Back Pain Doctor
Greater Trochanteric Pain Syndrome (Hip)
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
Greater trochanteric pain syndrome (GTPS) is the current term for pain on the outer hip that was once loosely called “bursitis”. In most cases the underlying problem is gluteal tendinopathy: load-related changes in the tendons that attach to the outer hip.
Management centres on a targeted gluteal strengthening program and load management, including avoiding positions and activities that compress the tendons. This is the best-evidenced approach and resolves symptoms for many people over time.
Where pain persists despite good rehabilitation, additional options such as shockwave therapy may be considered, as it has been studied for gluteal tendinopathy. Assessment separates GTPS from other causes of hip pain and recommends the approach that best fits the diagnosis.
Common symptoms
- Pain over the outer hip, sometimes radiating down the outer thigh
- Pain when lying on the affected side at night
- Pain with prolonged standing, walking or climbing stairs
- Tenderness over the bony point of the hip
Commonly seen in
Evidence for twelve treatment options in greater trochanteric pain syndrome (hip)
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation: diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan, with weight management where that is clinically relevant.
What the evidence shows
The strongest evidence here is what does not work. In a placebo-surgery controlled trial, arthroscopic subacromial decompression gave no benefit over a sham operation or over exercise therapy, at two years, at five, and at ten (Paavola, BMJ 2018; Paavola, Br J Sports Med 2020; Kanto, BMJ 2025). A network meta-analysis of 54 trials and 3,893 patients found shoulder-specific exercise reduced pain out to 52 weeks, and that adding injections, manual therapy or electrotherapy to it added little (Silveira, PLoS One 2024).
Pairing reviewed 2026-09-02.
Where it fits
Loading the shoulder properly is the treatment. An injection is occasionally used to settle pain enough to start, which is a different claim from treating the problem.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Dry needling studied, not injection
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with a very dilute local anaesthetic (0.02-0.08%) is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling (the same technique with nothing injected) is not offered here.
What the evidence shows
Searched 3 November 2026 (PubMed: trigger point injection, intramuscular injection or wet needling with greater trochanteric, gluteus medius, gluteal tendinopathy or lateral hip pain, 6 records, none a clinical study of this treatment; and a randomised-trial and systematic-review pass with dextrose, trigger point, dry needling or local anaesthetic, 12 records). No study has injected a buttock-muscle trigger point in this condition, with glucose or anything else. The nearest evidence is dry needling, which uses the same needle with nothing injected and is not offered here: in a 43-person trial, six weeks of dry needling was not inferior to a cortisone injection for pain and function at six weeks, with no adverse effects reported (Brennan, J Orthop Sports Phys Ther 2017), and a review of trials comparing the two found no difference in this condition, at very low certainty (Sousa Filho, Chiropr Man Therap 2021). In a network meta-analysis of 13 trials, only PRP and shockwave beat no treatment for pain at one to three months, and no treatment did at six to twelve months (Gazendam, Clin J Sport Med 2021).
Pairing reviewed 2026-11-03.
Where it fits
Considered only where examination finds a tender buttock-muscle band contributing to the pain, as an adjunct to the loading program, which treats the tendon itself.
Ultrasound-guided injections Guidance means the needle can be seen reaching the target. What goes into the needle depends on the diagnosis. Good support
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
Bursal and sheath targets are small, often deep, and poorly identified by surface landmarks; ultrasound guidance improved accuracy across shoulder girdle targets and improved efficacy where the target was a sheath rather than a large space (Aly, Br J Sports Med 2014).
Pairing reviewed 2026-08-30.
