If you’ve been told you have “hip bursitis,” you’re not alone. In fact, hip bursitis is one of the most common diagnoses given to patients with pain on the outside of the hip. However, there is a good chance that the diagnosis is incomplete or incorrect. Greater trochanteric pain syndrome (GTPS) is one of the most common causes of lateral hip pain, affecting up to 10–25% of the general population, and it is one of the most frequently misdiagnosed conditions in orthopedics (Jorgensen & Chiodo, Muscle Nerve 2025; Bateman et al., Muscle Nerve 2025).

In this article, we’ll discuss what GTPS actually is, why many cases labeled as “hip bursitis” are really gluteal tendinopathy, why cortisone injections may do more harm than good, and how regenerative treatments such as platelet-rich plasma (PRP), platelet lysate, and protein concentrate may help address the underlying problem.

What Is Greater Trochanteric Pain Syndrome?

GTPS is a term that describes pain on the outside of the hip, directly over the bony prominence known as the greater trochanter. This is where the gluteus medius and gluteus minimus muscles, the primary stabilizers of the pelvis during walking, running, and single-leg standing, attach via their tendons.

GTPS is especially common in women between the ages of 40 and 60 and affects women three to four times more often than men (Chamberlain, Am Fam Physician 2021; Jorgensen & Chiodo, Muscle Nerve 2025).

Today, many specialists consider GTPS to be the preferred medical term for what patients often describe as hip bursitis, trochanteric bursitis, pain on the outside of the hip, or lateral hip pain.

Typical symptoms include:

  • Pain on the outside of the hip that may radiate down the thigh
  • Pain when lying on the affected side, especially at night
  • Pain when climbing stairs, getting up from a chair, or walking for long periods
  • Tenderness when pressing directly on the greater trochanter

Importantly, GTPS is not a single diagnosis. It is an umbrella term that can include:

  • Gluteus medius tendinopathy
  • Gluteus minimus tendinopathy
  • Partial tendon tearing
  • Trochanteric bursitis
  • Iliotibial (IT) band thickening or friction

Research has shown that these conditions are not equally common. In fact, the diagnosis most patients have heard of, bursitis, is often not the primary problem.

The Bursitis Myth: Why Your “Hip Bursitis” Probably Isn’t Bursitis

For decades, patients with pain on the outside of the hip were routinely diagnosed with “trochanteric bursitis” or “hip bursitis.”

A bursa is a small fluid-filled sac that reduces friction between tissues. When it becomes inflamed, the condition is called bursitis. While this explanation sounds straightforward, modern imaging studies tell a very different story.

A landmark ultrasound study of 877 patients with greater trochanteric pain found that nearly 80% did not have bursitis at all. Instead:

  • Approximately 50% had gluteal tendinosis
  • 28.5% had a thickened IT band
  • Only 20.2% had bursitis
  • Just 0.5% had tendon tears

(Long et al., AJR Am J Roentgenol 2013)

The American Society of Regional Anesthesia and Pain Medicine (ASRA) guidelines confirm this, stating that “the current thinking is that GTPS is mostly caused by gluteal tendinopathy” and that bursitis as a cause of GTPS “is lower than previously thought” (Benzon et al., 2025).

This finding has changed how many orthopedic, sports medicine, and regenerative medicine specialists evaluate chronic lateral hip pain.

In other words, what most people call “hip bursitis” is usually gluteal tendinopathy, a degenerative condition affecting the gluteus medius and gluteus minimus tendons. When bursitis is present, it is often secondary to the tendon problem rather than the primary cause of pain (Jorgensen & Chiodo, Muscle Nerve 2025).

This distinction matters because treating inflammation alone does not address the underlying tendon degeneration.

The Hidden Drivers: Lumbosacral Radiculopathy and Hip Joint Pathology

Another important and often overlooked aspect of GTPS is that it frequently coexists with other conditions that must be identified and addressed for long-term relief.

Lumbosacral Spine Pathology

A study of 103 patients with hip abductor tendon disorders found that nearly half (48.5%) had a concurrent lumbosacral diagnosis, including degenerative disc disease (43.7%) and lumbar stenosis (19.4%) (Maldonado et al., Arthroscopy 2022).

In another series, 63% of patients with GTPS had previously been evaluated for suspected lumbar radiculopathy (Jorgensen & Chiodo, Muscle Nerve 2025).

This relationship exists because nerve irritation involving the L4, L5, or S1 nerve roots can weaken the gluteus medius muscle. That weakness alters gait mechanics, increases stress on the gluteal tendons, and may contribute to tendinopathy.

GTPS was present in 18% of patients referred specifically for lumbosacral radiculopathy (Bateman et al., Muscle Nerve 2025).

