Dealing with persistent hip pain is frustrating. You might have even been told you have “hip bursitis”—specifically, trochanteric bursitis on the outside of your hip, or iliopsoas bursitis felt deep in your groin. But here’s something I’ve learned after helping countless people with this exact issue: that bursitis diagnosis often misses the bigger picture. The pain you’re feeling is more accurately described as Greater Trochanteric Pain Syndrome (GTPS). This condition points to an issue with the gluteal tendons, not just an inflamed bursa. Understanding this difference is the first step toward finding real relief.

However, most of the patients we see may or may not have a bursitis even though they have a diagnosis of one and they are on anti-inflammatory medications. Bursitis is an inflammation of the protective, fluid filled sacs that prevent excessive friction between the functional soft tissue of the hip, i.e., the ligaments and tendons, and the bones they attach to and rub against. These bursae can become irritated from injury, excessive pressure, and overuse. More often this diagnosis is actually a problem of tendonitis or tendinosis. However, for the purpose of this article, I will focus on the problem of bursitis.

Once a diagnosis of bursitis is made, the patient will typically be given a “healing,” regiment that will include:

  • Activity modification and rest
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Physical therapy.
  • Injection of a corticosteroid

These treatments may be effective for some, non-effective for others. Once the cortisone injection or injections fail to provide any relief, the patient will usually start seeking other options. One option is Platelet Rich Plasma therapy or PRP. PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Why PRP?

### Understanding the Causes of Outer Hip Pain

If you’ve been told you have hip bursitis, you might be surprised to learn that the pain on the outside of your hip is often something else entirely. This issue is commonly known as greater trochanteric pain syndrome (GTPS), and while it was once blamed on an inflamed bursa—the small, fluid-filled sac that cushions your hip joint—we now understand the root cause is usually different. For most people, GTPS is actually caused by an injury or weakness in the tendons of the gluteal muscles. This condition, called tendinopathy, means the problem lies within the tendon tissue itself, not just simple inflammation. This pain can be triggered by a direct fall onto your hip, a sudden increase in physical activity, or even repetitive habits like crossing your legs or sitting for long periods in chairs that are too low.

### Who Is at Risk for GTPS?

While anyone can develop GTPS, certain factors can increase your risk. This condition is significantly more common in women, particularly those between the ages of 40 and 60. Lifestyle also plays a major role; individuals who are overweight or lead a more sedentary life are more susceptible to developing this type of outer hip pain. It’s a condition that highlights how our daily habits and body mechanics can impact our joints over time. Understanding these risk factors is the first step toward identifying the cause of your discomfort and finding a treatment plan that addresses the underlying tendon issue. Instead of just masking symptoms, regenerative treatments like PRP Therapy aim to heal the damaged tendon tissue directly.

Symptoms and Diagnosis of GTPS

Key Symptoms to Watch For

If you’re dealing with Greater Trochanteric Pain Syndrome (GTPS), the most telling symptom is pain on the outer part of your hip. It often starts as a sharp, intense sensation that eventually settles into a persistent, dull ache. You might also notice this pain traveling down the outside of your thigh toward your knee. Everyday activities can become challenging, sometimes causing a noticeable limp when you walk. Other signs include stiffness in the hip joint, some swelling or warmth in the area, and even a catching or clicking feeling with movement. The pain is typically at its worst when you’re lying on the affected side, trying to climb stairs, or standing on one leg for more than a few moments. Recognizing these specific triggers is a key part of understanding what’s going on with your hip.

How Doctors Diagnose GTPS

Getting to the bottom of hip pain starts with a conversation and a physical exam. Your doctor will want to hear about your symptoms and will likely perform a few tests to pinpoint the problem. This usually involves gently pressing on different spots around your hip to find the source of the tenderness. They might also watch you walk to check your gait or ask you to perform specific movements, like the single leg stance test, which is highly effective for confirming GTPS. To make sure nothing else is causing your pain, such as a fracture or arthritis, your doctor may order imaging tests like an X-ray, ultrasound, or an MRI. A precise diagnosis is the crucial first step before you can explore effective treatment options, so it’s important to get a thorough evaluation. If you’re ready to understand your options, you can always contact our team for a consultation.