Where it fits
Where an inflamed bursa is the identified target, this is a reasonable step, with the number of injections kept low. See the note on cortisone.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible: no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Outlasted cortisone, no sham win
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue, including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
Radial shockwave is the form the first trials at the outer hip used. In 229 people allocated in turn to home training, one cortisone injection or low-energy radial shockwave, cortisone was well ahead at one month (75% recovered or much improved, against 13% with shockwave), shockwave was ahead of both at four months (68% against 51% and 41%), and at fifteen months shockwave and home training (74% and 80%) were both ahead of cortisone (48%) (Rompe, Am J Sports Med 2009). A non-randomised comparison of 66 people, classed as radial by later reviews, found less pain than usual care at one, three and twelve months (Furia, Am J Sports Med 2009). In a randomised trial of 60, three sessions with a radial device matched a cortisone injection at three weeks and three months (Çağlar Yağcı, Turk J Phys Med Rehabil 2023). What is missing is a win against a sham. The one double-blind trial, in 120 people who also did a home exercise program, found the recommended dose no better than a minimal dose at any point to six months (Wheeler, Clin J Sport Med 2022). Pooling eight randomised trials and 754 people, five of focused and three of radial devices, shockwave gave a modest reduction in pain at two to four months, the focused form reduced pain more than the radial form, and seven of the eight trials were at high risk of bias (Rhim, JBJS Rev 2024).
Pairing reviewed 2026-10-09.
Where it fits
A reasonable option to discuss for gluteal tendon pain that has not settled with education and loading, as an alternative to repeating cortisone. The focused form has the stronger evidence at this site, including the only positive sham-controlled trial, and that is said when the two are compared. Either way it is added to the loading program, not used instead of it.
Focused shockwave (ESWT) A true shock wave converging at depth: for tendon, joint, ligament and bone. Good support
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form used for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Focused shockwave has the only sham-controlled trial at the outer hip, and it was positive. Across several centres, 103 people with long-standing pain did the same exercise program with three weekly sessions of focused shockwave or a sham. Pain fell from 6.3 to 2.0 out of 10 with treatment against 4.7 with the sham at two months, 87% were counted a success, and the difference held to six months with no complications (Ramon, J Bone Joint Surg Am 2020). Against an ultrasound-guided cortisone injection in 104 people there was no difference at three months and focused shockwave was ahead at twelve, pain 37 against 55 out of 100 (Heaver, Hip Int 2023). It reduced pain more than therapeutic ultrasound at two and six months in 50 people (Carlisi, Clin Rehabil 2019), and added to eccentric exercise it reduced pain more than exercise alone at two and six months in 53 (Shi, Zhongguo Gu Shang 2021). The contrary findings are these. In 44 people it was no different from an exercise program over six months (Notarnicola, J Pers Med 2023). Pooled across eight trials, the gain in function at six months was below the smallest change people notice, and seven of the eight trials were at high risk of bias (Rhim, JBJS Rev 2024). A second pooled analysis found no statistically significant advantage over control for pain or function (Harding, Musculoskeletal Care 2024). The older reviews that first supported shockwave here were written when the only trials were of the radial form (Mani-Babu, Am J Sports Med 2015; Korakakis, Br J Sports Med 2017).
Pairing reviewed 2026-10-09.
Where it fits
A reasonable option where a gluteal tendinopathy has not settled with loading, and a better long-term bet than repeated corticosteroid.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Usually painless, no contact. Plausible: no studies
What it involves
You sit with the applicator positioned over the area for a short session. It is usually painless and needs no gel or skin contact. It is usually given as a course, commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that could be identified. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative. A randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why it is described this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Beat cortisone, not placebo
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
Tested in five randomised trials at the outer hip, and they divide by what PRP was compared with. Against a cortisone injection it came out ahead. In a double-blind Melbourne trial of 80 people with gluteal tendinopathy, one ultrasound-guided injection into the tendon left the hip score at 74 out of 100 with PRP against 67 with cortisone at twelve weeks, and 78 against 66 at 24 weeks. The people who had PRP were at 83 two years later, in follow-up that was by then neither blinded nor controlled (Fitzpatrick, Am J Sports Med 2018 and 2019). A trial of 24 found the same direction at 24 weeks (Begkas, Cureus 2020), and in 92 people PRP was ahead of needling of the tendon attachment on sporting function at a year (Atilano, Orthop J Sports Med 2024). Against a dummy injection it was not ahead. In a double-blind trial of 79 people, ultrasound-guided PRP into the bursa and gluteus medius tendon was no different from placebo on any measure at any point to twelve months, and its authors do not support routine use (Atchia, J Bone Joint Surg Am 2025). A New Zealand trial of one injection against saline, both with an exercise program, found no difference in any outcome over a year (Thompson, N Z Med J 2019). A network meta-analysis of 13 trials and 1,034 people, completed before the larger placebo trial, found PRP better than no treatment for pain at one to three months and not beyond (Gazendam, Clin J Sport Med 2021).
