around the greater trochanter of the femur.
In short: Pain on the side of the hip
What causes the pain?
This hip pain is caused by irritation and degeneration of the tissues near the greater trochanter. These tissues include gluteal tendons and/or trochanteric bursa.
What causes the degeneration?
These tissues are irritated when the Tensor fascia latae (TFL) muscle and Iliotibial band (ITB) complex undergo tension resulting in compression of the underlying tissues against the greater trochanter.
Simplified Rehab Process
- Decrease TFL-ITB tension
- Less compression of gluteal tendons & bursa
- Less degeneration
- Less pain
- Happy patients
Why Stretching is common
Many clinicians assume that prescribing stretches will result in decreased TFL-ITB tension and overall less degeneration and pain.
This is only half-true, this perspective overlooks the potential harms of stretching.
Stretching does have benefits
After a stretch, the improved muscle extensibility and joint ROM can result in:
- Less ITB tension →
- Less tissue compression →
- Less degeneration →
- Less pain
The Drawbacks of Stretching
During the stretch, tension on the TFL-ITB increases and can cause:
- More compression →
- More degeneration →
- More pain
So… Should You stretch the ITB?
Deciding whether to stretch TFL-ITB will come down to a simple tradeoff:
Does stretching cause more or less net compression?
Net Compression
Choose the option that results in the least net compression
The long term decreases in compression from stretching must outweigh the short term increases in compression during the stretch exercise.
Know what to look for
In the clinic, look for a direct relationship where a limited TFL-ITB complex results in dysfunctional movement patterns.
Gather data
Perform a movement analysis and look for limitations in hip extension and adduction during:
- Sitting
- Standing
- Walking
- Lifting
- Running
- Jumping
Treat Accordingly
Patients who can perform these activities correctly without experiencing TFL-ITB tightness are less likely to benefit from stretching.
Patients who experience TFL-ITB tightness and exhibit movement compensations would benefit most from stretching.
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