Understanding Outer Hip Pain (Greater Trochanteric Pain Syndrome)
Trochanteric bursitis refers to pain over the bony bump on the outer hip (the greater trochanter), traditionally attributed to inflammation of the bursa there. We now know that in many cases, the surrounding gluteal tendons are also involved; this broader picture is called greater trochanteric pain syndrome (GTPS). Understanding which tissues are involved helps guide the most effective treatment.
Causes
Outer hip pain can develop from several overlapping causes:
Repetitive friction or overuse from running, cycling, or repetitive hip movement.
Direct trauma, like a fall onto the hip.
Tightness of the IT band
Tendinopathy or small tears of the gluteus medius/minimus tendons, which attach near the bursa.
Leg length discrepancy or altered walking mechanics.
Prior hip surgery.
Symptoms
Common symptoms include:
Aching or sharp pain over the outer hip and thigh.
Pain that worsens when lying on the affected side at night.
Pain with walking, climbing stairs, or standing up from a seated position.
Tenderness directly over the bony point of the outer hip.
Seek prompt medical care if: You can't bear weight after a fall, have fever with hip or groin pain, or develop sudden severe pain.
Imaging Studies to Consider
Imaging helps distinguish bursitis from gluteal tendon involvement:
MRI of the hip is the best test to evaluate both the bursa and the gluteal tendons for tears or tendinopathy.
Ultrasound allows dynamic assessment and guides precise injection placement.
X-ray of the hip helps rule out arthritis, fracture, or calcium deposits in the tendon.
Physical Therapy, Home Exercise & Other Conservative Techniques
Hip strengthening and activity modification are typically tried first for trochanteric bursitis:
Physical Therapy
Hip abductor strengthening.
IT band flexibility work.
Gait training to reduce hip drop and compensatory patterns.
Home Exercise Program
Side-lying hip abduction exercises.
Clamshell exercises.
IT band stretching.
Other Studied Techniques
Activity modification: avoiding lying directly on the affected hip and prolonged standing on one leg.
Ice over the outer hip.
Interventional Treatment Options
Treatment targets both the bursa and any involved tendon tissue:
Image-guided cortisone injection: Injected into the trochanteric bursa under ultrasound or fluoroscopic guidance to reduce inflammation and pain.
Platelet-rich plasma (PRP) injection: The evidence is genuinely mixed; some studies show PRP outperforming corticosteroid injection over a longer period, while a well-designed placebo-controlled trial found no real advantage over saline. PRP for trochanteric bursitis is usually given as a series of 2–3 injections once physical therapy and activity changes haven't been enough, particularly when gluteal tendinopathy contributes to symptoms.
Acupuncture: A technique that may help reduce outer hip pain alongside other treatments.
Surgical referral: For refractory gluteal tendon tears that don't respond to conservative and interventional care.
How Strong Is the Evidence?
A summary of the evidence supporting key treatments for greater trochanteric pain syndrome:
How to read this: Strong means consistent results from multiple high-quality studies. Moderate means generally favorable results with some limitations. Mixed or early means results so far are inconsistent or still emerging. Limited means few or lower-quality studies; these options can still be considered in select cases following a discussion with your healthcare provider.
Corticosteroid injection: Strong evidence.
Platelet-rich plasma (PRP): Mixed or early evidence.
Acupuncture: Limited evidence.
Evidence reviewed November 2026. These ratings summarize published research and major medical society guidelines available at that time. Research continues to evolve, and we will go over the most current evidence for your situation at your visit.
Pain Psychology Techniques
Pain psychology techniques support recovery, especially with chronic or recurring symptoms:
Graded activity pacing helps you gradually return to walking, stairs, and exercise without flare-ups.
Cognitive behavioral therapy (CBT) for pain helps manage the frustration of pain that disrupts sleep.
Relaxation training and diaphragmatic breathing.
Non-Opioid Medication Options
Non-opioid medications can help manage pain while the underlying tissue heals:
Anti-inflammatory and analgesic options
NSAIDs like ibuprofen or naproxen can reduce inflammation.
Topical NSAID gel is applied directly over the outer hip.
Acetaminophen for additional pain relief.
For chronic pain
Duloxetine is an SNRI antidepressant also approved for chronic musculoskeletal pain.
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Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