Pairing reviewed 2026-10-09.
Where it fits
Can be discussed for gluteal tendon pain that has not settled with education and a loading program, especially where a cortisone injection has helped only briefly. The position is that PRP has outlasted cortisone in trials but has not beaten a dummy injection, so some of the improvement may be time and exercise. If used, it is placed into the tendon under ultrasound guidance, the loading program continues, and the response is reviewed at about three months.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. One case report only
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
No trial or case series of prolotherapy at the outer hip was found. PubMed searches on 13 October 2026 (prolotherapy, dextrose, hypertonic glucose or hyperosmolar with trochanteric, greater trochanter, gluteal, gluteus, gluteal tendinopathy, hip bursitis or lateral hip pain) returned 19 distinct records, and passes restricted to randomised trials and to systematic reviews or meta-analyses found nothing in this condition. The one clinical record is a published case letter describing ultrasound-guided prolotherapy for gluteus medius tendinopathy that presented as a snapping hip; it has no abstract and its outcome has not been read (Hung, Pain Med 2015). The rest concerned the deep buttock, the sciatic nerve, the low back or unrelated uses of dextrose. The prolotherapy trials sit at other tendons, chiefly the elbow, the shoulder and the plantar fascia (Capotosto, Orthop J Sports Med 2024).
Pairing reviewed 2026-10-13.
Where it fits
Can be discussed where outer-hip pain persists despite a well-run gluteal loading program and load advice, with the absence of studies stated. Shockwave has controlled trials at the outer hip; prolotherapy does not.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not used here
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
Hyaluronic acid was one of the treatments compared in a network meta-analysis of 13 randomised trials and 1,034 people with this exact condition, and it did not separate from no treatment at any time point. PRP and shockwave both beat no treatment for pain at one to three months, and structured exercise was the only treatment to improve function (Gazendam, Clin J Sport Med 2021).
Pairing reviewed 2026-09-07.
Where it fits
Not offered for this problem. Loading exercise, shockwave and PRP are the options with trial support at this site.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve, not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Plausible: no studies
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
A PubMed search for perineural injection, neural prolotherapy or perineural dextrose combined with trochanteric or gluteal pain returns no study in this condition.
Pairing reviewed 2026-09-05.
Where it fits
Not offered. Gluteal tendon loading and reducing the compressive positions that irritate the tendon are the treatments with evidence behind them here.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Named in a review, with no primary study behind it that could be found. A scoping review of hydrodissection and hydrodilatation for joint pain screened 138 studies and included 21, and lists greater trochanteric pain syndrome among the conditions where the technique may relieve pain and improve function, with consistently low complication rates but wide variation in technique and injectate (Leahy, Front Pain Res 2026). A search for hydrodissection or hydrorelease against trochanteric, gluteal tendinopathy and snapping hip returned no trial of the technique in this condition.
Pairing reviewed 2026-09-08.
Where it fits
Only where a nerve is separately implicated, most often the lateral femoral cutaneous nerve or a gluteal branch. The tendon and bursa are treated by the options higher up this page.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments not offered, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So treatment plans are not built around it. Where an injection is the right call, the specific diagnosis and target are reviewed, what is being injected and why is discussed, the number is kept low, and it is paired with the loading work that changes the longer-term course.
When it might still be considered
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal: a trip, a procedure, a return to work
- Diagnostic use, where the response shows where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other hip & pelvis conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Related articles
Shorter articles that answer the questions patients ask most often about this.
- Hip Pain When Lying on Your Side: Could It Be GTPS?Pain on the outside of the hip, especially lying on that side, may be greater trochanteric pain syndrome. Learn what it means.
- Hip Pain: Causes, Symptoms, and Treatment OptionsHip osteoarthritis, labral tears, bursitis and femoroacetabular impingement each cause hip pain differently. How they are assessed and treated.
Frequently asked questions
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What helps GTPS the most?
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