Pain on the outside of the hip is often called hip bursitis, but that label can be incomplete. In many patients, the gluteus medius or gluteus minimus tendon is also involved. The broader diagnosis is greater trochanteric pain syndrome, or GTPS.
For most people with typical GTPS and no major weakness or traumatic injury, the best first treatment is load management plus progressive strengthening. Injections may help selected patients, but they should not replace rehabilitation or a careful diagnosis. MRI or ultrasound becomes more useful when symptoms persist, weakness is significant, or a tendon tear is suspected.
From my perspective as an orthopedic surgeon, the useful question is not simply, “Is there bursitis?” It is: Which structure is causing the symptoms, and what treatment matches that problem?
What does greater trochanteric pain syndrome feel like?
Common symptoms include pain directly over the outer hip, pain when lying on that side, pain with stairs or hills, tenderness over the greater trochanter, aching down the outside of the thigh, and weakness or fatigue with single-leg activity.
Pain that travels below the knee, prominent numbness or tingling, or burning pain into the foot raises more concern for a lumbar spine or nerve problem.
Why “bursitis” may not tell the whole story
The gluteus medius and minimus stabilize the pelvis while walking and standing on one leg. Repeated compression, sudden increases in activity, weakness, altered gait, or tendon degeneration can make their attachment painful. The nearby bursa may be irritated too, but treating only the bursa may miss the underlying tendon-loading problem.
Common contributors include a sudden increase in walking or hiking, hip abductor weakness, standing with the hip shifted outward, sleeping directly on the painful side, repeated leg crossing, hip arthritis, lumbar spine problems, a fall, previous hip surgery, or a partial or full-thickness gluteal tendon tear.
How is outer hip pain diagnosed?
Diagnosis starts with the history and physical examination. Useful findings include focal tenderness, pain with resisted hip abduction, pain with single-leg stance, weakness, pelvic drop, or a limp.
A 2024 systematic review found that combinations of clinical tests can meaningfully change the probability of GTPS, supporting a pattern-based examination rather than relying on one maneuver. Read the diagnostic review.
X-rays
X-rays do not show the gluteal tendon directly, but they can identify hip arthritis, calcification, bone abnormalities, or another explanation for pain.
Ultrasound
Musculoskeletal ultrasound can evaluate the gluteal tendons and bursae dynamically and can guide an injection to a specific target when appropriate.
MRI
MRI is more useful when symptoms are severe or persistent, significant weakness is present, a tendon tear is suspected, surgery is being considered, or the diagnosis remains uncertain. Imaging findings still need clinical context because tendon abnormalities can appear in people who are not symptomatic.
What is the best first treatment for GTPS?
For most patients, treatment begins with education, load management, and progressive exercise, not complete rest.
A 2024 systematic review and meta-analysis of six randomized trials involving 733 patients concluded that exercise should be considered first-line treatment for clinically diagnosed GTPS. Exercise modestly improved pain and function and produced better long-term global improvement than corticosteroid injection. Read the 2024 review.
A 2025 systematic review of higher-quality trials likewise found that education plus exercise had the strongest core evidence for improving pain and function. Read the 2025 review.
Practical changes may include avoiding direct pressure on the painful side, using a pillow between the knees when side-lying, temporarily reducing hills or long walks that clearly flare symptoms, avoiding aggressive stretching into painful compression, and then gradually rebuilding activity.
What should physical therapy focus on?
Physical therapy should be progressive and individualized. A useful program often includes gluteus medius and minimus strengthening, pelvic and trunk control, gradual single-leg loading, gait retraining when needed, and functional strengthening for stairs, walking, balance, and return to sport.
The goal is not simply to make the hip more flexible. The goal is to improve the tendon’s ability to tolerate the activities the patient actually needs and enjoys.
Learn more about physical therapy at Pacific Bone & Joint.
Should you get a cortisone injection?