Pain patterns also overlap considerably:

  • 50% of GTPS patients report pain radiating past the knee
  • 67% report pain extending below the knee

(Bateman et al., Muscle Nerve 2025)

Intrinsic Hip Joint Pathology

Conditions inside the hip joint commonly coexist with GTPS, including:

  • Labral tears
  • Cartilage injury
  • Femoroacetabular impingement (FAI)
  • Hip osteoarthritis

The prevalence of gluteus medius pathology in patients with FAI approaches one-third (Noble & Laskovski, Arthroscopy 2022).

A systematic review found that labral tears and cartilage lesions were common findings in patients undergoing surgery for GTPS, and approximately 9% eventually required total hip replacement (Yee et al., Arthroscopy 2023).

Hip joint pathology can alter biomechanics and overload the gluteal tendons. Conversely, gluteal tendon dysfunction can change force distribution across the hip joint.

The takeaway is simple: if you only treat the lateral hip pain without evaluating the lumbar spine and hip joint, you may achieve temporary symptom relief but are unlikely to achieve lasting improvement.

This is one reason a comprehensive evaluation is essential for patients with persistent hip pain. The source of symptoms may involve the gluteal tendons, the hip joint, the lumbar spine, or a combination of all three.

Why Cortisone Shots Are Not the Answer

Corticosteroid injections have been a common treatment for GTPS for decades because they often provide rapid pain relief.

The problem is that short-term relief does not necessarily translate into long-term healing.

Short-Term Gain, Long-Term Pain

A systematic review in The Lancet found that corticosteroid injections provide short-term benefit for tendinopathy but produce worse outcomes than conservative treatment at intermediate and long-term follow-up (Coombes et al., Lancet 2010).

This pattern has also been demonstrated in GTPS. In randomized trials comparing PRP with cortisone, corticosteroid injections provided early improvement, but those benefits faded by six months. PRP continued to improve outcomes for up to two years (Fitzpatrick et al., AJSM 2019).

Cortisone Damages Tendons

The biological explanation is important.

A systematic review of 50 studies found that corticosteroids can:

  • Disrupt collagen organization
  • Increase collagen necrosis
  • Reduce tendon-cell viability
  • Decrease collagen synthesis
  • Weaken tendon mechanical properties

(Dean et al., Semin Arthritis Rheum 2014)

Animal studies have also demonstrated increased matrix metalloproteinase activity and tendon-cell apoptosis after corticosteroid injection (Muto et al., J Orthop Res 2014).

In a condition where tendon degeneration is already the primary problem, injecting a substance that further compromises tendon health may be counterproductive.

Additional Risks

Potential risks include:

  • Skin thinning
  • Skin depigmentation
  • Fat atrophy
  • Blood sugar elevation
  • Rare tendon rupture

(Kamel et al., AJR Am J Roentgenol 2024; Abate et al., Expert Opin Drug Saf 2017)

PRP: A Better Alternative Backed by Evidence

Platelet-rich plasma (PRP) takes a fundamentally different approach.

Rather than suppressing inflammation, PRP uses concentrated platelets from your own blood to deliver growth factors involved in tissue repair.

These growth factors include:

  • Platelet-derived growth factor (PDGF)
  • Vascular endothelial growth factor (VEGF)
  • Transforming growth factor-beta (TGF-β)

In GTPS, PRP is typically directed at the diseased gluteus medius and gluteus minimus tendons rather than the bursa itself because the tendon is often the primary source of the problem.

Head-to-head against cortisone. The most important study comparing PRP to cortisone for gluteal tendinopathy is a double-blind randomized controlled trial of 80 patients with chronic gluteus medius and minimus tendinopathy. At 12 weeks, PRP was significantly superior to cortisone on the modified Harris Hip Score (74.05 vs. 67.13, P = .048), and 82% of PRP patients achieved a clinically meaningful improvement compared to only 57% in the cortisone group (P = .016). At 2-year follow-up, the PRP group continued to improve (baseline score 53.77 → 82.59, P < .0001), while the cortisone group’s benefit faded after 24 weeks. When 27 cortisone failures crossed over to receive PRP, they also improved significantly (Fitzpatrick et al., AJSM 2018; Fitzpatrick et al., AJSM 2019).

Systematic reviews confirm the advantage. Multiple systematic reviews and meta-analyses support PRP’s superiority over cortisone for GTPS:

  • A meta-analysis of 5 randomized trials (263 patients) found a significant treatment effect favoring PRP on the modified Harris Hip Score (P = .005) (Kuhns et al., Arthroscopy 2026).
  • A separate systematic review found PRP was superior to cortisone for function in the short term (Bremer et al., Clin Rehabil 2025).
  • A network meta-analysis of 13 randomized trials (1,034 patients) found PRP had the highest probability of being the best treatment for short-term pain relief at 1–3 months (Gazendam et al., Clin J Sport Med 2022).

Why some studies show mixed results — and why platelet dose is the key. Not all PRP studies have shown positive results. One placebo-controlled trial found no difference between PRP and saline injection (Atchia et al., JBJS 2025). This has led to confusion. But emerging research strongly suggests that the quality and concentration of the PRP preparation is the critical variable.