When to Seek Immediate Medical Help

While most hip pain can be managed with a scheduled doctor’s visit, some symptoms are red flags that require immediate medical attention. If your hip pain is the result of a serious fall or injury, or if you notice the leg looks deformed or is badly bruised, it’s time to go to the emergency room. You should also seek urgent care if you find you cannot move your hip at all or are unable to bear weight on the affected leg. Other serious warning signs include any issues with bladder or bowel control, as this could indicate a more significant underlying problem that needs to be addressed right away.

How Effective is PRP for Greater Trochanteric Pain Syndrome?

In January 2020, a study published in the medical journal Cureus, (1) offered the following on the superiority of PRP treatments to cortisone:

  • 24 patients with greater trochanteric pain syndrome were enrolled and randomized into two study groups
  • In Group A patients received ultrasound-guided PRP injection treatment, while group B patients received ultrasound-guided cortisone injections. Clinical outcomes in both groups were evaluated and compared using various patient reported scoring systems.
  • Both groups showed improved scores compared to the pre-injection period, but patients in the PRP group had a statistically significant decrease in pain and increase in functionality at the last follow-up (24 weeks post-injection). No complications were reported.
  • In conclusion, “patients with greater trochanteric pain syndrome present better and longer-lasting clinical results when treated with ultrasound-guided PRP injections compared to those with cortisone.s.

What is Greater Trochanteric Pain Syndrome?

A 2018 study in the Journal of hip preservation (2) made these observations on the use of Platelet Rich Plasma injections for greater trochanteric pain syndrome.

  • Greater trochanteric pain syndrome, (trochanteric bursitis), commonly affects middle-aged women.
  • It is characterized by pain over the outer side of the hip. Recently the understanding of Greater trochanteric pain syndrome has evolved. Gluteal tendinopathy is believed to be the main contributory factor rather than bursal inflammation. There are numerous studies reporting little evidence of bursal inflammation in Greater trochanteric pain syndrome but found gluteal tendon tendinopathy more commonly associated with Greater trochanteric pain syndrome.
  • Greater trochanteric pain syndrome has also been associated with low back pain, knee osteoarthritis and iliotibial band syndrome.
  • Greater trochanteric pain syndrome can be resolved with conservative treatments such as relative rest and anti-inflammatory medication in the majority of patients. If conservative measures fail then progressively more invasive treatment options including shockwave therapy, corticosteroid injections, PRP and surgery may be required.
  • Lately PRP has become very popular among the orthopedic community as a minimally invasive way of enhancing tissue healing. It is thought that PRP promotes soft tissue healing by delivering a higher than normal concentration of platelets and therefore increased concentration of platelet derived growth factors to the diseased area. This has been shown in various studies.
  • The use of PRP in treating Greater trochanteric pain syndrome has become more prevalent in recent times.
  • There is a lack of studies providing high-quality evidence as to what is causing the pain in Greater trochanteric pain syndrome. Quite often the pathology may be in the gluteus medius and minimus tendon and not exclusively the bursa, therefore the site of injection (treatment) needs to be considered.
  • In most improvements were observed during the first 3 months after PRP injection . Significant improvements were reported when patients were followed up to 12 months post treatment. There are, however, conflicting results between the randomized studies as to whether PRP is superior to corticosteroid. Considering these factors, PRP seems a viable alternative treatment with the current evidence in patients with Greater trochanteric pain syndrome not responding to conservative measures. Further large-sample and high-quality randomized clinical trials in the future should be conducted to present evidence of the efficacy for PRP as a treatment in Greater trochanteric pain syndrome.

Does the PRP Injection Method Actually Matter?

I want to bring attention to a December 2019 study (3) that questions whether PRP is an effective treatment for Greater trochanteric pain syndrome. In this study, patients with chronic lateral hip pain were randomised to either a PRP injection (intervention group) or a saline injection (control group) and both groups were prescribed identical eccentric exercise. The researchers found that there were no differences in any outcomes between the two groups at any follow-up point. They concluded a single injection of PRP resulted in no significant improvement for Greater trochanteric pain syndrome compared with a placebo injection.