A corticosteroid injection can help short-term pain, particularly when symptoms interfere with sleep, walking, or participation in rehabilitation. The tradeoff is that cortisone does not restore tendon capacity.
In a randomized BMJ trial, both corticosteroid injection and education plus exercise helped at eight weeks, but education plus exercise produced better global improvement at 52 weeks. Read the BMJ trial.
An injection should be targeted to the suspected pain generator. Repeated injections should not substitute for reassessing the diagnosis when weakness, limping, or a tendon tear is suspected.
What about PRP?
Platelet-rich plasma remains an evolving treatment for GTPS. Earlier comparative studies suggested benefit in selected patients, but a 2025 double-blind randomized placebo-controlled trial in The Journal of Bone & Joint Surgery found no significant benefit of ultrasound-guided leukocyte-rich PRP over placebo in 79 patients with refractory GTPS. Read the 2025 JBJS trial.
The responsible conclusion is that the evidence is mixed. PRP should not be presented as a guaranteed tendon-healing treatment.
Learn more about regenerative medicine options.
Is shockwave therapy useful?
Shockwave therapy may help selected patients with persistent gluteal tendinopathy. A 2024 systematic review and meta-analysis found evidence of pain improvement, although treatment protocols varied. Read the 2024 analysis.
I view shockwave as a possible adjunct for persistent symptoms, not a replacement for diagnosis, progressive strengthening, and load management.
When does a gluteal tendon tear need surgery?
Most patients with uncomplicated GTPS do not need surgery. Surgery becomes more reasonable when there is a defined structural problem that matches the symptoms, particularly a substantial gluteus medius or minimus tear, persistent weakness or limping, progressive functional loss, or symptoms that remain limiting despite a reasonable nonsurgical program.
A tendon repair requires protected healing and rehabilitation. It is not the same as a quick bursa procedure.
When should you get an orthopedic evaluation?
Further evaluation is useful when you cannot bear weight normally, pain followed a significant fall, weakness or limping is marked, symptoms are rapidly worsening, pain persists despite a well-designed rehabilitation program, or the pattern suggests hip arthritis, nerve irritation, fracture, infection, or another diagnosis.
Dr. Morton’s perspective
Outer hip pain is frequently treated as though every case is the same. It is not.
A patient with tendon overload needs a different plan than a patient with a full-thickness gluteal tendon tear, advanced hip arthritis, or lumbar nerve compression. For many patients, the most durable approach is education, load management, and progressive strengthening. An image-guided injection may help when pain is blocking rehabilitation. PRP can be discussed in selected cases, but expectations should reflect the mixed evidence. Surgery is reserved for appropriately selected structural problems.
Outer hip pain care in Hawai‘i
Pacific Bone & Joint evaluates lateral hip pain, gluteal tendon problems, hip arthritis, sports injuries, and persistent hip symptoms. Evaluation may include examination, X-rays, musculoskeletal ultrasound, MRI review, physical therapy, medication, image-guided injection, regenerative medicine discussion, and surgical consultation when appropriate.
If outer hip pain is limiting sleep, walking, exercise, or daily function and the diagnosis is still unclear, call (808) 439-6201 to request an appointment.
This article is educational and does not replace an individualized examination.
Sources and further reading
- Kjeldsen T, et al. Exercise Compared to a Control Condition or Other Conservative Treatment Options in Patients With Greater Trochanteric Pain Syndrome. Physiotherapy. 2024.
- Bremer T, et al. The Efficacy of Gluteal Tendinopathy Treatments: A Systematic Review. Clinical Rehabilitation. 2025.
- Mellor R, et al. Education Plus Exercise Versus Corticosteroid Injection Use Versus a Wait and See Approach. BMJ. 2018.
- Atchia I, et al. Efficacy of Platelet-Rich Plasma Versus Placebo for Greater Trochanteric Pain Syndrome. Journal of Bone and Joint Surgery. 2025.
- Kinsella R, et al. Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2024.
- Rhim HC, et al. Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome. JBJS Reviews. 2024.