A meta-analysis of PRP for lateral epicondylitis (tennis elbow) found that platelet concentration alone explained 58.5% of the variability in outcomes between studies. Studies using high-dose PRP (at least 3 times the baseline platelet concentration) showed significant pain improvement, while low-dose PRP showed no benefit at all (Oeding et al., AJSM 2025). Similar findings have been reported for knee osteoarthritis: high-platelet PRP (approximately 1,000,000 platelets per microliter or higher) exceeded the threshold for clinically meaningful pain relief at 3, 6, and 12 months, while low-platelet PRP did not (Bensa et al., AJSM 2025). Studies with positive outcomes used a mean platelet dose of 5,500 million platelets compared to only 2,302 million in negative studies (Berrigan et al., Arthroscopy 2025).

This means that when a study uses a low-quality PRP preparation with insufficient platelet concentration, it is essentially testing a diluted, subtherapeutic product — and unsurprisingly, the results are poor. The heterogeneity in PRP research is not evidence that PRP doesn’t work; it’s evidence that preparation quality matters enormously. As one editorial put it, “a signal of efficacy persists within the data” for PRP in GTPS, but standardized preparation protocols are needed (Brinkman et al., Arthroscopy 2026).

Platelet Lysate and Protein Concentrate: Advanced Options for Sensitive Patients

For patients who have significant bursitis or heightened sensitivity in the greater trochanteric region — or who want to avoid cortisone entirely — there are additional regenerative options that deserve attention.

Platelet lysate (PL) is created by freeze-thawing PRP, which ruptures the platelets and releases their entire payload of growth factors in a concentrated, cell-free solution. Because it contains no intact cells or white blood cells, platelet lysate tends to cause less post-injection irritation than standard PRP, making it particularly well-suited for patients with sensitive or inflamed tissue. Laboratory studies have shown that platelet lysate delivers concentrated growth factors (including PDGF-BB, bFGF, and TGF-β) that promote tendon cell activity, upregulate tendon-specific genes (SCX, COL1A1, TNC), and stimulate the production of collagen type I and tenascin C — the key structural proteins of healthy tendon (Costa-Almeida et al., Acta Biomater 2018). A randomized trial of platelet lysate for rotator cuff tendinopathy demonstrated superiority over the anti-inflammatory ketorolac for pain, function, and range of motion at 6 months (Markazi et al., Growth Factors 2022).

Autologous protein concentrate containing alpha-2-macroglobulin (A2M) offers a complementary mechanism. A2M is a naturally occurring protein in your blood that acts as a broad-spectrum protease inhibitor — meaning it blocks the destructive enzymes (matrix metalloproteinases, or MMPs) that break down tendon and cartilage tissue. A2M also directly binds and neutralizes pro-inflammatory cytokines including TNF-α, IL-1β, and IL-6 (Wu et al., J Immunol 1998). In animal studies, A2M significantly reduced MMP activity at the tendon-bone interface, enhanced collagen organization and fibrocartilage formation, and increased the ultimate strength of the healing tissue (Demirag et al., JBJS 2005; Bedi et al., J Shoulder Elbow Surg 2010). A narrative review of A2M as an orthobiologic therapy supports its role in protecting tissues from enzymatic degradation and inflammatory damage (Pugliese & Schnabel, Am J Vet Res 2026).

The combination of platelet lysate and A2M-rich protein concentrate is particularly appealing for GTPS patients with bursitis and regional sensitivity because it addresses both components of the problem: the platelet lysate provides the regenerative growth factors needed to heal the underlying tendon, while the A2M provides potent anti-inflammatory and tissue-protective effects to calm the inflamed bursa — all without the tissue-damaging effects of cortisone.

The Bottom Line

Greater trochanteric pain syndrome is far more than “hip bursitis.” The real problem is usually gluteal tendinopathy — degeneration of the tendons that attach your hip stabilizer muscles to the bone. True bursitis is present in only about 20% of cases and is typically a secondary consequence of the tendon problem. Underlying spine conditions and hip joint pathology frequently coexist and must be evaluated for lasting relief.

Cortisone injections, while providing quick temporary relief, have been shown to damage tendon tissue and produce worse long-term outcomes than doing nothing at all. PRP, when prepared at adequate platelet concentrations, has demonstrated superiority over cortisone in randomized trials with sustained improvement out to 2 years. For patients with bursitis or sensitivity who wish to avoid cortisone, platelet lysate and protein concentrate (including A2M) offer a biologically rational, corticosteroid-free alternative supported by translational and early clinical evidence.

If you’re dealing with lateral hip pain, the most important first step is getting an accurate diagnosis — not just of the hip itself, but of the spine and hip joint as well. From there, a treatment plan that addresses the root cause with regenerative therapies, combined with targeted rehabilitation, offers the best chance for long-term recovery.

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