  • A single injection is typically not as effective as “poking” the hip a few times within the single treatment. Patients will usually benefit from two or three PRP treatments. This would need to be confirmed before treatment begins.

This was a recent study published in the Journal of pain research.(4) It hits upon some good points that describe how PRP works and when PRP may not work.

  • Variability in treatment can lead to failure: “Despite great variability in pain outcomes, the application of autologous platelet-rich plasma (PRP) has become increasingly popular in attempts to reduce chronic pain. The variability in PRP efficacy raises the question of whether PRP actually has an analgesic capacity, and if so, can that capacity be made consistent and maximized. The best explanation for the variability in PRP analgesic efficacy is the failure during PRP preparation and application to take into account variables that can increase or eliminate its analgesic capabilities. This suggests that if the variables are reduced and controlled, a PRP preparation and application protocol can be developed leading to PRP inducing reliable, complete, and long-term pain relief.” To summarize that, you need to see a doctor or clinician that has developed effective protocols for the PRP treatment you are seeking. We have been doing regenerative medicine for over 30 Years.

 

 

References

1 Begkas D, Chatzopoulos ST, Touzopoulos P, Balanika A, Pastroudis A. Ultrasound-guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study. Cureus. 2020 Jan;12(1).
2 Ali M, Oderuth E, Atchia I, Malviya A. The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review. J Hip Preserv Surg. 2018 Aug 30;5(3):209-219. doi: 10.1093/jhps/hny027. PMID: 30393547; PMCID: PMC6206702.
3 Thompson G, Pearson JF. No attributable effects of PRP on greater trochanteric pain syndrome. N Z Med J. 2019 Dec 13;132(1507):22-32. PubMed PMID: 31830014.
4 Kuffler DP. Variables affecting the potential efficacy of PRP in providing chronic pain relief. J Pain Res. 2018;12:109-116. Published 2018 Dec 21. doi:10.2147/JPR.S190065

Comprehensive Treatment and Management Strategies

Navigating the path to relief from Greater Trochanteric Pain Syndrome involves a multi-faceted approach. For many, the journey begins with conservative treatments like rest and anti-inflammatory medications. While these can provide initial relief, the cornerstone of long-term success lies in a more active strategy. The focus should be on building strength and, when necessary, incorporating advanced treatments that address the root cause of the pain—often a gluteal tendinopathy rather than simple bursal inflammation. This comprehensive view ensures you’re not just masking symptoms but are actively healing the affected tissues for lasting results.

The Foundation: Strengthening and Lifestyle Changes

The most effective conservative treatment for GTPS is targeted exercise to strengthen your hip muscles. Building up the gluteal tendons provides better support for the hip joint, reducing strain and irritation. While foundational, this process takes time. For those seeking to accelerate healing, regenerative medicine offers a promising path. Treatments like PRP Therapy have become more prevalent because they use your body’s own growth factors to promote soft tissue repair directly at the site of injury. This approach helps heal the underlying tendinopathy, offering a more direct solution than simply managing inflammation.

Exercises to Avoid During Recovery

Knowing what not to do is just as important as knowing what to do. Certain movements can aggravate the inflamed tendons and bursa, making your hip pain worse and slowing down your recovery. The goal is to avoid activities that place excessive, repetitive stress on the outer hip. This means temporarily stepping back from high-impact exercises like running or jogging, especially on hard surfaces. You should also avoid deep squats and heavy, weight-bearing leg exercises that compress the gluteal tendons against the bone, which can perpetuate the cycle of pain and inflammation.

What to Expect During Your Recovery

Patience is a critical part of recovering from GTPS. Unlike an acute injury that heals in a few weeks, this condition often involves chronic tendon issues that require a slow and steady approach to resolve. Understanding the timeline, anticipating potential setbacks, and recognizing the importance of consistent treatment are key to a successful outcome. It’s a marathon, not a sprint, and managing your expectations will help you stay motivated and committed to your rehabilitation plan without getting discouraged by the non-linear nature of the healing process.

