Lateral Hip Pain Treatment in Bellingham, WA

Gluteal tendinopathy is an overload problem of the gluteus medius and minimus tendons where they attach to the greater trochanter — the bony point on the outer hip. It is now understood to be the main driver of what used to be called "trochanteric bursitis." While a bursa near those tendons can become irritated, research shows the tendons themselves are usually the primary problem, which is why the broader term greater trochanteric pain syndrome (GTPS) is often used.

The distinction matters for treatment: because the issue is mainly tendon overload and compression rather than simple inflammation, the most effective approach is load management and progressive strengthening — not just calming a bursa. Dr. Borys uses diagnostic ultrasound to look at the tendons directly and confirm what is actually generating your lateral hip pain.

The best-supported treatment is a combination of education and progressive exercise. In a landmark randomized trial (the LEAP trial, BMJ 2018), an education-plus-exercise program produced better global improvement and less pain than a corticosteroid injection — and far better results than waiting it out — at both 8 weeks and one year. Education focuses on reducing tendon compression (for example, how you sit, stand, and sleep), while the exercise program gradually rebuilds the strength and capacity of the gluteal tendons.

For cases that do not respond to a consistent program, in-office options such as shockwave therapy or PRP can be considered. Dr. Borys starts with the load-based plan that has the strongest evidence and adds procedures only when they are genuinely warranted.

There is reasonable support for it. A 2025 systematic review in Clinical Rehabilitation found that focused shockwave therapy (f-ESWT) showed superior long-term pain improvement compared with corticosteroid injection for gluteal tendinopathy, and concluded that exercise and education form the core approach and can be supplemented by shockwave or other options.

That makes shockwave a reasonable non-invasive adjunct for lateral hip pain that has stalled despite a good exercise program. It is typically used alongside continued strengthening rather than on its own. Dr. Borys will give you a straightforward read on whether it is a sensible addition in your case.

The evidence for PRP in gluteal tendinopathy is more encouraging than for some other tendons. A systematic review found PRP injections to be more effective than corticosteroid injections for greater trochanteric pain syndrome that has not responded to conservative care, and it appears to be a reasonable injectable option in that setting. That said, the authors note the literature still needs more large, high-quality trials.

Because of this, Dr. Borys treats PRP as a considered option for stubborn cases rather than a routine first step. Any recommendation is made after an exam and ultrasound, with a clear conversation about what the current evidence does and does not establish.

These positions load and compress the gluteal tendons against the greater trochanter. Lying on the painful side compresses the tendons directly, while lying on the opposite side lets the top leg drop and stretches them across the bone. Stairs, hills, standing on one leg, and sitting with crossed legs all increase compression and load at the tendon attachment, which is why they tend to flare the pain.

Understanding this is a core part of treatment. A major focus of the education component is reducing these compressive positions during daily life so the tendon can settle and respond to strengthening. Simple changes — like a pillow between the knees at night or avoiding crossing your legs — often make a meaningful difference.

Like other tendinopathies, gluteal tendinopathy is slow to recover, and improvement is usually measured over months rather than weeks. An education-and-exercise program is typically carried out over at least three months, with gains continuing beyond that. In the LEAP trial, the benefits of the education-plus-exercise approach were still evident at one year.

Consistency is the key variable. Reducing tendon compression in daily life and sticking with the progressive strengthening program — rather than stopping as soon as pain eases — is what produces durable results. Dr. Borys helps set realistic expectations and adjusts the plan based on how your hip is responding.

The initial evaluation is a standard office visit that may be billed through insurance depending on your individual plan and coverage. Regenerative injections such as PRP, along with shockwave therapy, are generally not covered and are paid out of pocket, as most plans still classify them as investigational.

Dr. Borys treats lateral hip pain and gluteal tendinopathy in Bellingham, WA, serving active adults throughout Whatcom County and the surrounding region. Pricing and which approach is most appropriate for your hip are reviewed at your initial visit.