Back Pain Doctor
Greater Trochanteric Pain Syndrome (Hip)
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. We assess your hip carefully, distinguish GTPS from other causes of hip pain, and recommend the approach best matched to your 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 for you
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. Plausible — no studies
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with 0.02-0.08% lignocaine 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
No trial of trigger point injection in this condition specifically, and none at all using 5% dextrose — the myofascial needling trials used local anaesthetic or saline.
Pairing reviewed 2026-08-30.
Where it fits for you
Considered only where examination finds a tender muscle contributing to the pain, as an adjunct to the loading programme.
Ultrasound-guided injections Guidance means we can see the needle reach 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 for you
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 for you
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. Plausible — no studies
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
The shockwave trials in this condition used FOCUSED devices. Radial delivers its energy most strongly at the skin surface and disperses with depth, so the focused results do not transfer automatically.
Pairing reviewed 2026-08-30.
Where it fits for you
Reasonable where the target is superficial; where the studied target is deeper, focused is the form the evidence supports.
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 we use 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
Moderate evidence that shockwave outperforms home training and corticosteroid injection at both short and long term (Mani-Babu, Am J Sports Med 2015). A separate review found corticosteroid better at short term but shockwave better at mid and long term (Korakakis, Br J Sports Med 2017).
Pairing reviewed 2026-08-30.
Where it fits for you
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. Painless, no contact. Plausible — no studies
What it involves
You sit with the applicator positioned over the area for a short session. Painless, no gel or contact required, and usually delivered 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 we can point to. 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 for you
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 we describe it 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. Worth discussing
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
A systematic review of randomised trials from 2014 to 2021 found positive results for PRP in Achilles and gluteal tendinopathy, while concluding overall that no research strongly advocates PRP over conventional management (O'Dowd, Orthop J Sports Med 2022).
Pairing reviewed 2026-08-30.
Where it fits for you
Discussed where loading has been done properly and has not been enough, with the cost and the modest evidence stated.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Plausible — no studies
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 randomised trial of prolotherapy in this condition. The evidence base sits in lateral epicondylitis, rotator cuff tendinopathy, plantar fasciitis and knee osteoarthritis (Capotosto, Orthop J Sports Med 2024). A network meta-analysis of 87 trials across chronic soft-tissue injury found prolotherapy had no statistically significant pain advantage over other therapies overall, though its effect size was consistently better than non-injection treatment and corticosteroid (Goh, PLoS One 2021).
Pairing reviewed 2026-08-30.
Where it fits for you
Can be discussed on the same rationale as the studied tendon and ligament problems, with the absence of direct trials stated plainly.
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 for you
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 for you
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 we could find. 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 for you
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.
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 we do not build treatment plans around it. Where an injection is the right call, we review the specific diagnosis and target, discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.
When we would still consider it
- 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 tells us 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.
Frequently asked questions
Why does it hurt to lie on that side?
What helps GTPS the most?
Are injections useful?
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