Persistent pain on the outside of the hip is often called hip bursitis or IT band pain, but greater trochanteric pain syndrome (GTPS) is broader than either label. Gluteus medius and minimus tendinopathy is a common contributor. Bursal, fascial, hip-joint and referred lumbar findings can produce similar symptoms. At Novo Soft Tissue in the Denver Tech Center, the first visit is an examination to determine which findings appear clinically relevant before treatment is chosen. Depending on the presentation, that may mean focused or radial shockwave, manual treatment, load modification and rehabilitation, imaging or referral.
Background
What Is Greater Trochanteric Pain Syndrome?
GTPS describes pain and tenderness around the greater trochanter, the bony point on the outside of the hip. It is a regional syndrome, not a single tissue diagnosis. The gluteus medius and minimus tendons attach there, alongside several bursae, with the fascia lata and IT band passing over the top.
Gluteal tendinopathy is now regarded as a major local source of lateral hip pain. It involves changes in tendon structure and load capacity. Compression of the tendons against the greater trochanter, particularly in sustained hip-adduction positions, may also contribute. The IT band is part of this mechanical environment, but an IT band that feels tight is not by itself a diagnosis.
Is GTPS the Same as Hip Bursitis?
No. In an ultrasound series of 877 patients with greater trochanteric pain, only about one in five (20.2%) had bursitis. Gluteal tendinosis was substantially more common (49.9%), and 28.5% had a thickened IT band. These findings often overlapped. Bursitis does occur, but it should not be the assumed diagnosis for every painful lateral hip. More detail is in GTPS vs. hip bursitis.
What Does Gluteal Tendinopathy Usually Feel Like?
- Pain over the outside of the hip around the greater trochanter
- Pain lying on the affected side
- Pain with prolonged walking, stairs or hills
- Pain standing on one leg
- Pain getting up after sitting, in some cases
- Flare-ups after a sudden increase in walking or running
- Pain during or after positions that hold the hip across the body, such as crossing the legs
Positions that increase sustained compression may aggravate an already sensitive tendon. The pattern points toward GTPS. It does not establish it.
Is the IT Band the Problem?
Sometimes it is part of the clinical picture, but lateral hip pain should not automatically be diagnosed as an IT band problem. The fascia lata and IT band pass over the greater trochanter and contribute to compressive load in the region, and ultrasound can show IT band thickening. Thickness does not prove the band is generating pain, "tightness" is not a tissue diagnosis, and foam rolling tells you little about which structure is involved. In GTPS, the gluteal tendons are more often implicated.
Can an MRI Tell What Is Causing Lateral Hip Pain?
Not by itself. Gluteal tendon abnormalities can appear on MRI even when the hip does not hurt: in one small study, all symptomatic women scanned and 88% of asymptomatic women had tendon changes. Imaging can help characterize tendon tears and exclude alternative pathology, but it must be interpreted alongside symptoms and examination.
Examination
What We Examine in Persistent Lateral Hip Pain
- Exact symptom location, and pain lying on either side
- Walking, stair, hill and single-leg tolerance
- Hip range of motion
- Tenderness at the greater trochanter and gluteal tendons
- Resisted hip abduction and abductor strength
- Gluteal, TFL and lateral fascial findings
- A lumbar screen, and a neurologic screen where indicated
- Previous imaging, injections and treatment response
- Anything that calls for imaging or referral
Clinical examination can materially change the likelihood of GTPS. In a diagnostic meta-analysis, positive greater trochanter palpation plus resisted hip abduction increased the estimated probability from 59% to 96%; when both were negative, it fell to 14%. These tests strongly shift probability, but they are not perfect, and no single maneuver reveals tendon histology.
Differential diagnosis
Not All Lateral Hip Pain Is GTPS
- Gluteal tendinopathy / GTPS Localized pain at the greater trochanter, often provoked by loading or compression.