The Road to Recovery: Timeline and Flare-Ups

Be prepared for a gradual recovery, as GTPS can take six to nine months, and sometimes even longer, to fully resolve. It’s a slow process that demands consistency with your treatment and exercise plan. During this time, pain flare-ups are common and should be expected. These flare-ups typically settle within about six weeks. When one occurs, don’t stop moving entirely. Instead, listen to your body—reduce activities that clearly make the pain worse and incorporate a bit more rest, but continue with gentle, approved exercises to maintain strength and flexibility without over-straining the area.

The Risks of Leaving GTPS Untreated

Ignoring the persistent pain of GTPS is not a viable long-term strategy. If left untreated, the condition can progress from a nagging annoyance to a source of chronic hip pain that significantly limits your mobility. This can make simple activities like walking, climbing stairs, or even lying on your side incredibly painful. Over time, your body may develop compensatory movement patterns to avoid the pain, which can lead to additional strain on your lower back, knees, and opposite hip. To avoid these cascading issues, it’s crucial to seek a proper diagnosis and an effective treatment plan.

Frequently Asked Questions

I was told I have hip bursitis, but this article says it’s likely GTPS. What’s the real difference? Think of it this way: for years, we blamed the messenger. A bursa is a small, fluid-filled sac that acts as a cushion. When it gets inflamed (bursitis), it’s usually because something else is irritating it. Greater Trochanteric Pain Syndrome, or GTPS, looks at the bigger picture. It recognizes that the root cause of that outer hip pain is often an injury or weakness in the nearby gluteal tendons. So, while you might have some bursal inflammation, the primary problem we need to fix is the unhealthy tendon tissue, not just the irritated cushion.

Why might a cortisone shot provide only temporary relief for my hip pain? A cortisone shot is a powerful anti-inflammatory. It can be very effective at calming down an inflamed bursa, which is why you might feel significant relief at first. However, it doesn’t do anything to repair the underlying cause of the problem, which is typically a weak or damaged gluteal tendon. Once the anti-inflammatory effects of the steroid wear off, the pain often returns because the fundamental tendon issue was never addressed. This is why we focus on treatments that promote actual tissue healing.

How does PRP therapy actually help heal the tendon? PRP therapy uses the concentrated healing components from your own blood to kickstart a natural repair process. We take a small blood sample and separate the platelets, which are rich in growth factors. When we inject this concentrated platelet-rich plasma directly into the damaged gluteal tendon, these growth factors signal your body to rebuild and strengthen the tissue. It’s a way of directing your body’s own powerful healing abilities right to the source of the injury to create a more durable, long-term fix.

I’ve heard mixed things about PRP. How can I be sure it will work for me? That’s a fair question, and the answer often comes down to experience and technique. The effectiveness of PRP isn’t just about the injection itself; it’s about how and where it’s administered. A successful outcome depends on a precise diagnosis, preparing the PRP correctly, and ensuring it’s delivered to the exact points of injury within the tendon. A single, simple injection might not be enough. This is why seeing a clinician with extensive experience in regenerative medicine is so important—the protocol truly matters.

How long will it take to recover from GTPS, and can I expect a smooth process? Recovering from a chronic tendon issue is more of a marathon than a sprint, so patience is key. A realistic timeline for significant improvement is often six to nine months. It’s also very normal for the recovery process to have ups and downs. You will likely experience pain flare-ups along the way, but these are part of the healing cycle and shouldn’t cause alarm. The goal is to work with your body, modifying activities when needed and staying consistent with your strengthening exercises to build a resilient hip for the long haul.

Key Takeaways

  • Look beyond the bursitis diagnosis: The persistent pain on the outside of your hip is often Greater Trochanteric Pain Syndrome (GTPS), which points to an underlying gluteal tendon injury, not just an inflamed bursa. A correct diagnosis is the first step toward effective treatment.
  • Prioritize treatments that heal the root cause: While cortisone can offer a temporary fix, PRP therapy aims for long-term repair by using your body’s own growth factors to heal the damaged tendon tissue directly. This addresses the source of the pain rather than just masking the symptoms.
  • Combine treatment with smart lifestyle changes: A successful recovery isn’t passive. It requires combining regenerative treatments with targeted strengthening exercises for your hip muscles and avoiding high-impact activities or deep squats that can make the pain worse.

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