- Trochanteric bursitis Can occur and can coexist with tendon changes, but is less common than once assumed.
- Hip osteoarthritis More likely to involve groin or front-of-hip pain, stiffness and restricted joint motion, although presentations overlap.
- Lumbar referred pain or radiculopathy Consider when there is back pain, pain spreading down the leg, numbness, tingling or weakness. See low back pain and sciatica and nerve entrapment. Pain spreading down the outer thigh does not by itself mean sciatica.
- Intra-articular hip pathology, including FAI Groin-dominant pain, catching or locking suggest a different pathway. Groin pain from the adductors or pubic region is covered on the adductor and groin pain page, and front-of-hip pain from the iliopsoas on the iliopsoas and hip flexor pain page.
- Significant gluteal tendon tear Marked abductor weakness or persistent disability may warrant imaging.
- Stress injury, fracture or other serious pathology A traumatic or atypical presentation needs appropriate workup.
Treatment selection
How Treatment Is Selected
Load management and rehabilitation are core, evidence-based care. Education about tendon loading and progressive exercise build hip abductor capacity, reduce provocative compression during irritable stages and support a return to walking, running or sport. In the 204-patient LEAP trial, education plus exercise outperformed corticosteroid injection for global improvement at both 8 and 52 weeks.
Focused shockwave concentrates energy at a selectable depth. The gluteus medius and minimus insertion is a common target when the examination supports tendon involvement, and several randomized trials have studied it in GTPS.
Radial shockwave spreads energy across a broader, more superficial field. It also has GTPS research and can address the wider peritrochanteric and gluteal region where clinically appropriate.
Manual treatment may address accessible muscular and fascial restriction around the lateral hip; it is not used as a direct tendon-remodeling treatment.
Both focused and radial ESWT have evidence in GTPS. Device selection depends on the target, its depth and the examination rather than a claim that one is universally better. You do not need to decide which treatment you need before your visit. The examination determines whether a Novo treatment fits. All four tools are compared on the services page, and tendon problems elsewhere are covered on chronic tendinopathy.
Imaging & referral
When Lateral Hip Pain Needs Medical Evaluation First
See a physician promptly after a fall or significant trauma, if you cannot bear weight, or for severe, progressive or unremitting rest or night pain, particularly when accompanied by fever, unexplained weight loss or other systemic symptoms, or a history of cancer. The same applies to deep groin pain after a sudden increase in running, or progressive leg weakness or numbness.
Evidence
What Research Says
- GTPS is broader than bursitis: in an 877-patient ultrasound study, only 20% had bursitis; about 50% had gluteal tendinosis (Long, 2013).
- Examination shifts probability: positive palpation plus resisted abduction moved the estimated probability of GTPS from 59% to 96%; a negative pair moved it to 14% (Kinsella, 2024).
- Exercise is foundational: in the LEAP trial of 204 people, education plus exercise achieved global success in 51 of 66 at eight weeks, compared with 38 of 65 after injection and 20 of 68 with wait and see (Mellor, 2018).
- Shockwave has randomized evidence: in a 103-patient trial, pain fell from 6.3 to 2.0 after focused ESWT plus exercise, compared with 4.7 after sham plus the same exercise at two months (Ramon, 2020).
- The evidence has limits: a 2024 meta-analysis of 8 trials found modest short-term pain benefit, with 7 of 8 at high risk of bias. A separate 2024 review of 1,121 participants found no statistically significant overall advantage over control (Rhim, 2024; Harding, 2024).
Read the full shockwave evidence review → · Read GTPS vs. hip bursitis →
Sources: Long et al., AJR 2013 · Kinsella et al., JOSPT 2024 · Mellor et al., BMJ 2018 · Ramon et al., J Bone Joint Surg Am 2020 · Rhim et al., JBJS Rev 2024 · Harding et al., Musculoskeletal Care 2024 · Grimaldi et al., Sports Med 2015 · Ganderton et al., J Womens Health 2017
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